Materiały źródłowe

• #1 Update on the pathophysiology and management of idiopathic intracranial hypertension

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3544160/

  Idiopathic Intracranial Hypertension (IIH) is a disease of unknown etiology typically affecting young, obese women, producing a syndrome of increased intracranial pressure without identifiable cause. Despite a large number of hypotheses and publications over the past decade, the etiology is still unknown. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding IIHs pathophysiology. […] The pathophysiologic mechanisms underlying the raised ICP in IIH remain unclear, but those proposed classically include increased brain water content, excess cerebrospinal fluid (CSF) production, reduced CSF absorption, and increased cerebral venous pressure. […] One long-standing hypothesis for the pathogenesis of IIH involves abnormal vitamin A metabolism.

• #2 Intracranial Hypertension – StatPearls – NCBI Bookshelf

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

  Intracranial hypertension is a state of pressure elevation within the skull that may cause various neurological disorders. Understanding the mechanisms underlying intracranial pressure alterations is crucial to diagnosis. A deep grasp of evidence-based interventions can help health providers determine the appropriate management strategy for a patient with intracranial hypertension. […] Intracranial hypertension is a condition characterized by elevated pressure within the skull. The increase in pressure can exert significant stress on the brain and other intracranial structures, potentially leading to a range of neurological symptoms and complications. […] Diagnosing intracranial hypertension typically involves a combination of clinical evaluation, results of neuroimaging studies like computed tomography (CT) and magnetic resonance imaging (MRI), and intracranial pressure (ICP) measurement via invasive or noninvasive techniques. Early recognition and prompt management of this condition are essential to prevent potential complications, including permanent neurological damage and even death.

• #3 Idiopathic intracranial hypertension (pseudotumor cerebri): Epidemiology and pathogenesis – UpToDate

  https://www.uptodate.com/contents/idiopathic-intracranial-hypertension-pseudotumor-cerebri-epidemiology-and-pathogenesis

  Idiopathic intracranial hypertension (IIH), also called pseudotumor cerebri, is a disorder defined by clinical criteria that include symptoms and signs isolated to those produced by increased intracranial pressure (ICP; eg, headache, papilledema, vision loss), elevated ICP with normal cerebrospinal fluid (CSF) composition, and no other cause of intracranial hypertension evident on neuroimaging or other evaluations. […] While the pathogenesis of IIH is unknown, risk factors have been identified and many theories advanced as to its cause. […] The epidemiology and pathogenesis of IIH will be reviewed here.

• #4 Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring | Fluids and Barriers of the CNS | Full Text

  https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-020-00201-8

  Measurement of intracranial pressure (ICP) is crucial in the management of many neurological conditions. […] The direct result of elevated ICP is reduced cerebral perfusion pressure (CPP), which can result in cerebral ischemia or herniation, potentially leading to disability and increased rates of mortality. […] Identifying and treating elevated ICP is imperative in the proper treatment of patients in neurocritical care settings and is essential to improving long term outcomes. […] Raised ICP is associated with increased mortality and poor neurologic outcomes, whereas ICP monitoring of patients has been shown to improve outcome in patients with closed head injuries. […] Allowing ICP to persist far outside of these ranges can have dire consequences. […] To understand the delicate balance involved in maintaining ICP, consider that the intracranial space contains three major components: cerebrospinal fluid (CSF), the blood supply consisting of the network of arteries and veins that supply blood to the brain and parenchymal tissue.

• #5 Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring | Fluids and Barriers of the CNS | Full Text

  https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-020-00201-8

  This relationship between the volume of the individual intracranial components and the ICP is known as the Monro-Kellie hypothesis. […] If the volume of either of these two components increases, through, e.g., intracranial hemorrhage or an inability to effectively absorb or drain CSF, without a compensatory decrease in another component, then the resulting net volume expansion will lead to increased ICP and eventually intracranial hypertension (ICH). […] A cascade of mechanisms normally operates in order to try to maintain CBF in cases of increased ICP; however, these mechanisms can in some cases result in a runaway feedback loop that results in intracranial hypertension and eventual cerebral ischemia. […] Altered ICP can result from a number of different conditions and is dependent on a number of physiological factors including autoregulation, vessel compliance, and mean arterial pressure (MAP). […] The complex dependence between these different components can complicate noninvasive ICP estimation methods that rely on assumptions about the relationships between these underlying factors.

• #6 Intracranial Hypertension – StatPearls – NCBI Bookshelf

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

  Intracranial volume is more or less constant once the sutures completely ossify. Intracranial tissue or fluid volume elevation can raise intracranial pressure, which can occur in the presence of intracranial masses, ventricular stenosis, and hematomas. A large part of treating intracranial hypertension involves mitigating the risk of increased ICP and making timely clinical decisions to prevent adverse consequences. […] Cerebral blood flow (CBF) is the primary intracranial blood volume regulator. Diseases obstructing venous outflow, such as venous sinus thrombosis, jugular vein compression, and neck surgery-associated structural changes, may cause intracranial blood congestion and intracranial hypertension. […] The total volume within the intracranial and spinal canals remains constant with only minute fluctuations. A volumetric increase can elevate ICP. Normal ICP in adults ranges from 10 to 20 cm H20. ICP elevation increases the risk of neural injury from direct compression or CBF reduction.

• #7 Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring | Fluids and Barriers of the CNS | Full Text

  https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-020-00201-8

  This relationship between the volume of the individual intracranial components and the ICP is known as the Monro-Kellie hypothesis. […] If the volume of either of these two components increases, through, e.g., intracranial hemorrhage or an inability to effectively absorb or drain CSF, without a compensatory decrease in another component, then the resulting net volume expansion will lead to increased ICP and eventually intracranial hypertension (ICH). […] A cascade of mechanisms normally operates in order to try to maintain CBF in cases of increased ICP; however, these mechanisms can in some cases result in a runaway feedback loop that results in intracranial hypertension and eventual cerebral ischemia. […] Altered ICP can result from a number of different conditions and is dependent on a number of physiological factors including autoregulation, vessel compliance, and mean arterial pressure (MAP). […] The complex dependence between these different components can complicate noninvasive ICP estimation methods that rely on assumptions about the relationships between these underlying factors.

• #8 Intracranial Hypertension – StatPearls – NCBI Bookshelf

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

  Intracranial volume is more or less constant once the sutures completely ossify. Intracranial tissue or fluid volume elevation can raise intracranial pressure, which can occur in the presence of intracranial masses, ventricular stenosis, and hematomas. A large part of treating intracranial hypertension involves mitigating the risk of increased ICP and making timely clinical decisions to prevent adverse consequences. […] Cerebral blood flow (CBF) is the primary intracranial blood volume regulator. Diseases obstructing venous outflow, such as venous sinus thrombosis, jugular vein compression, and neck surgery-associated structural changes, may cause intracranial blood congestion and intracranial hypertension. […] The total volume within the intracranial and spinal canals remains constant with only minute fluctuations. A volumetric increase can elevate ICP. Normal ICP in adults ranges from 10 to 20 cm H20. ICP elevation increases the risk of neural injury from direct compression or CBF reduction.

• #9 Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring | Fluids and Barriers of the CNS | Full Text

  https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-020-00201-8

  Measurement of intracranial pressure (ICP) is crucial in the management of many neurological conditions. […] The direct result of elevated ICP is reduced cerebral perfusion pressure (CPP), which can result in cerebral ischemia or herniation, potentially leading to disability and increased rates of mortality. […] Identifying and treating elevated ICP is imperative in the proper treatment of patients in neurocritical care settings and is essential to improving long term outcomes. […] Raised ICP is associated with increased mortality and poor neurologic outcomes, whereas ICP monitoring of patients has been shown to improve outcome in patients with closed head injuries. […] Allowing ICP to persist far outside of these ranges can have dire consequences. […] To understand the delicate balance involved in maintaining ICP, consider that the intracranial space contains three major components: cerebrospinal fluid (CSF), the blood supply consisting of the network of arteries and veins that supply blood to the brain and parenchymal tissue.

• #10 Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/87/9/982

  Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure (ICP) of unknown cause, when all other causes of raised ICP have been excluded. […] The pathophysiology of IIH is incompletely characterised; suggested underpinning mechanisms include the role of cerebrospinal fluid regulation as well as metabolic and endocrinological perspectives. […] The underlying pathogenesis of IIH is uncertain. Raised ICP is a uniform characteristic, but the mechanism by which ICP is elevated in IIH is not clear. […] Changes in the volume of blood, CSF and brain tissue influence ICP. IIH likely represents a disorder of CSF regulation, potentially through CSF hypersecretion or reduced drainage. […] Dysregulation of fluid transport in IIH may be important. […] A reduction in CSF absorption by the arachnoid granulations may be attributed to either an increase in CSF outflow resistance, or a reduction in the pressure gradient between the subarachnoid space and the superior sagittal sinus.

• #11 Idiopathic Intracranial Hypertension

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

  Multiple mechanisms have been postulated for IIH; however, the exact pathophysiology is unknown. Hypersecretion of CSF, outflow obstruction, and increased venous sinus pressures are 3 main mechanisms speculated to contribute to IIH. […] Hypersecretion of CSF in IIH may be linked to variations in aquaporin-1, which facilitates CSF secretion from the choroid plexus. Other studies have identified a breakdown of the blood-brain barrier in people with IIH and suggest a role for aquaporin-4. […] As etiologies of increased ICP, CSF outflow obstruction and venous sinus pressure may actually be one and the same. Smooth bilateral venous sinus stenosis is commonly observed in IIH. Disruption in the venous-CSF gradient caused by increased venous sinus pressure may reduce CSF outflow. […] Typically, IIH affects obese women of reproductive age. The relationship between obesity and elevated ICP may relate to increased intrathoracic pressure as a consequence of increased abdominal mass.

• #12 Idiopathic intracranial hypertension – Wikipedia

  https://en.wikipedia.org/wiki/Idiopathic_intracranial_hypertension

  Idiopathic intracranial hypertension (IIH), previously known as pseudotumor cerebri and benign intracranial hypertension, is a condition characterized by increased intracranial pressure (pressure around the brain) without a detectable cause. […] The cause of IIH is not known. The Monro-Kellie rule states that the intracranial pressure is determined by the amount of brain tissue, cerebrospinal fluid (CSF) and blood inside the bony cranial vault. Three theories therefore exist as to why the pressure might be raised in IIH: an excess of CSF production, increased volume of blood or brain tissue, or obstruction of the veins that drain blood from the brain. […] The first theory, that of increased production of cerebrospinal fluid, was proposed in early descriptions of the disease. However, there is no experimental data that supports a role for this process in IIH.

• #13 Idiopathic Intracranial Hypertension

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

  Multiple mechanisms have been postulated for IIH; however, the exact pathophysiology is unknown. Hypersecretion of CSF, outflow obstruction, and increased venous sinus pressures are 3 main mechanisms speculated to contribute to IIH. […] Hypersecretion of CSF in IIH may be linked to variations in aquaporin-1, which facilitates CSF secretion from the choroid plexus. Other studies have identified a breakdown of the blood-brain barrier in people with IIH and suggest a role for aquaporin-4. […] As etiologies of increased ICP, CSF outflow obstruction and venous sinus pressure may actually be one and the same. Smooth bilateral venous sinus stenosis is commonly observed in IIH. Disruption in the venous-CSF gradient caused by increased venous sinus pressure may reduce CSF outflow. […] Typically, IIH affects obese women of reproductive age. The relationship between obesity and elevated ICP may relate to increased intrathoracic pressure as a consequence of increased abdominal mass.

• #14 Idiopathic Intracranial Hypertension

  https://practicalneurology.com/diseases-diagnoses/headache-pain/idiopathic-intracranial-hypertension/31655/

  Multiple mechanisms have been postulated for IIH; however, the exact pathophysiology is unknown. Hypersecretion of CSF, outflow obstruction, and increased venous sinus pressures are 3 main mechanisms speculated to contribute to IIH. […] Hypersecretion of CSF in IIH may be linked to variations in aquaporin-1, which facilitates CSF secretion from the choroid plexus. Other studies have identified a breakdown of the blood-brain barrier in people with IIH and suggest a role for aquaporin-4. […] As etiologies of increased ICP, CSF outflow obstruction and venous sinus pressure may actually be one and the same. Smooth bilateral venous sinus stenosis is commonly observed in IIH. Disruption in the venous-CSF gradient caused by increased venous sinus pressure may reduce CSF outflow. […] Typically, IIH affects obese women of reproductive age. The relationship between obesity and elevated ICP may relate to increased intrathoracic pressure as a consequence of increased abdominal mass.

• #15 Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/87/9/982

  Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure (ICP) of unknown cause, when all other causes of raised ICP have been excluded. […] The pathophysiology of IIH is incompletely characterised; suggested underpinning mechanisms include the role of cerebrospinal fluid regulation as well as metabolic and endocrinological perspectives. […] The underlying pathogenesis of IIH is uncertain. Raised ICP is a uniform characteristic, but the mechanism by which ICP is elevated in IIH is not clear. […] Changes in the volume of blood, CSF and brain tissue influence ICP. IIH likely represents a disorder of CSF regulation, potentially through CSF hypersecretion or reduced drainage. […] Dysregulation of fluid transport in IIH may be important. […] A reduction in CSF absorption by the arachnoid granulations may be attributed to either an increase in CSF outflow resistance, or a reduction in the pressure gradient between the subarachnoid space and the superior sagittal sinus.

• #16 Lifestyle Modifications for Idiopathic Intracranial Hypertension – EyeWiki

  https://eyewiki.org/Lifestyle_Modifications_for_Idiopathic_Intracranial_Hypertension

  The pathogenesis of IIH is ill-defined and may be multifactorial. Below are some theories and suggested mechanisms: […] Increased Cerebrospinal fluid (CSF) Production: Original studies believed that CSF hypersecretion played a role in IIH. However, this was not supported by further studies. […] Decreased CSF Drainage across arachnoid granulations or lymphatics: Evidence exists that there may be delay clearance of CSF in patients with IIH. […] Increased Venous Sinus Pressure: Venous sinus stenoses are thought to be secondary to raised ICP. However, it is being increasingly recognized to nevertheless contribute to IIH. […] Proposed contributors: […] Obesity: A strong association exists between obesity and IIH. Initially, theories suggested that increased abdominal mass resulting in increased intrathoracic pressure led to increased venous pressures. Current studies focus on a possible obesity-related inflammatory component (i.e. release of „adipokines” by adipose tissue, or other inflammatory/thrombophilic factors) may impact CSF dynamics causing the disorder. […] Hormones: Current studies are seeking to understand the role of hormones in pathogenesis of IIH as the major demographic of patients affected are women of child-bearing age.

• #17 Idiopathic Intracranial Hypertension (IIH): Practice Essentials, Background, Pathophysiology

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

  Although not accepted as a method of primary surgical treatment for IIH, stenting of stenotic dural sinuses has been demonstrated to decrease ICP in patients with IIH. […] Another pathway of CSF drainage that is under study, the glymphatics, may prove to have an important role in the pathophysiology of IIH. Several studies show that the CSF glymphatic function is congested in IIH, resulting in elevated intracranial pressure. […] IIH commonly occurs in women who are overweight; however, the role obesity plays in this disorder is unclear. Although it has been proposed that obesity increases intra-abdominal pressure and thereby raises cardiac filling pressures, this is likely not the sole underlying link between obesity and IIH. […] However, obesity appears to have no association with IIH in the pediatric population. An autoimmune component may play a role in pediatric IIH, given the high rate of atopy observed in this pediatric IIH patient cohort.

• #18

  https://link.springer.com/article/10.1007/s11910-025-01420-y

  In IIH, as diagnostic criteria exclude causes of increased tissue or blood volume, it is presumed that raised ICP is driven by an excess CSF volume. […] CSF excess in IIH may be driven by either increased production of CSF, impaired clearance, or both. […] Many of the systemic metabolic changes seen in IIH have been linked to changes in CSF secretion. […] Increased CSF outflow resistance in IIH is likely to be multifactorial. […] The role of venous sinus stenosis (VSS) in IIH is of increasing interest. […] The description of the glymphatic system as an important mediator of brain water transport has led to hypotheses that dysfunction of this system may be important in the pathogenesis of IIH. […] Evidence suggests that the glia-neuro-vascular interface is disrupted in IIH, with reports of: changes in morphology and increased AQP4 expression at astrocytic endfeet; astrogliosis; increased frequency of pathological mitochondria in astrocytic endfeet; capillary damage and disruption of the BBB. […] Overall, there is evidence for a role of glucocorticoids and 11HSD1 dysregulation in IIH, but whether the direct action of glucocorticoids on CSF secretion is a key driver of raised ICP is uncertain.

• #19

  https://journals.lww.com/md-journal/fulltext/2023/01060/idiopathic_intracranial_hypertension_in_patients.9.aspx

  Since the pathophysiological mechanisms of IIH are still unknown, dysregulation of ICP is an important factor in IIH pathogenesis. Disorders of CSF dynamics disorders may involve CSF overproduction at the choroid plexus, CSF outflow disturbance at the AG, and increased venous sinus pressure gradients. […] The glymphatic system is a brain-wide network for fluid transport and metabolic waste clearance that connects the cerebrovascular system and the CSF circulation, consisting of periarterial influx (glymphatic influx) of the subarachnoid CSF into the brain interstitium and the efflux of ISF with accompanying large-caliber veins. […] The lymphatic outflow pathway has gained increasing attention in recent years. Lymphatic vessels have been noninvasively confirmed in human brains using magnetic resonance imaging.

• #20 Update on the pathophysiology and management of idiopathic intracranial hypertension

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3544160/

  These observations regarding vitamin A may be linked to another area of emerging interest in endocrinology and IIH, the nature of adipose tissue as an actively secreting endocrine tissue. […] Increased intracranial venous pressure related to stenosis of the distal portion of the transverse cerebral sinuses is another proposed mechanism of IIH that has received substantial recent interest. […] Another venous mechanism proposed in the development of increased ICP in IIH patients is the occurrence of microthrombosis from thrombophilia within the cerebral veins, resulting in impaired CSF absorption.

• #21 Intracranial Hypertension – StatPearls – NCBI Bookshelf

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

  Intracranial volume is more or less constant once the sutures completely ossify. Intracranial tissue or fluid volume elevation can raise intracranial pressure, which can occur in the presence of intracranial masses, ventricular stenosis, and hematomas. A large part of treating intracranial hypertension involves mitigating the risk of increased ICP and making timely clinical decisions to prevent adverse consequences. […] Cerebral blood flow (CBF) is the primary intracranial blood volume regulator. Diseases obstructing venous outflow, such as venous sinus thrombosis, jugular vein compression, and neck surgery-associated structural changes, may cause intracranial blood congestion and intracranial hypertension. […] The total volume within the intracranial and spinal canals remains constant with only minute fluctuations. A volumetric increase can elevate ICP. Normal ICP in adults ranges from 10 to 20 cm H20. ICP elevation increases the risk of neural injury from direct compression or CBF reduction.

• #22 Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/87/9/982

  Obesity is a consistent risk factor for the development of IIH. […] Despite the association between IIH and an obese phenotype, the pathological mechanisms tying the two together are unclear, and IIH is a rare disorder, while obesity is common. […] The degree of stenosis does not appear to uniformly correlate with ICP or visual loss. […] Improvements in brain venography imaging reveal that most patients with IIH have anatomical abnormalities of the cerebral venous sinus system.

• #23 Idiopathic Intracranial Hypertension (IIH): Practice Essentials, Background, Pathophysiology

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

  The pathophysiology of IIH is unclear. An initial theory thought that cerebral edema played a role in the pathogenesis of elevated ICP in these patients, but later reports described the edema to represent fixation artifact (ie, from tissue preparation) rather than in vivo edema. […] Although the precise mechanism is not understood, IIH is likely due to a dysregulation of CSF dynamics involving a blend of hypersecretion of CSF at the choroidal plexus, reduced reabsorption at the arachnoid granulations, and abnormal venous pressure gradients. […] In a series reported by Farb et al, 29 patients with IIH showed demonstrable narrowing of the transverse dural venous sinus on magnetic resonance (MR) venography, whereas none of the 59 control subjects had this finding. The authors suggested that the narrowing is a consequence of elevated ICP and that when the narrowing develops, it exacerbates the pressure elevation by increasing venous pressure in the superior sagittal sinus.

• #24 Idiopathic intracranial hypertension – Wikipedia

  https://en.wikipedia.org/wiki/Idiopathic_intracranial_hypertension

  The second theory posits that either increased blood flow to the brain or increase in the brain tissue itself may result in the raised pressure. Little evidence has accumulated to support the suggestion that increased blood flow plays a role, but recently Bateman et al. in phase contrast MRA studies have quantified cerebral blood flow (CBF) in vivo and suggests that CBF is abnormally elevated in many people with IIH. […] The third theory suggests that restricted venous drainage from the brain may be impaired resulting in congestion. Many people with IIH have narrowing of the transverse sinuses. It is not clear whether this narrowing is the pathogenesis of the disease or a secondary phenomenon. It has been proposed that a positive biofeedback loop may exist, where raised ICP (intracranial pressure) causes venous narrowing in the transverse sinuses, resulting in venous hypertension (raised venous pressure), decreased CSF resorption via arachnoid granulation and further rise in ICP.

• #25 Update on the pathophysiology and management of idiopathic intracranial hypertension

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3544160/

  These observations regarding vitamin A may be linked to another area of emerging interest in endocrinology and IIH, the nature of adipose tissue as an actively secreting endocrine tissue. […] Increased intracranial venous pressure related to stenosis of the distal portion of the transverse cerebral sinuses is another proposed mechanism of IIH that has received substantial recent interest. […] Another venous mechanism proposed in the development of increased ICP in IIH patients is the occurrence of microthrombosis from thrombophilia within the cerebral veins, resulting in impaired CSF absorption.

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

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

  Other studies have suggested a role for vitamin A in IIH pathogenesis based on elevated serum and CSF vitamin A, retinol, and retinol binding protein levels reported in IIH patients. […] It has also been proposed that there may be microthrombosis in the sagittal sinus, of insufficient size to be seen on neuroimaging studies, which is blocking CSF absorption in the arachnoid granulations.

• #27 Idiopathic Intracranial Hypertension

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

  Multiple mechanisms have been postulated for IIH; however, the exact pathophysiology is unknown. Hypersecretion of CSF, outflow obstruction, and increased venous sinus pressures are 3 main mechanisms speculated to contribute to IIH. […] Hypersecretion of CSF in IIH may be linked to variations in aquaporin-1, which facilitates CSF secretion from the choroid plexus. Other studies have identified a breakdown of the blood-brain barrier in people with IIH and suggest a role for aquaporin-4. […] As etiologies of increased ICP, CSF outflow obstruction and venous sinus pressure may actually be one and the same. Smooth bilateral venous sinus stenosis is commonly observed in IIH. Disruption in the venous-CSF gradient caused by increased venous sinus pressure may reduce CSF outflow. […] Typically, IIH affects obese women of reproductive age. The relationship between obesity and elevated ICP may relate to increased intrathoracic pressure as a consequence of increased abdominal mass.

• #28 Idiopathic intracranial hypertension – Wikipedia

  https://en.wikipedia.org/wiki/Idiopathic_intracranial_hypertension

  The second theory posits that either increased blood flow to the brain or increase in the brain tissue itself may result in the raised pressure. Little evidence has accumulated to support the suggestion that increased blood flow plays a role, but recently Bateman et al. in phase contrast MRA studies have quantified cerebral blood flow (CBF) in vivo and suggests that CBF is abnormally elevated in many people with IIH. […] The third theory suggests that restricted venous drainage from the brain may be impaired resulting in congestion. Many people with IIH have narrowing of the transverse sinuses. It is not clear whether this narrowing is the pathogenesis of the disease or a secondary phenomenon. It has been proposed that a positive biofeedback loop may exist, where raised ICP (intracranial pressure) causes venous narrowing in the transverse sinuses, resulting in venous hypertension (raised venous pressure), decreased CSF resorption via arachnoid granulation and further rise in ICP.

• #29 Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/87/9/982

  Obesity is a consistent risk factor for the development of IIH. […] Despite the association between IIH and an obese phenotype, the pathological mechanisms tying the two together are unclear, and IIH is a rare disorder, while obesity is common. […] The degree of stenosis does not appear to uniformly correlate with ICP or visual loss. […] Improvements in brain venography imaging reveal that most patients with IIH have anatomical abnormalities of the cerebral venous sinus system.

• #30 Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-023-00893-0

  The understanding of idiopathic intracranial hypertension (IIH) has evolved over the past few years. […] Recent advances have begun to redefine IIH as a probable metabolic disease involving a range of systemic manifestations. More than 95% of individuals affected by the disease are women of reproductive age with obesity. […] Contemporary insights identify associations with insulin resistance, type 2 diabetes and a twofold increased risk of cardiovascular disease in excess of that driven by obesity alone. […] Evidence now demonstrates adipose tissue dysfunction in people with IIH, involving transcriptional and metabolic priming for lipogenesis and weight gain. Hormonal perturbations are also observed, including a unique phenotype of androgen excess that promotes cerebrospinal fluid secretion.

• #31 Idiopathic intracranial hypertension: from concise history to current management | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00730-7

  Idiopathic intracranial hypertension (IIH), known as benign intracranial hypertension (BIH) since the report of Quincke in 1893, was described as a rare disorder of elevated intracranial hypertension with normal cerebrospinal fluid (CSF) and without any pathology. […] The pathophysiology remains unknown; however, some theories relate to its mechanism, including obesity and metabolic dysregulation. […] The underlying mechanism of IIH has been unknown; however, the significant risk factor identified is weight gain-induced signs and symptoms of IIH. […] Some proposed hypotheses of IIH include overproduction of CSF, outflow obstruction, increased central venous pressure, metabolism, and hormonal changes commonly found in obese patients. […] Central obesity may elevate intraabdominal, pleura, cardiac filling, and central venous pressure impairing CSF flows.

• #32 Idiopathic Intracranial Hypertension

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

  Multiple mechanisms have been postulated for IIH; however, the exact pathophysiology is unknown. Hypersecretion of CSF, outflow obstruction, and increased venous sinus pressures are 3 main mechanisms speculated to contribute to IIH. […] Hypersecretion of CSF in IIH may be linked to variations in aquaporin-1, which facilitates CSF secretion from the choroid plexus. Other studies have identified a breakdown of the blood-brain barrier in people with IIH and suggest a role for aquaporin-4. […] As etiologies of increased ICP, CSF outflow obstruction and venous sinus pressure may actually be one and the same. Smooth bilateral venous sinus stenosis is commonly observed in IIH. Disruption in the venous-CSF gradient caused by increased venous sinus pressure may reduce CSF outflow. […] Typically, IIH affects obese women of reproductive age. The relationship between obesity and elevated ICP may relate to increased intrathoracic pressure as a consequence of increased abdominal mass.

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

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

  Pseudotumor cerebri, also known as idiopathic intracranial hypertension (IIH), is a disorder characterized by increased intracranial pressure (ICP) of unknown cause that predominantly affects obese women of childbearing age. […] The pathophysiology remains unclear but multiple hypotheses have been suggested. […] Cerebral edema was one of the earliest proposed pathological mechanisms for IIH. However, it was quickly criticized because the elevated ICP was not associated with altered levels of alertness, cognitive impairments, or focal neurologic findings typically seen with cerebral edema. […] Another proposed mechanism involves stenosis of the distal portion of the transverse venous sinuses. This stenosis can result in cerebral venous hypertension and impaired CSF absorption. […] Some suggested that an increase in intraabdominal pressure, secondary to obesity, causes increased cardiac filling pressure which impedes venous return from the brain and subsequently leads to an elevated intracranial venous pressure and IIH.

• #34 Update on the pathophysiology and management of idiopathic intracranial hypertension

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3544160/

  These observations regarding vitamin A may be linked to another area of emerging interest in endocrinology and IIH, the nature of adipose tissue as an actively secreting endocrine tissue. […] Increased intracranial venous pressure related to stenosis of the distal portion of the transverse cerebral sinuses is another proposed mechanism of IIH that has received substantial recent interest. […] Another venous mechanism proposed in the development of increased ICP in IIH patients is the occurrence of microthrombosis from thrombophilia within the cerebral veins, resulting in impaired CSF absorption.

• #35 Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-023-00893-0

  The understanding of idiopathic intracranial hypertension (IIH) has evolved over the past few years. […] Recent advances have begun to redefine IIH as a probable metabolic disease involving a range of systemic manifestations. More than 95% of individuals affected by the disease are women of reproductive age with obesity. […] Contemporary insights identify associations with insulin resistance, type 2 diabetes and a twofold increased risk of cardiovascular disease in excess of that driven by obesity alone. […] Evidence now demonstrates adipose tissue dysfunction in people with IIH, involving transcriptional and metabolic priming for lipogenesis and weight gain. Hormonal perturbations are also observed, including a unique phenotype of androgen excess that promotes cerebrospinal fluid secretion.

• #36 Idiopathic intracranial hypertension: from concise history to current management | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-023-00730-7

  Insulin resistance and hyperleptinemia in centripetal obesity correlate with increased opening pressure in lumbar punction, nonetheless still unknown. […] Stenosis of the dural venous sinus or distal transverse cerebral sinus impairs the venous flow, induces venous hypertension, and increases intracranial hypertension. […] The mechanism remains unknown whether it arose as an incidental pathology, a secondary condition of elevated intracranial pressure related to arachnoid granulation. […] The pathophysiology of IIH remains unknown; however, some theories relate to its mechanism, including obesity and metabolic dysregulation.

• #37 Idiopathic intracranial hypertension, hormones, and 11B-hydroxys | JPR

  https://www.dovepress.com/idiopathic-intracranial-hypertension-hormones-and-11szlig-hydroxystero-peer-reviewed-fulltext-article-JPR

  Idiopathic intracranial hypertension (IIH) results in raised intracranial pressure (ICP) leading to papilledema, visual dysfunction, and headaches. […] The etiology of this debilitating condition remains undetermined. Dysregulation of CSF dynamics is key and may involve hypersecretion of CSF at the choroid plexus, reduced drainage at the arachnoid granulations and/or lymphatics, and aberrant venous pressure gradients. […] As the choroid plexus is very similar to the renal proximal tubules in terms of function and epithelial ultrastructure, a chronic elevation in leptin may drive Na+/K+ ATPase activity in epithelial choroid plexus cells resulting in increased CSF secretion and hence raised ICP. […] 11-HSD1 activity is highest in hepatic and adipose tissue but has also been identified in the brain, in particular the cerebellum, neocortex, hippocampus, choroid plexus, and arachnoid granulations.

• #38 Update on the pathophysiology and management of idiopathic intracranial hypertension

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3544160/

  Idiopathic Intracranial Hypertension (IIH) is a disease of unknown etiology typically affecting young, obese women, producing a syndrome of increased intracranial pressure without identifiable cause. Despite a large number of hypotheses and publications over the past decade, the etiology is still unknown. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding IIHs pathophysiology. […] The pathophysiologic mechanisms underlying the raised ICP in IIH remain unclear, but those proposed classically include increased brain water content, excess cerebrospinal fluid (CSF) production, reduced CSF absorption, and increased cerebral venous pressure. […] One long-standing hypothesis for the pathogenesis of IIH involves abnormal vitamin A metabolism.

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

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

  Other studies have suggested a role for vitamin A in IIH pathogenesis based on elevated serum and CSF vitamin A, retinol, and retinol binding protein levels reported in IIH patients. […] It has also been proposed that there may be microthrombosis in the sagittal sinus, of insufficient size to be seen on neuroimaging studies, which is blocking CSF absorption in the arachnoid granulations.

• #40

  https://omim.org/entry/243200

  Buchheit et al. (1969) described 2 sisters with idiopathic intracranial hypertension with papilledema (pseudotumor cerebri). […] Warner et al. (2002) quantified vitamin A in the cerebrospinal fluid of patients with idiopathic intracranial hypertension, elevated intracranial pressure of other causes, and normal intracranial pressure. There was a significantly higher level of vitamin A in the cerebrospinal fluid of some patients with idiopathic intracranial hypertension. The authors concluded that vitamin A toxicity might play a role in the pathogenesis of idiopathic intracranial hypertension. […] Katz et al. (2002) demonstrated the presence of both somatostatin receptor types 1 (182451) and 2 (182452) in all samples of normal human choroid plexus and arachnoid granulations. The authors proposed that these receptors might be involved in the processes of cerebrospinal fluid production and absorption and, thus, might play a role in the increased intracranial pressure of idiopathic intracranial hypertension.

• #41 Vitamin A and Idiopathic Intracranial Hypertension | Pediatric Neurology Briefs

  https://pediatricneurologybriefs.com/articles/10.15844/pedneurbriefs-16-11-5

  Vitamin A levels were measured in the cerebrospinal fluid of a total of 78 patients having idiopathic intracranial hypertension (IIH;n=20), elevated pressure of other causes (E-ICP;n=19), and normal pressure (N-ICP;n=39), in a study at the University of Utah, Salt Lake City, UT. […] Higher CSF vitamin A levels found in some patients with IIH were significantly correlated (p=0.036) when compared with control E-ICP and IIH patients. […] High vitamin A levels in patients with IIH and high average vitamin A levels in patients with breakdown of the blood-brain barrier are suggestive of a toxic effect of CSF retinol on the arachnoid granulation resorption mechanism in IIH. […] Vitamin A may have a specific transport mechanism into the CSF, and it becomes toxic when the level exceeds the RBP binding capacity. […] It is speculated that vitamin A increases CSF volume and pressure by an effect on aquaporins present in membranes of the choroid plexus that control CSF secretion.

• #42 Vitamin A and Idiopathic Intracranial Hypertension | Pediatric Neurology Briefs

  https://pediatricneurologybriefs.com/articles/10.15844/pedneurbriefs-16-11-5

  Vitamin A levels were measured in the cerebrospinal fluid of a total of 78 patients having idiopathic intracranial hypertension (IIH;n=20), elevated pressure of other causes (E-ICP;n=19), and normal pressure (N-ICP;n=39), in a study at the University of Utah, Salt Lake City, UT. […] Higher CSF vitamin A levels found in some patients with IIH were significantly correlated (p=0.036) when compared with control E-ICP and IIH patients. […] High vitamin A levels in patients with IIH and high average vitamin A levels in patients with breakdown of the blood-brain barrier are suggestive of a toxic effect of CSF retinol on the arachnoid granulation resorption mechanism in IIH. […] Vitamin A may have a specific transport mechanism into the CSF, and it becomes toxic when the level exceeds the RBP binding capacity. […] It is speculated that vitamin A increases CSF volume and pressure by an effect on aquaporins present in membranes of the choroid plexus that control CSF secretion.

• #43 Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-023-00893-0

  The understanding of idiopathic intracranial hypertension (IIH) has evolved over the past few years. […] Recent advances have begun to redefine IIH as a probable metabolic disease involving a range of systemic manifestations. More than 95% of individuals affected by the disease are women of reproductive age with obesity. […] Contemporary insights identify associations with insulin resistance, type 2 diabetes and a twofold increased risk of cardiovascular disease in excess of that driven by obesity alone. […] Evidence now demonstrates adipose tissue dysfunction in people with IIH, involving transcriptional and metabolic priming for lipogenesis and weight gain. Hormonal perturbations are also observed, including a unique phenotype of androgen excess that promotes cerebrospinal fluid secretion.

• #44

  https://insight.jci.org/articles/view/125348

  Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology, characterized by elevated intracranial pressure frequently manifesting with chronic headaches and visual loss. […] IIH is overwhelmingly a disease of obese women of reproductive age, and endocrine disturbances have been hypothesized to play a pathogenic role. […] IIH shares phenotypic characteristics with polycystic ovary syndrome (PCOS), in which androgen excess is a defining feature. […] We aimed to delineate the androgen phenotype of women with active IIH and to explore the potential role of androgens in disease pathogenesis. […] We highlight a distinct profile of androgen excess in women with IIH and demonstrate an impact of androgens on surrogate markers of CSF secretion in a cell model, providing evidence for a pathogenetic link between androgen excess and increased ICP in IIH. […] We propose that potent androgens are activated in the choroid plexus and/or cross the blood-brain barrier after activation in other tissues where they affect CSF secretion and ICP.

• #45

  https://link.springer.com/article/10.1007/s11910-025-01420-y

  In IIH, as diagnostic criteria exclude causes of increased tissue or blood volume, it is presumed that raised ICP is driven by an excess CSF volume. […] CSF excess in IIH may be driven by either increased production of CSF, impaired clearance, or both. […] Many of the systemic metabolic changes seen in IIH have been linked to changes in CSF secretion. […] Increased CSF outflow resistance in IIH is likely to be multifactorial. […] The role of venous sinus stenosis (VSS) in IIH is of increasing interest. […] The description of the glymphatic system as an important mediator of brain water transport has led to hypotheses that dysfunction of this system may be important in the pathogenesis of IIH. […] Evidence suggests that the glia-neuro-vascular interface is disrupted in IIH, with reports of: changes in morphology and increased AQP4 expression at astrocytic endfeet; astrogliosis; increased frequency of pathological mitochondria in astrocytic endfeet; capillary damage and disruption of the BBB. […] Overall, there is evidence for a role of glucocorticoids and 11HSD1 dysregulation in IIH, but whether the direct action of glucocorticoids on CSF secretion is a key driver of raised ICP is uncertain.

• #46 Idiopathic Intracranial Hypertension (IIH): Practice Essentials, Background, Pathophysiology

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

  Although not accepted as a method of primary surgical treatment for IIH, stenting of stenotic dural sinuses has been demonstrated to decrease ICP in patients with IIH. […] Another pathway of CSF drainage that is under study, the glymphatics, may prove to have an important role in the pathophysiology of IIH. Several studies show that the CSF glymphatic function is congested in IIH, resulting in elevated intracranial pressure. […] IIH commonly occurs in women who are overweight; however, the role obesity plays in this disorder is unclear. Although it has been proposed that obesity increases intra-abdominal pressure and thereby raises cardiac filling pressures, this is likely not the sole underlying link between obesity and IIH. […] However, obesity appears to have no association with IIH in the pediatric population. An autoimmune component may play a role in pediatric IIH, given the high rate of atopy observed in this pediatric IIH patient cohort.

• #47 Idiopathic Intracranial Hypertension (IIH): Practice Essentials, Background, Pathophysiology

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

  Although a role for vitamin A in the pathogenesis of IIH was initially suspected, the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) demonstrated no difference in CSF vitamin A levels in patients with IIH versus obese controls over a 6-month period except in those treated with acetazolamide. […] Other medications that have been implicated for resulting in IIH include tetracycline, amiodarone, oral contraceptives such as levonorgestrel (Norplant), cyclosporine, cytarabine, growth hormone, isotretinoin, levothyroxine (children), lithium carbonate and acute change of steroid use.

• #48 Idiopathic Intracranial Hypertension Related to Chronic Use of Mesalamine: A Case Report and Literature Review | Mehta | Journal of Neurology Research

  https://www.neurores.org/index.php/neurores/article/view/537/496

  Idiopathic intracranial hypertension (IIH) is commonly seen related to iatrogenic causes such as excess retinol, tetracyclines, and amiodarone. […] IIH is likely a rare side effect of mesalamine use likely related to 5-aminosalycilate use. This class of medication typically causes headache so this is likely a more complex version. The mechanism of how this occurs is largely unknown. […] The exact mechanism of why 5-asa has a relationship with IIH is not clear. However, it is known that headache is the most common and quite a significant side effect of 5-asa and its derivatives. Discontinuation of the offending agent is met with a decrease in headache frequency. […] Despite the discontinuation of acetazolamide and lack of weight loss at follow-up, our patients symptoms did not recur, further supporting the notion that there is a relationship between IIH and 5-asa derivatives.

• #49

  https://link.springer.com/article/10.1007/s11910-025-01420-y

  Development of safe targeted therapies for idiopathic intracranial hypertension requires a thorough understanding of recent evidence discovering the pathophysiology of the condition. […] Idiopathic intracranial hypertension has a profile of systemic metabolic changes, endocrine dysfunction and cardiovascular risk profile distinct from that associated with obesity alone. […] These systemic metabolic changes are likely to contribute to dysregulation of cerebrospinal fluid dynamics, primarily hypersecretion but with a possible additional effect of reduced clearance resulting in the core feature of raised intracranial pressure. […] The mechanisms by which these changes lead to raised ICP, have been uncertain (hence the term idiopathic) but current research now provides valuable insights.

• #50 Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-023-00893-0

  Knowledge of these additional disease features is driving research into novel therapeutic targets and altering the approach to multidisciplinary care. […] A positive relationship between headache and intracranial pressure has been observed, and specific signalling pathways have been speculated to be mechanistic drivers of IIH headaches. […] New therapeutic avenues are emerging to target metabolic pathways. The glucagon-like peptide 1 receptor agonist exenatide has been demonstrated to significantly reduce intracranial pressure in a randomized placebo-controlled trial.

• #51 Preclinical update on regulation of intracranial pressure in relation to idiopathic intracranial hypertension | Fluids and Barriers of the CNS | Full Text

  https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-019-0155-4

  The most commonly used drugs for IIH have been evaluated in vivo for their efficacy at lowering ICP in the existing animal models. […] These studies suggest these drugs, including acetazolamide, might have limited or no reducing effect on ICP. […] Topiramate was tested at both clinical low and high doses, which lowered ICP levels by 32% and 21% respectively in healthy rats. […] It remains to elucidate the effect of this drug on ICP in animal models with raised ICP and evaluate its effect of daily dosing as performed in the clinical studies. […] The role of obesity on ICP regulation has been evaluated in vivo and lead to the first animal model mimicking some aspects of IIH. […] Preclinical research suggests a GLP-1R agonist as a novel drug target for elevated ICP which needs to be further evaluated. […] In conclusion, preclinical investigations including the development of adequate in vivo models are warranted in order to increase our understanding in IIH pathophysiology and to explore novel drug targets able to reduce ICP.

• #52 Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms | Nature Reviews Neurology

  https://www.nature.com/articles/s41582-023-00893-0

  Knowledge of these additional disease features is driving research into novel therapeutic targets and altering the approach to multidisciplinary care. […] A positive relationship between headache and intracranial pressure has been observed, and specific signalling pathways have been speculated to be mechanistic drivers of IIH headaches. […] New therapeutic avenues are emerging to target metabolic pathways. The glucagon-like peptide 1 receptor agonist exenatide has been demonstrated to significantly reduce intracranial pressure in a randomized placebo-controlled trial.

• #53 Idiopathic Intracranial Hypertension | IntechOpen

  https://www.intechopen.com/online-first/1208685

  Idiopathic Intracranial Hypertension (IIH) remains a challenging condition characterized by elevated intracranial pressure in the absence of identifiable causes like tumors or venous thrombosis. […] We delve into the complex interplay of factors contributing to IIHs pathogenesis, including cerebrospinal fluid dynamics, venous pressure abnormalities, and metabolic/hormonal influences. […] The pathophysiology of idiopathic intracranial hypertension (IIH) likely involves a complex interplay of multiple mechanisms. These include dysregulation of cerebrospinal fluid (CSF) dynamics, which may involve hypersecretion or reduced absorption, changes in venous sinus pressure that could exacerbate elevated intracranial pressure, and potential metabolic and hormonal factors that are increasingly recognized as contributing elements.

• #54 Understanding the pathophysiology of idiopathic intracranial hypertension (IIH): a review of recent developments | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/95/4/375.abstract

  Idiopathic intracranial hypertension (IIH) is a condition of significant morbidity and rising prevalence. […] Raised intracranial pressure without a secondary identified cause remains a key diagnostic feature of this condition, however, the underlying pathophysiological mechanisms that drive this increase are poorly understood. […] Given the emerging evidence, it is likely that IIH is triggered by the interaction of multiple aetiological factors that ultimately results in the disruption of CSF dynamics. This review aims to provide a comprehensive update on the current theories regarding the pathogenesis of IIH.

• #55

  https://link.springer.com/article/10.1007/s11910-025-01420-y

  Development of safe targeted therapies for idiopathic intracranial hypertension requires a thorough understanding of recent evidence discovering the pathophysiology of the condition. […] Idiopathic intracranial hypertension has a profile of systemic metabolic changes, endocrine dysfunction and cardiovascular risk profile distinct from that associated with obesity alone. […] These systemic metabolic changes are likely to contribute to dysregulation of cerebrospinal fluid dynamics, primarily hypersecretion but with a possible additional effect of reduced clearance resulting in the core feature of raised intracranial pressure. […] The mechanisms by which these changes lead to raised ICP, have been uncertain (hence the term idiopathic) but current research now provides valuable insights.

• #56

  https://link.springer.com/article/10.1007/s11910-025-01420-y

  Development of safe targeted therapies for idiopathic intracranial hypertension requires a thorough understanding of recent evidence discovering the pathophysiology of the condition. […] Idiopathic intracranial hypertension has a profile of systemic metabolic changes, endocrine dysfunction and cardiovascular risk profile distinct from that associated with obesity alone. […] These systemic metabolic changes are likely to contribute to dysregulation of cerebrospinal fluid dynamics, primarily hypersecretion but with a possible additional effect of reduced clearance resulting in the core feature of raised intracranial pressure. […] The mechanisms by which these changes lead to raised ICP, have been uncertain (hence the term idiopathic) but current research now provides valuable insights.

• #57 Preclinical update on regulation of intracranial pressure in relation to idiopathic intracranial hypertension | Fluids and Barriers of the CNS | Full Text

  https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-019-0155-4

  The most commonly used drugs for IIH have been evaluated in vivo for their efficacy at lowering ICP in the existing animal models. […] These studies suggest these drugs, including acetazolamide, might have limited or no reducing effect on ICP. […] Topiramate was tested at both clinical low and high doses, which lowered ICP levels by 32% and 21% respectively in healthy rats. […] It remains to elucidate the effect of this drug on ICP in animal models with raised ICP and evaluate its effect of daily dosing as performed in the clinical studies. […] The role of obesity on ICP regulation has been evaluated in vivo and lead to the first animal model mimicking some aspects of IIH. […] Preclinical research suggests a GLP-1R agonist as a novel drug target for elevated ICP which needs to be further evaluated. […] In conclusion, preclinical investigations including the development of adequate in vivo models are warranted in order to increase our understanding in IIH pathophysiology and to explore novel drug targets able to reduce ICP.

• #58

  https://journals.lww.com/co-neurology/fulltext/2019/02000/advances_in_the_understanding_of_headache_in.16.aspx

  Other investigators have supported theories that headache in IIH is attributed to more complex mechanisms than ICP elevation alone. […] There is an unmet need to treat headaches in IIH. Future studies should consider core outcome measures for headache, as used in migraine trials, which would optimise meta-analysis.

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