Materiały źródłowe

• #1 Idiopathic intracranial hypertension: consensus guidelines on management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/89/10/1088

  The aim was to capture interdisciplinary expertise from a large group of clinicians, reflecting practice from across the UK and further, to inform subsequent development of a national consensus guidance for optimal management of idiopathic intracranial hypertension (IIH). […] Three main principles were identified: (1) to treat the underlying disease; (2) to protect the vision; and (3) to minimise the headache morbidity. […] In collaboration with many different specialists, professions and patient representatives, we have developed guidance statements for the investigation and management of adult IIH. […] Weight loss reduces ICP and has been shown to be effective in improving papilloedema and headaches. […] The main principles of management of IIH are: (1) to treat the underlying disease; (2) to protect the vision; (3) to minimise the headache morbidity.

• #2 Intracranial hypertension

  https://www.nhs.uk/conditions/intracranial-hypertension/

  Treatment for these types of IH depends on the cause. […] Treatments for idiopathic intracranial hypertension (IH) can include: losing weight if you’re overweight. This can often help to reduce your symptoms and may sometimes relieve them altogether […] stopping any medicine that may be causing your symptoms […] medicine to remove excess fluid from the body (diuretics) […] medicine to reduce the production of cerebrospinal fluid in your brain […] a short course of steroid medicine to relieve headaches and reduce the risk of vision loss. […] Surgery may be considered if other treatments do not help, particularly if your vision is getting worse or you’re at risk of loss of vision. […] The main types of surgery for idiopathic IH are: shunt surgery a thin, flexible tube is inserted into the fluid-filled space in your skull or spine to divert excess fluid to another part of your body […] optic nerve sheath fenestration the protective layer surrounding your optic nerve (the nerve connecting the eye to the brain) is opened up to relieve pressure on it and allow fluid to drain away. […] Treatment can help with problems with your vision and can reduce the risk of loss of vision.

• #3 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  Idiopathic intracranial hypertension (IIH) was formerly called pseudotumor cerebri. It is a disorder defined by clinical criteria that include symptoms and signs isolated to those produced by increased intracranial pressure (ICP; eg, headache, papilledema, double vision, transient visual obscurations, and vision loss), elevated ICP with normal cerebrospinal fluid (CSF) composition, and no other cause of intracranial hypertension evident on neuroimaging or other evaluations. […] Recommendations for the treatment of IIH are limited by only a few randomized controlled trials. The treatment of patients with IIH has two major goals: the alleviation of symptoms (usually headache) and the preservation of vision. […] For initial treatment of patients with IIH who have vision loss and/or vision symptoms, we suggest the carbonic anhydrase inhibitor acetazolamide. Carbonic anhydrase inhibitors are believed to reduce the rate of CSF production and have been associated with modestly improved outcomes in patients with IIH.

• #4 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  Idiopathic intracranial hypertension (IIH) is increased pressure in your skull. Treatments are available. […] Treatment options are available for IIH. […] A healthcare provider can quickly treat this condition to prevent complications. […] The goals of IIH treatment are to decrease pressure on your brain and prevent vision loss. […] Your provider will determine what type of treatment is best by reviewing diagnostic test results. […] Severe cases may require surgery to prevent permanent vision loss. […] Some medicines can help you manage IIH symptoms. […] Your provider may prescribe: Acetazolamide or topiramate to help your body produce less CSF. […] In severe cases, you may need surgery for IIH. […] A shunt is a long, thin tube placed in your brain to drain excess CSF. […] To prevent IIH from happening again, your provider may suggest making lifestyle changes to improve your overall health.

• #5 Idiopathic intracranial hypertension | Neurosurgery Inselspital Bern

  https://neurochirurgie.insel.ch/en/diseases-specialities/liquor-disorders/idiopathic-intracranial-hypertension

  The treatment options for IIH are applied in a stepwise escalation, depending on the severity of the symptoms. […] Depending on the nature of the symptoms at the initial diagnosis, an individualized treatment strategy must be determined and adjusted according to the course of the disease. The Association of the Scientific Medical Societies in Germany (AWMF) recommends a stepwise approach: […] For mild symptoms (headaches without visual disturbances), conservative treatment is primarily recommended. Potential triggers of idiopathic intracranial hypertension must be identified to counteract them. […] Fundamental for sustained therapeutic success is always consistent and long-term weight reduction. Additionally, the medication acetazolamide, a carbonic anhydrase inhibitor, can be taken to reduce cerebrospinal fluid production. An alternative is topiramate (another carbonic anhydrase inhibitor), which also leads to weight reduction. If necessary, furosemide (a diuretic) may be used additionally to eliminate excess body water.

• #6 Intracranial Hypertension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507811/

  A large part of treating intracranial hypertension involves mitigating the risk of increased ICP and making timely clinical decisions to prevent adverse consequences. […] Intracranial hypertension management has 4 tiers. Implementation should begin at Tier 0 and progress stepwise if the patient does not improve. […] Tier 0: Elevate the head of the bed to 30 with a neutral position to minimize venous outflow resistance and maximize CSF flow dynamics. […] Hyperosmolar therapy may be initiated to decrease cerebral edema. […] An external ventricular catheter may be placed for ICP monitoring and lowering by CSF drainage. […] Surgical interventions are typically reserved for patients at risk of vision loss. […] A high-volume lumbar puncture can be performed to decrease ocular pressures and temporize until a more definitive surgical intervention can be achieved.

• #7 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Management guidelines are based on symptoms and extent of visual impairment at presentation. If there is no immediate threat to vision, medical therapy is recommended. In the event of an immediate threat to visual function, a temporary CSF draining procedure (ie, placement of a lumbar drain) is immediately performed, and a definitive surgical plan is made; either a ventriculoperitoneal shunt or optic nerve sheath fenestration. […] The primary treatment objectives for patients with idiopathic intracranial hypertension (IIH) are to preserve optic nerve function, manage elevated intracranial pressure (ICP), and alleviate symptoms. […] The initial treatment typically involves administering acetazolamide, dosed according to the patient’s symptoms, tolerance, and visual function. If progressive visual field loss occurs despite maximal medical therapy, urgent surgical intervention may be necessary.

• #8 Idiopathic intracranial hypertension: consensus guidelines on management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/89/10/1088

  Weight loss is the only disease-modifying therapy in typical IIH. […] Where there is evidence of declining visual function, the acute management to preserve vision is surgical. […] A temporising measure of a lumbar drain could be useful to protect the vision while planning urgent surgical treatment. […] In the UK, the preferred surgical procedure is neurosurgical CSF diversion. […] Where possible, it should be performed by an experienced clinician with an interest in CSF disorders. […] CSF diversion is generally not recommended as a treatment for headache alone in IIH. […] Neurovascular stenting is not currently a treatment for headache in IIH. […] Medication overuse is a common issue for patients with IIH. […] Successfully removing excessive analgesic use significantly improves headaches.

• #9 Treatment | IIH UK – (Idiopathic intracranial hypertension)

  https://www.iih.org.uk/product/5/2/treatment

  Shunt surgery one end of a flexible tube is put into the fluid filled space in your brain (ventricle) or your spine (lumbar) and the other end in another part of your body, such as your abdominal cavity (peritoneum). […] The IIH:WT (weight trial) has shown that for those IIH patients with obesity, gastric surgery is proven to reduce pressure, headache and quality of life for people with IIH. […] There is now definitive evidence that weight and IIH are related. Weight loss has been shown to be the only treatment to modify the underlying condition. […] Recent studies have shown that weight loss is an effective treatment to reduce papilloedema and headaches, putting IIH in to remission. […] Shunt surgery has proven to be a successful long term relief from IIH symptoms and raised ICP. […] Venous Sinus Stenting Is also used as a surgical procedure for people with IIH who have Venous Sinus Stenosis.

• #10 European Headache Federation guideline on idiopathic intracranial hypertension | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0919-2

  The Neuro-Ophthalmology Research Disease Investigator Consortium (NORDIC) are currently planning a randomised controlled surgical trial, SIGHT, which will compare shunting with ONSF and acetazolamide. […] There is a clear association between IIH and weight with over 90-95% of patients being obese. […] Weight loss is the only established disease modifying therapy in IIH. […] Consequently, patients should be sensitively counselled about the importance of weight loss. […] The role of bariatric surgery is being increasingly suggested as a lasting therapy to induce IIH remission. […] Bariatric surgery leads to greater weight loss compared to dietary regimes, with mean reduction in body mass index (BMI) of 7.05-15.34m/kg2 at 12 months and significant sustained long term weight loss. […] A systematic review of the IIH cases treated with bariatric surgery report 100% resolution of papilloedema and 90% experience headache improvement.

• #11 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Reduction of body weight by 5-10% was found to be effective with resulting improvement of papilledema and visual fields. […] An additional study that investigated the long-term outcomes of bariatric surgery in IIH patients looked at 30 patients who underwent bariatric surgery at least 4 years prior and found that attaining and maintaining a BMI of 30 or below was associated with long-term improvement of signs and symptoms of IIH.

• #12 Idiopathic Intracranial Hypertension | National Eye Institute

  https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/idiopathic-intracranial-hypertension

  Treatment: Weight loss, medicine, surgery […] For most people, IIH symptoms get better with treatment. Treatments include: […] Weight loss. For people who are overweight or obese and have IIH, weight loss is usually the first treatment. Losing about 5 to 10 percent of your body weight can help lessen your symptoms for example, if you weigh 200 pounds, that means losing about 10 to 20 pounds. Talk with your doctor about safe, sustainable ways to lose weight. […] Medicine. Your doctor may recommend a medicine called acetazolamide (Diamox) in addition to weight loss. This medicine helps your body make less CSF. […] Surgery. If other treatments dont work, your doctor might suggest surgery to help relieve the pressure. In shunt surgery, doctors make a small hole and add a thin tube, called a shunt, to help extra fluid drain from around your brain into the rest of your body. There is also an eye surgery where doctors make a small hole in the covering around the optic nerve.

• #13 Intracranial hypertension

  https://www.nhs.uk/conditions/intracranial-hypertension/

  Treatment for these types of IH depends on the cause. […] Treatments for idiopathic intracranial hypertension (IH) can include: losing weight if you’re overweight. This can often help to reduce your symptoms and may sometimes relieve them altogether […] stopping any medicine that may be causing your symptoms […] medicine to remove excess fluid from the body (diuretics) […] medicine to reduce the production of cerebrospinal fluid in your brain […] a short course of steroid medicine to relieve headaches and reduce the risk of vision loss. […] Surgery may be considered if other treatments do not help, particularly if your vision is getting worse or you’re at risk of loss of vision. […] The main types of surgery for idiopathic IH are: shunt surgery a thin, flexible tube is inserted into the fluid-filled space in your skull or spine to divert excess fluid to another part of your body […] optic nerve sheath fenestration the protective layer surrounding your optic nerve (the nerve connecting the eye to the brain) is opened up to relieve pressure on it and allow fluid to drain away. […] Treatment can help with problems with your vision and can reduce the risk of loss of vision.

• #14 Pseudotumor cerebri (idiopathic intracranial hypertension) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudotumor-cerebri/diagnosis-treatment/drc-20354036

  The goal of pseudotumor cerebri treatment is to improve your symptoms and keep your eyesight from worsening. […] If you’re obese, your doctor might recommend a low-sodium weight-loss diet to help improve your symptoms. You might work with a dietitian to help with your weight-loss goals. Some people benefit from weight-loss programs or gastric surgery. […] One of the first drugs usually tried is acetazolamide, a glaucoma drug. This medication might reduce the production of cerebrospinal fluid and reduce symptoms. […] If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure might be necessary. […] In this procedure, a surgeon cuts a window into the membrane that surrounds the optic nerve to allow excess cerebrospinal fluid to escape.

• #15 Managing idiopathic intracranial hypertension in the eye clinic | Eye

  https://www.nature.com/articles/s41433-024-03140-y

  In cases with improvement of papilloedema and stabilisation of visual fields, continuing headaches may require additional medication. […] Weight loss methods have evolved over time and the evidence from studies demonstrated good correlation between weight loss and disease remission, however sustained weight loss has not generally been achievable through dietary interventions alone. […] The IIH weight trial (IIHWT) was a United Kingdom (UK) multicenter randomised controlled trial that evaluated the effect of bariatric surgery and a community weight management intervention on intracranial pressure in women with active IIH and a body mass index of 35kg/m2 or greater. […] It found that bariatric surgery provided sustained ICP reduction and weight loss for up to two years of follow-up. […] The decision to proceed to surgical management in medically refractory cases should be made on a case by case basis.

• #16 Idiopathic intracranial hypertension doc – Bobby Jones CSF

  https://bobbyjonescsf.org/physician-information/idiopathic-intracranial-hypertension/

  Repeated lumbar punctures with drainage of up to 30 to 40 cc of spinal fluid can improve IIH symptoms temporarily, sometimes for a month or more. […] If the pressure is 25 mmH2O or greater, and a Chiari I malformation is not present, a spinal fluid shunt can be considered. These shunts drain spinal fluid into the abdominal cavity and reduce intracranial and spinal pressure. […] If the body mass index is very high (BMI of 35kg/m2 or more) spinal fluid shunts fail so often that they are not advised. The current recommendation when the BMI is 35kg/m2 or greater is to consider bariatric surgery. […] In those patients with deteriorating vision facing the risk of blindness, fenestration of the optic nerve sheath can be considered. The procedure is performed through a brain operation or through an endoscope placed in the nose a procedure called an endonasal endoscopic optic nerve fenestration (ONSF). Small slits are performed in the optic nerve sheath to reduce the pressure on the nerve. ONSF has been found to improve vision in 59% and headache in 44%.

• #17 Idiopathic intracranial hypertension (IIH) | CUH

  https://www.cuh.nhs.uk/patient-information/idiopathic-intracranial-hypertension-iih/

  Weight loss is the most important treatment for IIH. Many medical research studies have shown that losing weight and maintaining that weight loss is effective at reducing the fluid pressure, headaches and problems with vision. […] Medications can be used alongside weight loss. […] The most commonly prescribed medication is a water tablet called acetazolomide (Diamox). Other medications include topiramate, furosemide and bendroflumethiazide. […] Surgery is a last resort and is only considered when weight loss and medications have failed and there are significant visual problems arising from the condition. […] Neurosurgical CSF shunting is the most commonly used procedure. This is where a plastic tube is placed permanently inside the body with one end draining the fluid, and the other end depositing it into the abdomen.

• #18 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  Timely treatment at the first sign of vision changes or symptoms can help reduce your risk of complications like permanent vision loss. […] Treatment is often successful at relieving symptoms. […] There isnt a cure for IIH, so you may have to manage this condition for the rest of your life. […] It’s important to follow your treatment plan, especially if your provider recommends making changes to the foods you eat or your activity level to help reduce your risk.

• #19 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  Idiopathic intracranial hypertension (IIH) was formerly called pseudotumor cerebri. It is a disorder defined by clinical criteria that include symptoms and signs isolated to those produced by increased intracranial pressure (ICP; eg, headache, papilledema, double vision, transient visual obscurations, and vision loss), elevated ICP with normal cerebrospinal fluid (CSF) composition, and no other cause of intracranial hypertension evident on neuroimaging or other evaluations. […] Recommendations for the treatment of IIH are limited by only a few randomized controlled trials. The treatment of patients with IIH has two major goals: the alleviation of symptoms (usually headache) and the preservation of vision. […] For initial treatment of patients with IIH who have vision loss and/or vision symptoms, we suggest the carbonic anhydrase inhibitor acetazolamide. Carbonic anhydrase inhibitors are believed to reduce the rate of CSF production and have been associated with modestly improved outcomes in patients with IIH.

• #20 Managing idiopathic intracranial hypertension in the eye clinic | Eye

  https://www.nature.com/articles/s41433-024-03140-y

  Idiopathic intracranial hypertension (IIH) is a neuro-ophthalmological condition characterised by a raised intracranial pressure and papilloedema that causes disabling headaches. […] The majority of people are offered acetazolamide. Those with sight threatening disease need urgent management, though there is little high quality evidence to recommend any particular surgical intervention. […] While weight loss is the main stay of disease modifying therapy this is challenging to access and many healthcare professionals that manage the condition have no formal training or accessible pathways for weight management. […] The main principles of treatment of IIH are to: Protect vision, Treat the underlying cause, Reduce headache morbidity. […] The use of acetazolamide, a carbonic anhydrase inhibitor, is the most widespread treatment currently used to treat IIH to help with reduction of ICP and to protect the vision.

• #21 Idiopathic Intracranial Hypertension (IIH) Medication: Antiglaucoma, Carbonic Anhydrase Inhibitors, Loop diuretics, Cardiovascular, Other, Corticosteroids, Beta-Blockers, Tricyclic Antidepressants, Antiepileptics, Antidiabetics, Glucagon-like Peptide-1 Ag

  https://emedicine.medscape.com/article/1214410-medication

  Specific therapy for idiopathic intracranial hypertension (IIH) is aimed at lowering ICP pharmacologically. Carbonic anhydrase inhibitors (eg, acetazolamide) and loop diuretics (eg, furosemide) are thought to exert their effect on ICP by reducing cerebrospinal fluid (CSF) production at the choroid plexus. […] Corticosteroids are indicated on a short-term basis in patients who present with severe papilledema and compromised visual function. They are effective in reducing ICP, but the mechanism of action is unknown. Corticosteroids are often used as maximum medical management when rapid lowering of ICP is required. […] Topiramate also is an excellent choice, in that one of its side effects is weight loss (a common association in IIH), which can help put the disease in remission. […] Furosemide inhibits CSF production, but the precise mechanism by which it does so is unclear. A combination of CA inhibition and an effect on sodium absorption across the choroid plexus may result in the decreased CSF production.

• #22 A High-Pressure Situation: Idiopathic Intracranial Hypertension Diagnosis and Treatments – Ophthalmology Advisor

  https://www.ophthalmologyadvisor.com/features/pseudotumor-cerebri-iih-diagnosis-protocol-and-treatment-options/

  The goals of treatment with IIH are to limit visual morbidity from persistent optic nerve edema and to relieve symptoms, which is most commonly headache. […] Weight loss and treatment with carbonic anhydrase inhibitors (CAI) such as acetazolamide are the mainstays of managing IIH. […] The Idiopathic Intracranial Hypertension Treatment Trial was a multicenter, double-blind, randomized, placebo-controlled study of acetazolamide in 165 IIH participants with mild visual loss that found subjects taking acetazolamide along with a low-sodium diet program had significantly better visual outcomes than those taking placebo along with the diet. […] An important consideration that should be discussed with IIH patients is the potential risk of acetazolamide for pregnancy. […] For patients who cannot be treated with acetazolamide due to side effect intolerance, methazolamide and topiramate are potential alternative options.

• #23 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  For patients with persistent or worsening visual symptoms despite maximizing treatment with acetazolamide, we suggest the addition of furosemide. […] Patients with IIH can continue to have headaches despite improvement in papilledema and visual function. Medications used in the prophylactic treatment of migraine headaches are often used for headache management in IIH if other treatments described above are not effective in this regard. […] Rare patients present with or develop rapidly progressive vision loss (ie, fulminant IIH). Treatment is urgent to preserve vision: Acetazolamide should be initiated promptly and can be rapidly titrated up to 4 grams per day divided into two doses. […] Patients with IIH who appear to benefit from surgical intervention include those who fail, are intolerant to, or are noncompliant with maximum medical therapy. The two main surgical procedures in IIH are optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF) shunting procedures.

• #24 Idiopathic Intracranial Hypertension: pseudotumor cerebri

  https://webeye.ophth.uiowa.edu/eyeforum/article/iih/pc-medical-tx.htm

  In our experience, acetazolamide appears to be an effective treatment for idiopathic intracranial hypertension. We start the patient with a dose of 250 mg p.o. b.i.d. and increase the dose every four days by 250 mg until a dose of 1 gram a day is reached or the patient becomes intolerant to the side effects. […] If acetazolamide is not well tolerated we use furosemide or topiramate. Modification of therapy is based on a combination of the patients symptoms, visual field examinations and changes in papilledema.

• #25

  https://journals.lww.com/jneuro-ophthalmology/fulltext/2014/06000/the_idiopathic_intracranial_hypertension_treatment.2.aspx

  Possible acetazolamide-associated adverse events were considered when designing the trial, particularly with regard to aplastic anemia and hypokalemia. […] The intervention covered all 3 disciplines of weight loss and lifestyle modification, that is, nutrition, physical activity, and behavior. […] Regression of papilledema and symptoms in IIH has been demonstrated with modest weight loss. […] The study was conceived and designed under the auspices of the NORDIC. The IIHTT is the first randomized, placebo-controlled double-masked study to assess treatment strategies and investigate potential etiologies of IIH in patients with mild visual loss.

• #26 Idiopathic Intracranial Hypertension

  https://practicalneurology.com/articles/2020-may/idiopathic-intracranial-hypertension

  Acetazolamide, a carbonic anhydrase inhibitor, has been used for the treatment of IIH for years based on studies that demonstrated efficacy for improving papilledema and vision, making acetazolamide an evidence-based first-line therapy. […] Topiramate is an evidence-based medication for the preventive treatment of migraine that is a weak inhibitor of carbonic anhydrase and often used in the treatment of IIH. […] Furosemide, a loop diuretic, also inhibits carbonic anhydrase. […] Octreotide, a somatostatin analogue, has been shown to reduce ICP and improve headache. […] Obesity is associated with IIH and individuals with IIH who have a body mass index (BMI) greater than 40 kg/m2 are at higher risk for vision loss, making weight loss critical in the treatment of IIH. […] Surgical intervention should be considered for individuals who are at immediate risk of vision loss and have medically refractory disease. There are 3 main surgical options for IIH treatment. These include CSF-diverting procedures: LP or ventriculoperitoneal (VP) shunting, optic nerve sheath fenestration (ONSF), and venous sinus stenting.

• #27 Idiopathic Intracranial Hypertension – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/idiopathic-intracranial-hypertension

  Idiopathic intracranial hypertension occasionally resolves without treatment. […] Treatment of idiopathic intracranial hypertension is aimed at the following: […] Reducing pressure […] Preserving vision […] Relieving symptoms. […] The carbonic anhydrase inhibitor acetazolamide or topiramate (which also inhibits carbonic anhydrase) is used. Acetazolamide reduces cerebrospinal fluid production. Topiramate can help patients lose weight, help lower intracranial pressure, and may relieve headache. […] Preventive medications used for migraine may relieve headache. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as needed. […] Patients with obesity are encouraged to lose weight, which may help reduce intracranial pressure. […] Serial lumbar punctures are controversial but are sometimes used, particularly if, while waiting for definitive treatment, vision is threatened.

• #28 Idiopathic Intracranial Hypertension (IIH) Medication: Antiglaucoma, Carbonic Anhydrase Inhibitors, Loop diuretics, Cardiovascular, Other, Corticosteroids, Beta-Blockers, Tricyclic Antidepressants, Antiepileptics, Antidiabetics, Glucagon-like Peptide-1 Ag

  https://emedicine.medscape.com/article/1214410-medication

  Specific therapy for idiopathic intracranial hypertension (IIH) is aimed at lowering ICP pharmacologically. Carbonic anhydrase inhibitors (eg, acetazolamide) and loop diuretics (eg, furosemide) are thought to exert their effect on ICP by reducing cerebrospinal fluid (CSF) production at the choroid plexus. […] Corticosteroids are indicated on a short-term basis in patients who present with severe papilledema and compromised visual function. They are effective in reducing ICP, but the mechanism of action is unknown. Corticosteroids are often used as maximum medical management when rapid lowering of ICP is required. […] Topiramate also is an excellent choice, in that one of its side effects is weight loss (a common association in IIH), which can help put the disease in remission. […] Furosemide inhibits CSF production, but the precise mechanism by which it does so is unclear. A combination of CA inhibition and an effect on sodium absorption across the choroid plexus may result in the decreased CSF production.

• #29 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  For patients with persistent or worsening visual symptoms despite maximizing treatment with acetazolamide, we suggest the addition of furosemide. […] Patients with IIH can continue to have headaches despite improvement in papilledema and visual function. Medications used in the prophylactic treatment of migraine headaches are often used for headache management in IIH if other treatments described above are not effective in this regard. […] Rare patients present with or develop rapidly progressive vision loss (ie, fulminant IIH). Treatment is urgent to preserve vision: Acetazolamide should be initiated promptly and can be rapidly titrated up to 4 grams per day divided into two doses. […] Patients with IIH who appear to benefit from surgical intervention include those who fail, are intolerant to, or are noncompliant with maximum medical therapy. The two main surgical procedures in IIH are optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF) shunting procedures.

• #30 Idiopathic Intracranial Hypertension (IIH) Medication: Antiglaucoma, Carbonic Anhydrase Inhibitors, Loop diuretics, Cardiovascular, Other, Corticosteroids, Beta-Blockers, Tricyclic Antidepressants, Antiepileptics, Antidiabetics, Glucagon-like Peptide-1 Ag

  https://emedicine.medscape.com/article/1214410-medication

  Specific therapy for idiopathic intracranial hypertension (IIH) is aimed at lowering ICP pharmacologically. Carbonic anhydrase inhibitors (eg, acetazolamide) and loop diuretics (eg, furosemide) are thought to exert their effect on ICP by reducing cerebrospinal fluid (CSF) production at the choroid plexus. […] Corticosteroids are indicated on a short-term basis in patients who present with severe papilledema and compromised visual function. They are effective in reducing ICP, but the mechanism of action is unknown. Corticosteroids are often used as maximum medical management when rapid lowering of ICP is required. […] Topiramate also is an excellent choice, in that one of its side effects is weight loss (a common association in IIH), which can help put the disease in remission. […] Furosemide inhibits CSF production, but the precise mechanism by which it does so is unclear. A combination of CA inhibition and an effect on sodium absorption across the choroid plexus may result in the decreased CSF production.

• #31 Idiopathic intracranial hypertension (IIH) | CUH

  https://www.cuh.nhs.uk/patient-information/idiopathic-intracranial-hypertension-iih/

  Weight loss is the most important treatment for IIH. Many medical research studies have shown that losing weight and maintaining that weight loss is effective at reducing the fluid pressure, headaches and problems with vision. […] Medications can be used alongside weight loss. […] The most commonly prescribed medication is a water tablet called acetazolomide (Diamox). Other medications include topiramate, furosemide and bendroflumethiazide. […] Surgery is a last resort and is only considered when weight loss and medications have failed and there are significant visual problems arising from the condition. […] Neurosurgical CSF shunting is the most commonly used procedure. This is where a plastic tube is placed permanently inside the body with one end draining the fluid, and the other end depositing it into the abdomen.

• #32 Idiopathic intracranial hypertension: consensus guidelines on management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/89/10/1088

  The current Cochrane review on IIH management reported on the use of acetazolamide, a carbonic anhydrase inhibitor, in IIH. […] Acetazolamide could be prescribed for those with IIH symptoms. […] The optimal dose of acetazolamide is not established. […] The role of other diuretics such as furosemide, amiloride and coamilofruse are not certain but are used by some as alternative therapies. […] A multidisciplinary team approach could be considered including, ideally, an assessment by an experienced clinician with an interest in headache management. […] These statements are not mandatory recommendations but are intended to be used as a guide for doctors who investigate and treat IIH.

• #33 Idiopathic Intracranial Hypertension (IIH) Medication: Antiglaucoma, Carbonic Anhydrase Inhibitors, Loop diuretics, Cardiovascular, Other, Corticosteroids, Beta-Blockers, Tricyclic Antidepressants, Antiepileptics, Antidiabetics, Glucagon-like Peptide-1 Ag

  https://emedicine.medscape.com/article/1214410-medication

  Specific therapy for idiopathic intracranial hypertension (IIH) is aimed at lowering ICP pharmacologically. Carbonic anhydrase inhibitors (eg, acetazolamide) and loop diuretics (eg, furosemide) are thought to exert their effect on ICP by reducing cerebrospinal fluid (CSF) production at the choroid plexus. […] Corticosteroids are indicated on a short-term basis in patients who present with severe papilledema and compromised visual function. They are effective in reducing ICP, but the mechanism of action is unknown. Corticosteroids are often used as maximum medical management when rapid lowering of ICP is required. […] Topiramate also is an excellent choice, in that one of its side effects is weight loss (a common association in IIH), which can help put the disease in remission. […] Furosemide inhibits CSF production, but the precise mechanism by which it does so is unclear. A combination of CA inhibition and an effect on sodium absorption across the choroid plexus may result in the decreased CSF production.

• #34 Idiopathic Intracranial Hypertension (IIH) Medication: Antiglaucoma, Carbonic Anhydrase Inhibitors, Loop diuretics, Cardiovascular, Other, Corticosteroids, Beta-Blockers, Tricyclic Antidepressants, Antiepileptics, Antidiabetics, Glucagon-like Peptide-1 Ag

  https://emedicine.medscape.com/article/1214410-medication

  Glucocorticoids reduce ICP through an unknown mechanism. […] The mechanism of action by which corticosteroids lower CSF pressure has not been established. Some believe that they may facilitate outflow at arachnoid granulations. […] Treatment with GLP-1 receptor agonists is associated with significant weight loss and favorable headache outcomes in idiopathic intracranial hypertension. […] Exenatide is commonly used to treat type-2 diabetes and obesity. Recent studies also show that it can reduce CSF secretion and ICP.

• #35 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  While used in rare situations as a temporizing measure prior to surgical intervention, we and others avoid using glucocorticoids for long-term management of IIH. […] Most patients with IIH improve or stabilize with medical treatment over the course of several months. Recurrences may occur even after several years, necessitating ongoing monitoring.

• #36 Idiopathic Intracranial Hypertension (IIH) Medication: Antiglaucoma, Carbonic Anhydrase Inhibitors, Loop diuretics, Cardiovascular, Other, Corticosteroids, Beta-Blockers, Tricyclic Antidepressants, Antiepileptics, Antidiabetics, Glucagon-like Peptide-1 Ag

  https://emedicine.medscape.com/article/1214410-medication

  Glucocorticoids reduce ICP through an unknown mechanism. […] The mechanism of action by which corticosteroids lower CSF pressure has not been established. Some believe that they may facilitate outflow at arachnoid granulations. […] Treatment with GLP-1 receptor agonists is associated with significant weight loss and favorable headache outcomes in idiopathic intracranial hypertension. […] Exenatide is commonly used to treat type-2 diabetes and obesity. Recent studies also show that it can reduce CSF secretion and ICP.

• #37

  https://www.birmingham.ac.uk/news/2023/new-drug-to-lower-brain-pressure-could-treat-blinding-iih-headaches-trial-finds

  Patients with blinding headaches known as Idiopathic Intercranial Hypertension (IIH) could be treated with an injectable peptide used for type 2 diabetes, a new trial has found. […] The study, published in the journal Brain, today reports on a phase two trial of a drug called exenatide, a GLP-1 receptor agonist, as a potential treatment for IIH. […] The IIH Pressure Trial led by a team of neurologists from the University of Birmingham and University Hospitals Birmingham found that for the seven patients who received regular injections of the drug, currently approved for use in Type 2 Diabetes, led to a drop in pressure in the brain during both short (2.5hrs and 24hrs) and long term (12 weeks) measurements. […] The trial also saw significant reductions in the numbers of headaches across the 12 weeks that participants took part, with an average of 7.7 fewer days per month of headaches compared to the baseline, compared to only 1.5 fewer days in the placebo arm.

• #38

  https://www.birmingham.ac.uk/news/2023/new-drug-to-lower-brain-pressure-could-treat-blinding-iih-headaches-trial-finds

  The phase two trial resulted in our treatment group having lower brain pressure both immediately and after 12 weeks and nearly 8 fewer headache days across the 12-week period. […] There are no current licenced drugs to treat IIH and hence this result is a major step forward for IIH patients. […] We now hope to see a much larger trial of exenatide to literally ease the pressure for the many people around the world suffering with IIH. […] A key finding was the rapid action of the drug, with results indicating that brain pressure was significantly reduced within two and half hours of taking the medication. […] The results of this clinical trial are a shot in the arm for finding clinical treatments for IIH. […] While we need to do further trials before such a treatment could be available for patients in the future, we are encouraged by the significant results from this trial that made a real difference for those in the treatment arm and this treatment may prove relevant for other conditions resulting in raised brain pressure. […] This is such exciting progress. New drug options is vitally important for IIH and this trial brings hope to the millions of patients living with the condition. […] Ultimately the aim is to gain enough evidence to allow the drug to be licensed for use in IIH patients in the future.

• #39

  https://www.birmingham.ac.uk/news/2023/new-drug-to-lower-brain-pressure-could-treat-blinding-iih-headaches-trial-finds

  Patients with blinding headaches known as Idiopathic Intercranial Hypertension (IIH) could be treated with an injectable peptide used for type 2 diabetes, a new trial has found. […] The study, published in the journal Brain, today reports on a phase two trial of a drug called exenatide, a GLP-1 receptor agonist, as a potential treatment for IIH. […] The IIH Pressure Trial led by a team of neurologists from the University of Birmingham and University Hospitals Birmingham found that for the seven patients who received regular injections of the drug, currently approved for use in Type 2 Diabetes, led to a drop in pressure in the brain during both short (2.5hrs and 24hrs) and long term (12 weeks) measurements. […] The trial also saw significant reductions in the numbers of headaches across the 12 weeks that participants took part, with an average of 7.7 fewer days per month of headaches compared to the baseline, compared to only 1.5 fewer days in the placebo arm.

• #40

  https://www.birmingham.ac.uk/news/2023/new-drug-to-lower-brain-pressure-could-treat-blinding-iih-headaches-trial-finds

  The phase two trial resulted in our treatment group having lower brain pressure both immediately and after 12 weeks and nearly 8 fewer headache days across the 12-week period. […] There are no current licenced drugs to treat IIH and hence this result is a major step forward for IIH patients. […] We now hope to see a much larger trial of exenatide to literally ease the pressure for the many people around the world suffering with IIH. […] A key finding was the rapid action of the drug, with results indicating that brain pressure was significantly reduced within two and half hours of taking the medication. […] The results of this clinical trial are a shot in the arm for finding clinical treatments for IIH. […] While we need to do further trials before such a treatment could be available for patients in the future, we are encouraged by the significant results from this trial that made a real difference for those in the treatment arm and this treatment may prove relevant for other conditions resulting in raised brain pressure. […] This is such exciting progress. New drug options is vitally important for IIH and this trial brings hope to the millions of patients living with the condition. […] Ultimately the aim is to gain enough evidence to allow the drug to be licensed for use in IIH patients in the future.

• #41 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  For patients with persistent or worsening visual symptoms despite maximizing treatment with acetazolamide, we suggest the addition of furosemide. […] Patients with IIH can continue to have headaches despite improvement in papilledema and visual function. Medications used in the prophylactic treatment of migraine headaches are often used for headache management in IIH if other treatments described above are not effective in this regard. […] Rare patients present with or develop rapidly progressive vision loss (ie, fulminant IIH). Treatment is urgent to preserve vision: Acetazolamide should be initiated promptly and can be rapidly titrated up to 4 grams per day divided into two doses. […] Patients with IIH who appear to benefit from surgical intervention include those who fail, are intolerant to, or are noncompliant with maximum medical therapy. The two main surgical procedures in IIH are optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF) shunting procedures.

• #42 Idiopathic Intracranial Hypertension

  https://practicalneurology.com/articles/2020-may/idiopathic-intracranial-hypertension

  Despite improving visual outcomes by reducing ICP, many people with IIH continue to have disabling headache even after ICP returns to normal. […] Ultimately, treatment of headache in IIH is based on the headache phenotype, which is typically migrainous, and data on specific therapies for headache in IIH are limited.

• #43 Idiopathic Intracranial Hypertension

  https://practicalneurology.com/articles/2020-may/idiopathic-intracranial-hypertension

  Acetazolamide, a carbonic anhydrase inhibitor, has been used for the treatment of IIH for years based on studies that demonstrated efficacy for improving papilledema and vision, making acetazolamide an evidence-based first-line therapy. […] Topiramate is an evidence-based medication for the preventive treatment of migraine that is a weak inhibitor of carbonic anhydrase and often used in the treatment of IIH. […] Furosemide, a loop diuretic, also inhibits carbonic anhydrase. […] Octreotide, a somatostatin analogue, has been shown to reduce ICP and improve headache. […] Obesity is associated with IIH and individuals with IIH who have a body mass index (BMI) greater than 40 kg/m2 are at higher risk for vision loss, making weight loss critical in the treatment of IIH. […] Surgical intervention should be considered for individuals who are at immediate risk of vision loss and have medically refractory disease. There are 3 main surgical options for IIH treatment. These include CSF-diverting procedures: LP or ventriculoperitoneal (VP) shunting, optic nerve sheath fenestration (ONSF), and venous sinus stenting.

• #44 Digoxin as a Treatment for Patients With Idiopathic Intracranial Hypertension

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2014.039/html?lang=en&srsltid=AfmBOophN0QsF2ln3TatwZG871ZInAcwD1iUwasDP3HuBZ_140KMkisg

  Idiopathic intracranial hypertension (IIH) sometimes called pseudotumor cerebri is a neurologic condition distinguished by any of the following symptoms: headache, increased cerebrospinal fluid pressure, papilledema, vision loss, diplopia, tinnitus, deafness, nausea and vomiting, or sixth nerve palsy. Medical and surgical management options are available for patients with IIH. […] Management of IIH involves both medical and surgical modalities. If a patient is obese, weight loss is encouraged, and acetazolamide and topiramate are frequently prescribed, as is furosemide. A physician may also perform serial lumbar punctures to decrease CSF pressure. […] We report a case of IIH that demonstrates the effects of digoxin, a medication that may benefit patients for whom other treatments have failed or who are unable or unwilling to undergo surgical procedures.

• #45 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Pharmacologic management generally includes carbonic anhydrase inhibitors such as acetazolamide or topiramate. Acetazolamide decreases cerebrospinal fluid production, whereas topiramate promotes weight loss, potentially reducing intracranial pressure and alleviating headaches. […] In cases where obesity is a factor, weight reduction is advised to significantly decrease intracranial pressure. For patients unable to lose weight through traditional methods, bariatric surgery, possibly supported by medications like GLP-1 receptor agonists, may be an effective solution. […] The use of serial lumbar punctures remains controversial but can be considered in urgent situations to protect vision while waiting for more definitive treatments such as optic nerve sheath fenestration, shunting procedures, or venous sinus stenting.

• #46 Idiopathic intracranial hypertension: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000351.htm

  Treatment is aimed at the cause of IIH. The main goal of treatments is to preserve vision and reduce the severity of headaches. […] A lumbar puncture (spinal tap) can help relieve pressure in the brain and prevent vision problems. Repeat lumbar punctures are helpful for pregnant women in order to delay surgery until after delivery. […] Other treatments may include: fluid or salt restriction, medicines such as corticosteroids, acetazolamide, furosemide, and topiramate, shunting procedures to relieve pressure from spinal fluid buildup, surgery to relieve pressure on the optic nerve, weight loss, treatment of the underlying disease, such as vitamin A overdose. […] People will need to have their vision closely monitored. There can be vision loss, which is sometimes permanent. Follow-up MRI or CT scans may be done to rule out problems such as tumors or hydrocephalus (buildup of fluid inside the skull). […] In some cases, the pressure inside the brain remains high for many years. Symptoms can return in some people. A small number of people have symptoms that slowly get worse and lead to blindness.

• #47 Idiopathic intracranial hypertension: consensus guidelines on management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/89/10/1088

  Weight loss is the only disease-modifying therapy in typical IIH. […] Where there is evidence of declining visual function, the acute management to preserve vision is surgical. […] A temporising measure of a lumbar drain could be useful to protect the vision while planning urgent surgical treatment. […] In the UK, the preferred surgical procedure is neurosurgical CSF diversion. […] Where possible, it should be performed by an experienced clinician with an interest in CSF disorders. […] CSF diversion is generally not recommended as a treatment for headache alone in IIH. […] Neurovascular stenting is not currently a treatment for headache in IIH. […] Medication overuse is a common issue for patients with IIH. […] Successfully removing excessive analgesic use significantly improves headaches.

• #48 Idiopathic intracranial hypertension: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000351.htm

  Treatment is aimed at the cause of IIH. The main goal of treatments is to preserve vision and reduce the severity of headaches. […] A lumbar puncture (spinal tap) can help relieve pressure in the brain and prevent vision problems. Repeat lumbar punctures are helpful for pregnant women in order to delay surgery until after delivery. […] Other treatments may include: fluid or salt restriction, medicines such as corticosteroids, acetazolamide, furosemide, and topiramate, shunting procedures to relieve pressure from spinal fluid buildup, surgery to relieve pressure on the optic nerve, weight loss, treatment of the underlying disease, such as vitamin A overdose. […] People will need to have their vision closely monitored. There can be vision loss, which is sometimes permanent. Follow-up MRI or CT scans may be done to rule out problems such as tumors or hydrocephalus (buildup of fluid inside the skull). […] In some cases, the pressure inside the brain remains high for many years. Symptoms can return in some people. A small number of people have symptoms that slowly get worse and lead to blindness.

• #49 Idiopathic Intracranial Hypertension – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/idiopathic-intracranial-hypertension

  Idiopathic intracranial hypertension occasionally resolves without treatment. […] Treatment of idiopathic intracranial hypertension is aimed at the following: […] Reducing pressure […] Preserving vision […] Relieving symptoms. […] The carbonic anhydrase inhibitor acetazolamide or topiramate (which also inhibits carbonic anhydrase) is used. Acetazolamide reduces cerebrospinal fluid production. Topiramate can help patients lose weight, help lower intracranial pressure, and may relieve headache. […] Preventive medications used for migraine may relieve headache. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as needed. […] Patients with obesity are encouraged to lose weight, which may help reduce intracranial pressure. […] Serial lumbar punctures are controversial but are sometimes used, particularly if, while waiting for definitive treatment, vision is threatened.

• #50 Idiopathic intracranial hypertension doc – Bobby Jones CSF

  https://bobbyjonescsf.org/physician-information/idiopathic-intracranial-hypertension/

  Repeated lumbar punctures with drainage of up to 30 to 40 cc of spinal fluid can improve IIH symptoms temporarily, sometimes for a month or more. […] If the pressure is 25 mmH2O or greater, and a Chiari I malformation is not present, a spinal fluid shunt can be considered. These shunts drain spinal fluid into the abdominal cavity and reduce intracranial and spinal pressure. […] If the body mass index is very high (BMI of 35kg/m2 or more) spinal fluid shunts fail so often that they are not advised. The current recommendation when the BMI is 35kg/m2 or greater is to consider bariatric surgery. […] In those patients with deteriorating vision facing the risk of blindness, fenestration of the optic nerve sheath can be considered. The procedure is performed through a brain operation or through an endoscope placed in the nose a procedure called an endonasal endoscopic optic nerve fenestration (ONSF). Small slits are performed in the optic nerve sheath to reduce the pressure on the nerve. ONSF has been found to improve vision in 59% and headache in 44%.

• #51 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Pharmacologic management generally includes carbonic anhydrase inhibitors such as acetazolamide or topiramate. Acetazolamide decreases cerebrospinal fluid production, whereas topiramate promotes weight loss, potentially reducing intracranial pressure and alleviating headaches. […] In cases where obesity is a factor, weight reduction is advised to significantly decrease intracranial pressure. For patients unable to lose weight through traditional methods, bariatric surgery, possibly supported by medications like GLP-1 receptor agonists, may be an effective solution. […] The use of serial lumbar punctures remains controversial but can be considered in urgent situations to protect vision while waiting for more definitive treatments such as optic nerve sheath fenestration, shunting procedures, or venous sinus stenting.

• #52 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Regular ophthalmologic assessments, especially quantitative visual field tests, are crucial to evaluate the effectiveness of the treatment plan. […] If vision deteriorates despite ongoing treatment, surgical options like optic nerve sheath fenestration, lumboperitoneal or ventriculoperitoneal shunting, or endovascular venous stenting should be considered. […] Patients with IIH should be closely monitored while on medical treatment. […] Surgical intervention should be considered in these situations, most often taking one of the following two general approaches: Optic nerve sheath fenestration or cerebrospinal fluid diversion (ie, via a lumboperitoneal or ventriculoperitoneal shunt). […] CSF diversion procedures are highly effective in lowering ICP. […] Uncontrolled studies report shunting results in the alleviation of headache, diplopia, papilledema, and visual loss.

• #53 Managing idiopathic intracranial hypertension in the eye clinic | Eye

  https://www.nature.com/articles/s41433-024-03140-y

  The surgical management of IIH includes optic nerve sheath fenestration (ONSF), CSF diversion procedures and venous stenting. […] CSF diversion procedures, ventriculoperitoneal shunt and lumboperitoneal shunt, reduce ICP efficiently, leading to resolution of optic nerve oedema and improvement of headaches (in the short term). […] The newest option for treatment is neurovascular stenting.

• #54 Intracranial hypertension

  https://www.nhs.uk/conditions/intracranial-hypertension/

  Treatment for these types of IH depends on the cause. […] Treatments for idiopathic intracranial hypertension (IH) can include: losing weight if you’re overweight. This can often help to reduce your symptoms and may sometimes relieve them altogether […] stopping any medicine that may be causing your symptoms […] medicine to remove excess fluid from the body (diuretics) […] medicine to reduce the production of cerebrospinal fluid in your brain […] a short course of steroid medicine to relieve headaches and reduce the risk of vision loss. […] Surgery may be considered if other treatments do not help, particularly if your vision is getting worse or you’re at risk of loss of vision. […] The main types of surgery for idiopathic IH are: shunt surgery a thin, flexible tube is inserted into the fluid-filled space in your skull or spine to divert excess fluid to another part of your body […] optic nerve sheath fenestration the protective layer surrounding your optic nerve (the nerve connecting the eye to the brain) is opened up to relieve pressure on it and allow fluid to drain away. […] Treatment can help with problems with your vision and can reduce the risk of loss of vision.

• #55 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  ONSF appears to be an effective procedure in patients who have progressive vision loss despite medical therapy. It is usually performed using a medial orbital approach. The optic nerve sheath is identified and a window is cut in this sheath, allowing CSF egress into the orbit. […] CSF shunting procedures include ventriculoperitoneal shunt (VPS) or lumboperitoneal shunt (LPS). Uncontrolled observations report that shunt placement can relieve headache, diplopia, papilledema, and visual loss in patients with IIH. […] Venous sinus stenting is a relatively new and somewhat controversial treatment option for IIH. Its use results from the observation that many patients with IIH have apparent stenoses of the transverse venous sinus or other cerebral veins, although whether this is a primary or secondary phenomenon is uncertain.

• #56 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Regular ophthalmologic assessments, especially quantitative visual field tests, are crucial to evaluate the effectiveness of the treatment plan. […] If vision deteriorates despite ongoing treatment, surgical options like optic nerve sheath fenestration, lumboperitoneal or ventriculoperitoneal shunting, or endovascular venous stenting should be considered. […] Patients with IIH should be closely monitored while on medical treatment. […] Surgical intervention should be considered in these situations, most often taking one of the following two general approaches: Optic nerve sheath fenestration or cerebrospinal fluid diversion (ie, via a lumboperitoneal or ventriculoperitoneal shunt). […] CSF diversion procedures are highly effective in lowering ICP. […] Uncontrolled studies report shunting results in the alleviation of headache, diplopia, papilledema, and visual loss.

• #57 European Headache Federation guideline on idiopathic intracranial hypertension | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0919-2

  Surgical management is essential for IIH patients with rapidly declining visual function. […] The evidence base for choice of surgical technique is lacking and practice varies internationally and with surgeon preference. CSF diversion procedures including ventriculo-peritoneal, lumbo-peritoneal, and less frequently ventriculo-atrial shunting may be utilised. […] Ventriculo-peritoneal shunts are preferred due to lower revision rates compared to lumbo-peritoneal shunts (1.8 versus 4.3 revisions per patient respectively). […] However, ventriculo-peritoneal shunt insertion leads to a temporary driving restriction in some countries such as the United Kingdom. […] An alternative to shunting is optic nerve sheath fenestration (ONSF) which is more cost effective in some health care systems than CSF shunting.

• #58 Intracranial Hypertension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507811/

  Ventriculoperitoneal shunting complications most commonly present as shunt malfunction (proximal or distal obstruction) requiring shunt revision procedures. […] Decompressive craniectomy is used for treating severe uncontrolled intracranial hypertension. This procedure surgically removes part of the calvaria to create a window in the skull, allowing the swollen brain to herniate through the bone window, thus relieving pressure.

• #59 Intracranial Hypertension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507811/

  Ventriculoperitoneal shunting complications most commonly present as shunt malfunction (proximal or distal obstruction) requiring shunt revision procedures. […] Decompressive craniectomy is used for treating severe uncontrolled intracranial hypertension. This procedure surgically removes part of the calvaria to create a window in the skull, allowing the swollen brain to herniate through the bone window, thus relieving pressure.

• #60 Pseudotumor cerebri (idiopathic intracranial hypertension) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudotumor-cerebri/diagnosis-treatment/drc-20354036

  The goal of pseudotumor cerebri treatment is to improve your symptoms and keep your eyesight from worsening. […] If you’re obese, your doctor might recommend a low-sodium weight-loss diet to help improve your symptoms. You might work with a dietitian to help with your weight-loss goals. Some people benefit from weight-loss programs or gastric surgery. […] One of the first drugs usually tried is acetazolamide, a glaucoma drug. This medication might reduce the production of cerebrospinal fluid and reduce symptoms. […] If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure might be necessary. […] In this procedure, a surgeon cuts a window into the membrane that surrounds the optic nerve to allow excess cerebrospinal fluid to escape.

• #61 Treatment | IIH UK – (Idiopathic intracranial hypertension)

  https://www.iih.org.uk/product/5/2/treatment

  ONSF (optical nerve fenestration) May be considered (very rarely) if vision is severely affected or threatened. In this procedure, the sheath surrounding the optic nerve is slit, or a 'window’ cut into the sheath to relieve the pressure on the nerve and allow the CSF to escape. ONSF is very effective at relieving the pressure on the optic nerves and thus helps to resolve papilledema. However the amount of CSF drained due to this procedure is negligible. ONSF has little effect on the overall ICP and can lead to complications including blindness.

• #62 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  ONSF appears to be an effective procedure in patients who have progressive vision loss despite medical therapy. It is usually performed using a medial orbital approach. The optic nerve sheath is identified and a window is cut in this sheath, allowing CSF egress into the orbit. […] CSF shunting procedures include ventriculoperitoneal shunt (VPS) or lumboperitoneal shunt (LPS). Uncontrolled observations report that shunt placement can relieve headache, diplopia, papilledema, and visual loss in patients with IIH. […] Venous sinus stenting is a relatively new and somewhat controversial treatment option for IIH. Its use results from the observation that many patients with IIH have apparent stenoses of the transverse venous sinus or other cerebral veins, although whether this is a primary or secondary phenomenon is uncertain.

• #63 Pseudotumor Cerebri (Idiopathic Intracranial Hypertension) – EyeWiki

  https://eyewiki.org/Pseudotumor_Cerebri_(Idiopathic_Intracranial_Hypertension)

  Medical therapy is usually considered among patients with mild to moderate disease. […] Among the options available, acetazolamide, a carbonic anhydrase inhibitors, is believed to reduce the rate of CSF production and is the first-line medical treatment for IIH. When the latter is inefficient or not tolerated it may be combined with or substituted by: […] Surgical management should be the option of choice among patients with refractory headaches or more severe/ rapidly progressive visual field loss when all other options have failed to prevent progressive visual loss. […] The two most used procedures are CSF diversion via shunt and optic nerve sheath fenestration. […] Optic nerve sheath fenestration is the preferred surgical procedure for papilledema with associated severe vision loss but no or minimal ICP symptoms (such as headache). […] CSF shunting produces rapid reduction in ICP and is therefore most beneficial among patients with vision loss and symptoms of raised ICP. […] Venous sinus stenting (VSS) is an emerging procedure based on the findings of venous sinus stenosis in IIH patients.

• #64 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  ONSF appears to be an effective procedure in patients who have progressive vision loss despite medical therapy. It is usually performed using a medial orbital approach. The optic nerve sheath is identified and a window is cut in this sheath, allowing CSF egress into the orbit. […] CSF shunting procedures include ventriculoperitoneal shunt (VPS) or lumboperitoneal shunt (LPS). Uncontrolled observations report that shunt placement can relieve headache, diplopia, papilledema, and visual loss in patients with IIH. […] Venous sinus stenting is a relatively new and somewhat controversial treatment option for IIH. Its use results from the observation that many patients with IIH have apparent stenoses of the transverse venous sinus or other cerebral veins, although whether this is a primary or secondary phenomenon is uncertain.

• #65 SciELO Brazil – Update on Idiopathic Intracranial Hypertension Management Update on Idiopathic Intracranial Hypertension Management

  https://www.scielo.br/j/anp/a/4vM8KHWz57PFMpbDjfwG5PR/

  In the presence of imminent visual deterioration, surgical management is an effective alternative for visual protection. CSF diversion and optic nerve sheath fenestration (ONSF) have been employed in the short term. […] The optic nerve sheath fenestration (ONSF) is a technique with a lower complication rate and no reported mortality. […] A more recent therapeutic approach for IIH is venous sinus stenting, reported for the first time in 2002. […] As obesity is the main modifiable risk factor for IIH, researchers have hypothesized that treatment targeting body weight control improves clinical outcome. […] The treatments used for visual protection, either clinical with acetazolamide or surgical, have not shown benefit in improving headaches and therefore should not be prescribed for this purpose.

• #66 Idiopathic intracranial hypertension | Neurosurgery Inselspital Bern

  https://neurochirurgie.insel.ch/en/diseases-specialities/liquor-disorders/idiopathic-intracranial-hypertension

  In 2002, Higgins et al. published a new procedure: the first catheter-based intervention in the form of sinus stenting in a patient with bilateral distal transverse sinus stenoses that were not treatable with conventional methods. The intervention resulted in a significant improvement of symptoms. However, this method is not considered a standard procedure for IIH and is only applied in very carefully selected patients, exclusively in specialized centers such as Inselspital.

• #67 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  ONSF appears to be an effective procedure in patients who have progressive vision loss despite medical therapy. It is usually performed using a medial orbital approach. The optic nerve sheath is identified and a window is cut in this sheath, allowing CSF egress into the orbit. […] CSF shunting procedures include ventriculoperitoneal shunt (VPS) or lumboperitoneal shunt (LPS). Uncontrolled observations report that shunt placement can relieve headache, diplopia, papilledema, and visual loss in patients with IIH. […] Venous sinus stenting is a relatively new and somewhat controversial treatment option for IIH. Its use results from the observation that many patients with IIH have apparent stenoses of the transverse venous sinus or other cerebral veins, although whether this is a primary or secondary phenomenon is uncertain.

• #68 Idiopathic Intracranial Hypertension New York, NY | Spinal Fluid Shunt New York, NY

  https://www.athospatsalidesmd.com/idiopathic-intracranial-hypertension-interventional-neuroradiologist-new-york-ny.html

  If the patient is overweight, the initial recommendation will be weight loss. Achieving a healthy weight may help alleviate headache and other symptoms. […] There are medications that can help reduce intracranial pressure, including diuretics (which reduce fluids in body tissue) and migraine drugs. Medicines used to treat glaucoma can also be effective, since they reduce pressure by suppressing production of cerebrospinal fluid (CSF). […] Traditional surgical treatments include: Shunt surgery: placement of a shunt in the brain to drain excess CSF and relieve the pressure. Optic Nerve Sheath Fenestration: surgery around the optic nerve to relieve pressure around the optic nerve and protect the vision. […] A new minimally invasive procedure called Venous sinus stenting has been performed by Dr. Patsalides since 2012 has been shown to be effective in the treatment of patients with IIH. Clinical trials conducted at Weill Cornell have shown that venous sinus stent is effective in decreasing intracranial pressure and alleviating symptoms of IIG in carefully selected patients with IIH.

• #69 Preserving vision, easing headaches: Timely multidisciplinary care for idiopathic intracranial hypertension – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/preserving-vision-easing-headaches-timely-multidisciplinary-care-for-idiopathic-intracranial-hypertension/mac-20468518

  Mayo Clinic’s cerebral spinal fluid (CSF) dynamics clinic provides a multidisciplinary, specialized approach to the management of idiopathic intracranial hypertension (IIH). […] Timely diagnosis and treatment are essential for the optimal treatment of IIH. […] Once the diagnosis of IIH is confirmed, initial treatment focuses on lowering intracranial pressure to relieve papilledema. […] Depending on the degree of papilledema, medications such as acetazolamide might be tried. […] If the IIH is fulminant or medication fails to adequately reduce pressure, surgery is recommended. […] The classic surgical treatment involves the implantation of a shunt. […] To avoid that scenario, Mayo Clinic often uses venous sinus stenting as a surgical option. […] If a significant pressure gradient is detected, a stent is placed.

• #70 Idiopathic Intracranial Hypertension: Symptoms, Causes, and Treatment

  https://headacheaustralia.org.au/types-of-headaches/idiopathic-intracranial-hypertension-iih/

  Medication e.g. acetazolamide […] Lumbar punctures to lower intracranial pressure […] CSF shunt diversion procedures […] Optical nerve sheath fenestration […] Stenting of transverse sinus stenosis as treatment for IIH Reference: R.M. Ahmed, M. Wilkinson, G.D. Parker, M.J. Thurtell, J. Macdonald, P.J. McCluskey, R. Allan, V. Dunne, M. Hanlon, B.K. Owler and G.M. Halmagyi. Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions. AJNR, 2011 […] The association between IIH and obstructive sleep apnoea Reference: Thurtell M, Bruce BB, Rye DB, Newman NJ, Biousse V. The berlin questionnaire screens for obstructive sleep apnoea in idiopathic intracranial hypertension. J Neurophthal. 2011.

• #71 Transforming Care: A Minimally Invasive Approach for the Treatment of Idiopathic Intracranial Hypertension – Advances in Neurology & Neurosurgery } NewYork-Presbyterian

  https://www.nyp.org/advances/article/neurology-neurosurgery/transforming-care-a-minimally-invasive-approach-for-the-treatment-of-idiopathic-intracranial-hypertension

  Given the minimally invasive nature of this procedure, patients can often go home the same day or the following morning. […] It is associated with a less than 1% risk of complications, and meta-analyses suggest this technique is the most effective treatment option for IIH patients. […] Despite these challenges, evidence suggests that VSS is still the best treatment option for IIH patients.

• #72 Idiopathic intracranial hypertension | Neurosurgery Inselspital Bern

  https://neurochirurgie.insel.ch/en/diseases-specialities/liquor-disorders/idiopathic-intracranial-hypertension

  In 2002, Higgins et al. published a new procedure: the first catheter-based intervention in the form of sinus stenting in a patient with bilateral distal transverse sinus stenoses that were not treatable with conventional methods. The intervention resulted in a significant improvement of symptoms. However, this method is not considered a standard procedure for IIH and is only applied in very carefully selected patients, exclusively in specialized centers such as Inselspital.

• #73 What are the Treatment Options? | Harvard Medical School Department of Ophthalmology

  https://eye.hms.harvard.edu/book/what-are-treatment-options

  Traditional surgical treatments, such as CSF diversion (ventriculoperitoneal shunt or lumboperitoneal shunt) and optic nerve sheath fenestration, are appropriate for patients with progressive visual loss due to papilledema that is unresponsive to medical therapy or weight loss. Transverse cerebral venous sinus stenting is an endovascular treatment for medically refractory patients, but it has not been studied in a randomized-controlled clinical trial. Preliminary case series suggest efficacy in select patients with appropriate venous anatomy.

• #74 European Headache Federation guideline on idiopathic intracranial hypertension | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0919-2

  Therapeutic agents currently used in IIH aim to reduce ICP through reduction in CSF secretion. […] Acetazolamide is the only therapeutic that has been evaluated in RCT and is regarded as the first line therapy for IIH. […] However, not all clinicians prescribe acetazolamide for IIH due to the limitations of the evidence base highlighted by the 2015 Cochrane review in conjunction with the potential side effect profile. […] In pregnancy the use of acetazolamide is controversial. […] There is insufficient evidence to support venous stenting to exclusively treat headache.

• #75 A High-Pressure Situation: Idiopathic Intracranial Hypertension Diagnosis and Treatments – Ophthalmology Advisor

  https://www.ophthalmologyadvisor.com/features/pseudotumor-cerebri-iih-diagnosis-protocol-and-treatment-options/

  The goals of treatment with IIH are to limit visual morbidity from persistent optic nerve edema and to relieve symptoms, which is most commonly headache. […] Weight loss and treatment with carbonic anhydrase inhibitors (CAI) such as acetazolamide are the mainstays of managing IIH. […] The Idiopathic Intracranial Hypertension Treatment Trial was a multicenter, double-blind, randomized, placebo-controlled study of acetazolamide in 165 IIH participants with mild visual loss that found subjects taking acetazolamide along with a low-sodium diet program had significantly better visual outcomes than those taking placebo along with the diet. […] An important consideration that should be discussed with IIH patients is the potential risk of acetazolamide for pregnancy. […] For patients who cannot be treated with acetazolamide due to side effect intolerance, methazolamide and topiramate are potential alternative options.

• #76 Idiopathic intracranial hypertension: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000351.htm

  Treatment is aimed at the cause of IIH. The main goal of treatments is to preserve vision and reduce the severity of headaches. […] A lumbar puncture (spinal tap) can help relieve pressure in the brain and prevent vision problems. Repeat lumbar punctures are helpful for pregnant women in order to delay surgery until after delivery. […] Other treatments may include: fluid or salt restriction, medicines such as corticosteroids, acetazolamide, furosemide, and topiramate, shunting procedures to relieve pressure from spinal fluid buildup, surgery to relieve pressure on the optic nerve, weight loss, treatment of the underlying disease, such as vitamin A overdose. […] People will need to have their vision closely monitored. There can be vision loss, which is sometimes permanent. Follow-up MRI or CT scans may be done to rule out problems such as tumors or hydrocephalus (buildup of fluid inside the skull). […] In some cases, the pressure inside the brain remains high for many years. Symptoms can return in some people. A small number of people have symptoms that slowly get worse and lead to blindness.

• #77 SciELO Brazil – Update on Idiopathic Intracranial Hypertension Management Update on Idiopathic Intracranial Hypertension Management

  https://www.scielo.br/j/anp/a/4vM8KHWz57PFMpbDjfwG5PR/

  In the presence of imminent visual deterioration, surgical management is an effective alternative for visual protection. CSF diversion and optic nerve sheath fenestration (ONSF) have been employed in the short term. […] The optic nerve sheath fenestration (ONSF) is a technique with a lower complication rate and no reported mortality. […] A more recent therapeutic approach for IIH is venous sinus stenting, reported for the first time in 2002. […] As obesity is the main modifiable risk factor for IIH, researchers have hypothesized that treatment targeting body weight control improves clinical outcome. […] The treatments used for visual protection, either clinical with acetazolamide or surgical, have not shown benefit in improving headaches and therefore should not be prescribed for this purpose.

• #78 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Regular ophthalmologic assessments, especially quantitative visual field tests, are crucial to evaluate the effectiveness of the treatment plan. […] If vision deteriorates despite ongoing treatment, surgical options like optic nerve sheath fenestration, lumboperitoneal or ventriculoperitoneal shunting, or endovascular venous stenting should be considered. […] Patients with IIH should be closely monitored while on medical treatment. […] Surgical intervention should be considered in these situations, most often taking one of the following two general approaches: Optic nerve sheath fenestration or cerebrospinal fluid diversion (ie, via a lumboperitoneal or ventriculoperitoneal shunt). […] CSF diversion procedures are highly effective in lowering ICP. […] Uncontrolled studies report shunting results in the alleviation of headache, diplopia, papilledema, and visual loss.

• #79 Idiopathic intracranial hypertension: consensus guidelines on management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/89/10/1088

  The current Cochrane review on IIH management reported on the use of acetazolamide, a carbonic anhydrase inhibitor, in IIH. […] Acetazolamide could be prescribed for those with IIH symptoms. […] The optimal dose of acetazolamide is not established. […] The role of other diuretics such as furosemide, amiloride and coamilofruse are not certain but are used by some as alternative therapies. […] A multidisciplinary team approach could be considered including, ideally, an assessment by an experienced clinician with an interest in headache management. […] These statements are not mandatory recommendations but are intended to be used as a guide for doctors who investigate and treat IIH.

• #80 Treatment of Papilledema from Idiopathic Intracranial Hypertension | Rush

  https://www.rush.edu/treatment-papilledema-idiopathic-intracranial-hypertension

  A female patient in her 30s was referred to me for evaluation of papilledema. […] I diagnosed the patient with papilledema, and her presentation and exam findings were consistent with idiopathic intracranial hypertension. […] The initial approach to treat the patient was through medication management. […] Consistent with the standard of care, I treated the patient with acetazolamide to lower the intracranial pressure and discussed the role that weight loss can play in the management of the disease. […] I recommended that she see Webster Crowley, MD, a neurosurgeon at RUSH, for venous sinus stenting due to her medication intolerance and intractable papilledema with progressive vision loss. The stenting was performed in June 2023. […] For most patients, IIH can be cured through a combination of weight loss and medication management. […] Ultimately, despite optimal medical management, more invasive treatments may be needed.

• #81

  https://link.springer.com/article/10.1007/s00540-020-02795-7

  To control elevated ICP refractory to maximum standard medical and surgical treatment, at first, high-dose barbiturate administration and then decompressive craniectomy as a last step are recommended with unclear and probable benefit on outcomes, respectively. […] The therapeutic strategy should be based on a staircase approach and be individualized for each patient. […] Since most therapeutic interventions have an uncertain effect on neurological outcome and mortality, future research should focus on both studying the long-term benefits of current strategies and developing new ones.

• #82 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  For patients with persistent or worsening visual symptoms despite maximizing treatment with acetazolamide, we suggest the addition of furosemide. […] Patients with IIH can continue to have headaches despite improvement in papilledema and visual function. Medications used in the prophylactic treatment of migraine headaches are often used for headache management in IIH if other treatments described above are not effective in this regard. […] Rare patients present with or develop rapidly progressive vision loss (ie, fulminant IIH). Treatment is urgent to preserve vision: Acetazolamide should be initiated promptly and can be rapidly titrated up to 4 grams per day divided into two doses. […] Patients with IIH who appear to benefit from surgical intervention include those who fail, are intolerant to, or are noncompliant with maximum medical therapy. The two main surgical procedures in IIH are optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF) shunting procedures.

• #83 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Management guidelines are based on symptoms and extent of visual impairment at presentation. If there is no immediate threat to vision, medical therapy is recommended. In the event of an immediate threat to visual function, a temporary CSF draining procedure (ie, placement of a lumbar drain) is immediately performed, and a definitive surgical plan is made; either a ventriculoperitoneal shunt or optic nerve sheath fenestration. […] The primary treatment objectives for patients with idiopathic intracranial hypertension (IIH) are to preserve optic nerve function, manage elevated intracranial pressure (ICP), and alleviate symptoms. […] The initial treatment typically involves administering acetazolamide, dosed according to the patient’s symptoms, tolerance, and visual function. If progressive visual field loss occurs despite maximal medical therapy, urgent surgical intervention may be necessary.

• #84 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  For patients with persistent or worsening visual symptoms despite maximizing treatment with acetazolamide, we suggest the addition of furosemide. […] Patients with IIH can continue to have headaches despite improvement in papilledema and visual function. Medications used in the prophylactic treatment of migraine headaches are often used for headache management in IIH if other treatments described above are not effective in this regard. […] Rare patients present with or develop rapidly progressive vision loss (ie, fulminant IIH). Treatment is urgent to preserve vision: Acetazolamide should be initiated promptly and can be rapidly titrated up to 4 grams per day divided into two doses. […] Patients with IIH who appear to benefit from surgical intervention include those who fail, are intolerant to, or are noncompliant with maximum medical therapy. The two main surgical procedures in IIH are optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF) shunting procedures.

• #85 Intracranial Hypertension – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK507811/

  A large part of treating intracranial hypertension involves mitigating the risk of increased ICP and making timely clinical decisions to prevent adverse consequences. […] Intracranial hypertension management has 4 tiers. Implementation should begin at Tier 0 and progress stepwise if the patient does not improve. […] Tier 0: Elevate the head of the bed to 30 with a neutral position to minimize venous outflow resistance and maximize CSF flow dynamics. […] Hyperosmolar therapy may be initiated to decrease cerebral edema. […] An external ventricular catheter may be placed for ICP monitoring and lowering by CSF drainage. […] Surgical interventions are typically reserved for patients at risk of vision loss. […] A high-volume lumbar puncture can be performed to decrease ocular pressures and temporize until a more definitive surgical intervention can be achieved.

• #86 Idiopathic Intracranial Hypertension (IH) Treatment | VNSC

  https://www.vnsc.org/conditions-treated/idiopathic-intracranial-hypertension/

  However, most patients show improvement from IIH symptoms within a few months of beginning treatment. […] IIH treatment options may include: […] For patients with a BMI over 30, weight loss of 5 to 10% of body weight may help reduce symptoms or relieve them entirely […] Diuretic medications to decrease fluid retention […] Medications to reduce CSF production […] Steroid medications to relieve headaches and reduce vision loss risks […] Lumbar punctures to remove excess CSF and reduce pressure on the brain. […] In severe cases of IIH, where other treatments have failed to improve symptoms, surgery may be an option. […] Surgery is considered if your vision is worsening or youre at significant risk of permanent vision loss. […] The types of surgery for IIH include: […] Spinal Fluid Shunt involves inserting a shunt, or a long, thin tube, into the brain to help drain CSF and divert the excess fluid to be reabsorbed in another part of the body.

• #87 Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-prognosis-and-treatment

  While used in rare situations as a temporizing measure prior to surgical intervention, we and others avoid using glucocorticoids for long-term management of IIH. […] Most patients with IIH improve or stabilize with medical treatment over the course of several months. Recurrences may occur even after several years, necessitating ongoing monitoring.

• #88 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Regular ophthalmologic assessments, especially quantitative visual field tests, are crucial to evaluate the effectiveness of the treatment plan. […] If vision deteriorates despite ongoing treatment, surgical options like optic nerve sheath fenestration, lumboperitoneal or ventriculoperitoneal shunting, or endovascular venous stenting should be considered. […] Patients with IIH should be closely monitored while on medical treatment. […] Surgical intervention should be considered in these situations, most often taking one of the following two general approaches: Optic nerve sheath fenestration or cerebrospinal fluid diversion (ie, via a lumboperitoneal or ventriculoperitoneal shunt). […] CSF diversion procedures are highly effective in lowering ICP. […] Uncontrolled studies report shunting results in the alleviation of headache, diplopia, papilledema, and visual loss.

• #89 Idiopathic Intracranial Hypertension – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/idiopathic-intracranial-hypertension

  Definitive treatment includes optic nerve sheath fenestration, shunting, and venous sinus stenting. […] Frequent ophthalmologic assessment (including quantitative visual fields) is required to monitor response to treatment; testing visual acuity is not sensitive enough to warn of impending vision loss. […] If vision deteriorates despite treatment, one of the following may be indicated: […] Optic nerve sheath fenestration […] Shunting (lumboperitoneal or ventriculoperitoneal) […] Endovascular venous stenting. […] Bariatric surgery with sustained weight loss may cure the disorder in patients who have obesity and were otherwise unable to lose weight (eg, with use of GLP-1 receptor agonists). […] Advise weight loss if needed, and treat with acetazolamide or topiramate. […] Do frequent ophthalmologic assessments (including quantitative visual fields) to monitor response to treatment. […] If vision deteriorates despite treatment, consider optic nerve sheath fenestration, shunting, or endovascular venous stenting.

• #90 Clinical profile and treatment outcomes of idiopathic intracranial hypertension: a multicenter study from Korea | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01794-3

  Currently, there is a relative lack of detailed reports regarding clinical presentation and outcome of idiopathic intracranial hypertension in Asians. This study aims to describe the clinical features and treatment outcomes of Korean patients with idiopathic intracranial hypertension. […] After 36 months of treatment, the intracranial pressure normalized in 8/32 (25.0%), improved in 17/32 (53.1%), no changed in 7/32 (21.9%), and worsened in none. […] Medical treatment resulted in overall favorable short-term outcomes; however, the headaches did not improve in a small proportion of patients. […] The majority of patients received medical treatment with acetazolamide, with approximately 86% reporting either effective or partial effective response. […] No surgical treatment was required, and no patients reported any visual loss. […] At 6-month follow-up, 25% had achieved ICP normalization and approximately 50% showed improved outcomes. […] However, approximately 15% of patients reported no change or worsening of headache status at follow-up between 36 months.

• #91 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  Timely treatment at the first sign of vision changes or symptoms can help reduce your risk of complications like permanent vision loss. […] Treatment is often successful at relieving symptoms. […] There isnt a cure for IIH, so you may have to manage this condition for the rest of your life. […] It’s important to follow your treatment plan, especially if your provider recommends making changes to the foods you eat or your activity level to help reduce your risk.

• #92 Idiopathic Intracranial Hypertension

  https://practicalneurology.com/articles/2020-may/idiopathic-intracranial-hypertension

  Despite improving visual outcomes by reducing ICP, many people with IIH continue to have disabling headache even after ICP returns to normal. […] Ultimately, treatment of headache in IIH is based on the headache phenotype, which is typically migrainous, and data on specific therapies for headache in IIH are limited.

• #93 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  Timely treatment at the first sign of vision changes or symptoms can help reduce your risk of complications like permanent vision loss. […] Treatment is often successful at relieving symptoms. […] There isnt a cure for IIH, so you may have to manage this condition for the rest of your life. […] It’s important to follow your treatment plan, especially if your provider recommends making changes to the foods you eat or your activity level to help reduce your risk.

• #94 Intracranial Hypertension (Pseudotumor Cerebri): Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/intracranial-hypertension-pseudotumor-cerebri

  If treated, the outcome is good. If not treated, permanent blindness can occur. Unfortunately, up to one in 10 people with intracranial hypertension have some vision loss. Treatment typically lasts six to 12 months. With treatment, in most cases, this condition goes away. However, increased pressure can return months or even years later. You can reduce this risk by helping your child maintain a healthy weight. It is important to have regular eye exams to check for vision loss even after the intracranial hypertension gets better.

• #95

  https://www.birmingham.ac.uk/news/2023/new-drug-to-lower-brain-pressure-could-treat-blinding-iih-headaches-trial-finds

  Patients with blinding headaches known as Idiopathic Intercranial Hypertension (IIH) could be treated with an injectable peptide used for type 2 diabetes, a new trial has found. […] The study, published in the journal Brain, today reports on a phase two trial of a drug called exenatide, a GLP-1 receptor agonist, as a potential treatment for IIH. […] The IIH Pressure Trial led by a team of neurologists from the University of Birmingham and University Hospitals Birmingham found that for the seven patients who received regular injections of the drug, currently approved for use in Type 2 Diabetes, led to a drop in pressure in the brain during both short (2.5hrs and 24hrs) and long term (12 weeks) measurements. […] The trial also saw significant reductions in the numbers of headaches across the 12 weeks that participants took part, with an average of 7.7 fewer days per month of headaches compared to the baseline, compared to only 1.5 fewer days in the placebo arm.

• #96

  https://www.birmingham.ac.uk/news/2023/new-drug-to-lower-brain-pressure-could-treat-blinding-iih-headaches-trial-finds

  The phase two trial resulted in our treatment group having lower brain pressure both immediately and after 12 weeks and nearly 8 fewer headache days across the 12-week period. […] There are no current licenced drugs to treat IIH and hence this result is a major step forward for IIH patients. […] We now hope to see a much larger trial of exenatide to literally ease the pressure for the many people around the world suffering with IIH. […] A key finding was the rapid action of the drug, with results indicating that brain pressure was significantly reduced within two and half hours of taking the medication. […] The results of this clinical trial are a shot in the arm for finding clinical treatments for IIH. […] While we need to do further trials before such a treatment could be available for patients in the future, we are encouraged by the significant results from this trial that made a real difference for those in the treatment arm and this treatment may prove relevant for other conditions resulting in raised brain pressure. […] This is such exciting progress. New drug options is vitally important for IIH and this trial brings hope to the millions of patients living with the condition. […] Ultimately the aim is to gain enough evidence to allow the drug to be licensed for use in IIH patients in the future.

• #97 Preserving vision, easing headaches: Timely multidisciplinary care for idiopathic intracranial hypertension – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/preserving-vision-easing-headaches-timely-multidisciplinary-care-for-idiopathic-intracranial-hypertension/mac-20468518

  The gradient disappears, and intracranial pressure is normalized in a nontraumatic way. […] The papilledema almost always improves or resolves. […] To learn more about the optimal treatment of IIH, Mayo Clinic is participating in the Surgical Idiopathic Intracranial Hypertension Treatment Trial (SIGHT), a randomized, multicenter clinical trial comparing treatments for IIH involving moderate to severe vision loss. […] Other research efforts include a clinical trial investigating the use of MR elastography (MRE) to evaluate raised intracranial pressure.

• #98 European Headache Federation guideline on idiopathic intracranial hypertension | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0919-2

  The Neuro-Ophthalmology Research Disease Investigator Consortium (NORDIC) are currently planning a randomised controlled surgical trial, SIGHT, which will compare shunting with ONSF and acetazolamide. […] There is a clear association between IIH and weight with over 90-95% of patients being obese. […] Weight loss is the only established disease modifying therapy in IIH. […] Consequently, patients should be sensitively counselled about the importance of weight loss. […] The role of bariatric surgery is being increasingly suggested as a lasting therapy to induce IIH remission. […] Bariatric surgery leads to greater weight loss compared to dietary regimes, with mean reduction in body mass index (BMI) of 7.05-15.34m/kg2 at 12 months and significant sustained long term weight loss. […] A systematic review of the IIH cases treated with bariatric surgery report 100% resolution of papilloedema and 90% experience headache improvement.

• #99 Preserving vision, easing headaches: Timely multidisciplinary care for idiopathic intracranial hypertension – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/preserving-vision-easing-headaches-timely-multidisciplinary-care-for-idiopathic-intracranial-hypertension/mac-20468518

  The gradient disappears, and intracranial pressure is normalized in a nontraumatic way. […] The papilledema almost always improves or resolves. […] To learn more about the optimal treatment of IIH, Mayo Clinic is participating in the Surgical Idiopathic Intracranial Hypertension Treatment Trial (SIGHT), a randomized, multicenter clinical trial comparing treatments for IIH involving moderate to severe vision loss. […] Other research efforts include a clinical trial investigating the use of MR elastography (MRE) to evaluate raised intracranial pressure.

• #100 DigitalCommons@PCOM – Research Day: A holistic approach to idiopathic intracranial hypertension treatment and management

  https://digitalcommons.pcom.edu/research_day/research_day_GA_2024/researchGA2024/55/

  A holistic approach to idiopathic intracranial hypertension treatment and management […] Effective IIH management requires a comprehensive care team to ensure that the patient feels supported in all aspects of health management. This approach should have a PCP serving as the center of a coordinated care model encompassing various resources (e.g., mental health professionals, dietitians, osteopathic manipulative treatment.) Emphasizing the importance of a holistic strategy that addresses both mental and physical aspects of the disease can improve positive outcomes in patient care and disease management. Until further research sheds light on the underlying pathophysiology of IIH, the focus should shift towards establishing holistic treatment protocols and developing multifaceted care teams to promote the best outcomes for patients. This approach will empower patients and allow them to foster a sense of control in the face of this challenging condition.

• #101 Vascular & Interventional Partners | Phoenix, AZ| IIH

  https://www.vipinterventional.com/conditions/idiopathic-intracranial-hypertension

  It’s important to note that these procedures are typically reserved for cases of IIH that are severe or that don’t respond to other treatments. […] The success rate of IIH treatment varies depending on the severity of your condition and the medical treatment method used. However, many patients see significant improvement in their symptoms after treatment. The success rate of medication therapy ranges from 50-80%, while the success rate of surgical treatments, such as optic nerve sheath fenestration and CSF shunting, ranges from 70-90%. […] As with any medical procedure, there are potential risks and complications associated with IIH treatment.

• #102 Idiopathic Intracranial Hypertension (IIH) Treatment & Management: Approach Considerations, Pharmacologic Therapy, Optic Nerve Sheath Fenestration, CSF Diversion, and Venous Sinus Stenting

  https://emedicine.medscape.com/article/1214410-treatment

  Reduction of body weight by 5-10% was found to be effective with resulting improvement of papilledema and visual fields. […] An additional study that investigated the long-term outcomes of bariatric surgery in IIH patients looked at 30 patients who underwent bariatric surgery at least 4 years prior and found that attaining and maintaining a BMI of 30 or below was associated with long-term improvement of signs and symptoms of IIH.

• #103 Treatment | IIH UK – (Idiopathic intracranial hypertension)

  https://www.iih.org.uk/product/5/2/treatment

  Shunt surgery one end of a flexible tube is put into the fluid filled space in your brain (ventricle) or your spine (lumbar) and the other end in another part of your body, such as your abdominal cavity (peritoneum). […] The IIH:WT (weight trial) has shown that for those IIH patients with obesity, gastric surgery is proven to reduce pressure, headache and quality of life for people with IIH. […] There is now definitive evidence that weight and IIH are related. Weight loss has been shown to be the only treatment to modify the underlying condition. […] Recent studies have shown that weight loss is an effective treatment to reduce papilloedema and headaches, putting IIH in to remission. […] Shunt surgery has proven to be a successful long term relief from IIH symptoms and raised ICP. […] Venous Sinus Stenting Is also used as a surgical procedure for people with IIH who have Venous Sinus Stenosis.

• #104 Vascular & Interventional Partners | Phoenix, AZ| IIH

  https://www.vipinterventional.com/conditions/idiopathic-intracranial-hypertension

  It’s important to note that these procedures are typically reserved for cases of IIH that are severe or that don’t respond to other treatments. […] The success rate of IIH treatment varies depending on the severity of your condition and the medical treatment method used. However, many patients see significant improvement in their symptoms after treatment. The success rate of medication therapy ranges from 50-80%, while the success rate of surgical treatments, such as optic nerve sheath fenestration and CSF shunting, ranges from 70-90%. […] As with any medical procedure, there are potential risks and complications associated with IIH treatment.

• #105 Vascular & Interventional Partners | Phoenix, AZ| IIH

  https://www.vipinterventional.com/conditions/idiopathic-intracranial-hypertension

  It’s important to note that these procedures are typically reserved for cases of IIH that are severe or that don’t respond to other treatments. […] The success rate of IIH treatment varies depending on the severity of your condition and the medical treatment method used. However, many patients see significant improvement in their symptoms after treatment. The success rate of medication therapy ranges from 50-80%, while the success rate of surgical treatments, such as optic nerve sheath fenestration and CSF shunting, ranges from 70-90%. […] As with any medical procedure, there are potential risks and complications associated with IIH treatment.

• #106 European Headache Federation guideline on idiopathic intracranial hypertension | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0919-2

  The Neuro-Ophthalmology Research Disease Investigator Consortium (NORDIC) are currently planning a randomised controlled surgical trial, SIGHT, which will compare shunting with ONSF and acetazolamide. […] There is a clear association between IIH and weight with over 90-95% of patients being obese. […] Weight loss is the only established disease modifying therapy in IIH. […] Consequently, patients should be sensitively counselled about the importance of weight loss. […] The role of bariatric surgery is being increasingly suggested as a lasting therapy to induce IIH remission. […] Bariatric surgery leads to greater weight loss compared to dietary regimes, with mean reduction in body mass index (BMI) of 7.05-15.34m/kg2 at 12 months and significant sustained long term weight loss. […] A systematic review of the IIH cases treated with bariatric surgery report 100% resolution of papilloedema and 90% experience headache improvement.

• #107 Intracranial Hypertension (Pseudotumor Cerebri): Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/intracranial-hypertension-pseudotumor-cerebri

  If treated, the outcome is good. If not treated, permanent blindness can occur. Unfortunately, up to one in 10 people with intracranial hypertension have some vision loss. Treatment typically lasts six to 12 months. With treatment, in most cases, this condition goes away. However, increased pressure can return months or even years later. You can reduce this risk by helping your child maintain a healthy weight. It is important to have regular eye exams to check for vision loss even after the intracranial hypertension gets better.

• #108 Idiopathic Intracranial Hypertension (IH) Treatment | VNSC

  https://www.vnsc.org/conditions-treated/idiopathic-intracranial-hypertension/

  Optic Nerve Sheath Fenestration is an eye surgery that uses small incisions in the protective layer surrounding the optic nerve to reduce pressure and allow better draining of CSF. […] After treatment, many patients experience relief from IIH symptoms as well as a reduced risk of vision loss. […] Even following treatment, IIH recurrences can occur, so its critical to monitor your vision for any changes through regular checkups with your ophthalmologist and IIH specialist. […] With dedication to providing outstanding results, Dr. Taqi and his team are your choice as the best idiopathic intracranial hypertension treatment specialists in Thousand Oaks, CA.

• #109 Idiopathic Intracranial Hypertension: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21968-idiopathic-intracranial-hypertension

  Timely treatment at the first sign of vision changes or symptoms can help reduce your risk of complications like permanent vision loss. […] Treatment is often successful at relieving symptoms. […] There isnt a cure for IIH, so you may have to manage this condition for the rest of your life. […] It’s important to follow your treatment plan, especially if your provider recommends making changes to the foods you eat or your activity level to help reduce your risk.

• #110 Neurology idiopathic intracranial hypertension clinic | Dayton Children’s Hospital

  https://www.childrensdayton.org/patients-visitors/services/neurology/services-and-programs/idiopathic-intracranial-hypertension

  Dayton Childrens neurology department offers a specialty clinic for care for idiopathic intracranial hypertension syndrome (IIH) that brings together a team of experts in one convenient appointment. […] This multidisciplinary approach is beneficial for clear communication and holistic care, leading to the best clinical outcomes for the child. […] During this visit, the child will be evaluated by each specialist within the clinic. Discussions will include appropriate testing and management of the condition and staff will answer any questions you may have. […] Since the majority of IIH patients have an unhealthy weight, weight loss is recommended. Healthy eating and exercise are a critical part of treatment for these patients. Losing weight can reduce CSF intracranial pressure, optic nerve swelling and headaches, and can help lead to remission. Studies have shown that patients have reported improvement in their symptoms after losing as low as 5-10 percent of their total body weight.

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