Update on Idiopathic Intracranial Hypertension

Update on Idiopathic Intracranial Hypertension Purpose of review This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. Recent findings A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial—IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone. Furthermore, management of IIH-related headache, even in patients with papilledema, may require treatment other than ICP lowering for patients to experience symptomatic relief. Finally, a number of uncontrolled interventional studies have shown transverse sinus stenting to be a potentially effective treatment for medically refractory IIH. Summary Medical therapy with acetazolamide should be considered in addition to structured weight loss in patients with mild IIH. Surgical treatment for patients with vision- threatening disease IIH can be performed by either optic nerve sheath fenestration or cerebrospinal fluid diversion, with venous sinus stenting emerging as an alternate therapy. Headache relief from ICP lowering http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Treatment Options in Neurology Springer Journals

Update on Idiopathic Intracranial Hypertension

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Publisher
Springer US
Copyright
Copyright © 2018 by Springer Science+Business Media, LLC, part of Springer Nature
Subject
Medicine & Public Health; Neurology; Intensive / Critical Care Medicine; Internal Medicine; Ophthalmology; General Practice / Family Medicine; Diabetes
ISSN
1092-8480
eISSN
1534-3138
D.O.I.
10.1007/s11940-018-0512-7
Publisher site
See Article on Publisher Site

Abstract

Purpose of review This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. Recent findings A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial—IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone. Furthermore, management of IIH-related headache, even in patients with papilledema, may require treatment other than ICP lowering for patients to experience symptomatic relief. Finally, a number of uncontrolled interventional studies have shown transverse sinus stenting to be a potentially effective treatment for medically refractory IIH. Summary Medical therapy with acetazolamide should be considered in addition to structured weight loss in patients with mild IIH. Surgical treatment for patients with vision- threatening disease IIH can be performed by either optic nerve sheath fenestration or cerebrospinal fluid diversion, with venous sinus stenting emerging as an alternate therapy. Headache relief from ICP lowering

Journal

Current Treatment Options in NeurologySpringer Journals

Published: May 28, 2018

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