From the Guidelines
The treatment for Pseudo tumor cerebri (Idiopathic Intracranial Hypertension) should focus on weight management and headache control, as vision loss is not a common morbidity in these patients. According to the most recent guidelines, once a diagnosis of IIHWOP (Idiopathic Intracranial Hypertension Without Papilledema) is made, patients should be managed similarly to those with typical IIH, with an emphasis on weight management and headache control 1.
Key Components of Treatment
- Weight management: All patients should be counselled about weight management, as this is a crucial aspect of treatment for IIH, including those without papilledema 1.
- Headache management: The management of headache should be the same as for typical IIH, focusing on reducing symptoms and improving quality of life 1.
- Surgical management: Surgical interventions, such as those to control elevated intracranial pressures, should not be routinely considered unless advised by experienced clinicians within a multidisciplinary team setting 1.
Additional Considerations
- Neurovascular stenting has been explored as a potential treatment option, but its role in IIH is not yet established, and it carries risks such as stent-adjacent stenosis, vessel perforation, and the need for long-term antithrombotic therapy 1.
- Regular monitoring and a multidisciplinary approach are essential for managing IIH effectively, focusing on reducing intracranial pressure, alleviating symptoms, and improving the patient's quality of life.
From the Research
Treatment Options for Pseudo Tumor Cerebri (Idiopathic Intracranial Hypertension)
The treatment approach for pseudo tumor cerebri, also known as idiopathic intracranial hypertension (IIH), depends on the severity and time course of symptoms and visual loss. The main goals of treatment are alleviation of symptoms, including headache, and preservation of vision 2, 3.
- Lifestyle Modifications: All overweight IIH patients should be encouraged to enter a weight-management program with a goal of 5-10 % weight loss, along with a low-salt diet 2.
- Medical Treatment:
- Acetazolamide is the primary medical treatment for IIH, especially when there is mild visual loss 2, 3.
- Other medical treatments can be added or substituted when acetazolamide is insufficient as monotherapy or poorly tolerated 2.
- Topiramate may be considered for refractory IIH cases before surgical treatments, as it has shown to be effective in controlling IIH in some cases 4.
- Surgical Interventions:
- Optic nerve sheath fenestration is effective and safe for patients with severe or rapidly progressive visual loss 2, 3.
- Cerebrospinal fluid (CSF) shunting may be required to prevent further irreversible visual loss, especially if symptoms of headache are prominent and refractory to medical therapy 2, 3.
- Transverse venous sinus stenting is an expanding area of treatment, but its role remains unclear 5.
- Special Considerations: