From the Guidelines
Management of pseudotumor cerebri, also known as idiopathic intracranial hypertension (IIH), should focus on weight management and headache control, as the risk of vision loss is not a primary concern in patients with IIHWOP, according to the most recent guidelines 1. When managing IIHWOP, it is essential to consider the following key points:
- Weight management is crucial, as all patients should be counselled about it, similar to typical IIH cases 1.
- Headache management should follow the same approach as for typical IIH, emphasizing the importance of controlling the principal morbidity in these patients 1.
- Surgical management to control elevated intracranial pressures should not be routinely considered unless advised by experienced clinicians within a multidisciplinary team setting, highlighting the need for a cautious and individualized approach 1. Some important considerations in the management of pseudotumor cerebri include:
- The role of weight loss in improving symptoms, even with modest reductions, which is a key aspect of management 1.
- The importance of regular monitoring, including ophthalmologic evaluations, to track disease progression and treatment response, although the primary focus is on headache control in IIHWOP cases.
- The need to avoid medications that may exacerbate the condition, such as certain hormonal contraceptives, tetracyclines, and vitamin A derivatives, to minimize potential risks and optimize treatment outcomes.
From the FDA Drug Label
For adjunctive treatment of: edema due to congestive heart failure; drug-induced edema; centrencephalic epilepsies (petit mal, unlocalized seizures); chronic simple (open-angle) glaucoma, secondary glaucoma, and preoperatively in acute angle-closure glaucoma where delay of surgery is desired in order to lower intraocular pressure. The FDA drug label does not answer the question.
From the Research
Management for Pseudotumor
The management of pseudotumor, also known as idiopathic intracranial hypertension (IIH), involves a combination of medical and surgical treatments. The goals of treatment are to alleviate symptoms, including headache, and preserve vision.
Medical Treatment
- Weight management: 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, 3, 4.
- Acetazolamide: Medical treatment with acetazolamide should be initiated when there is mild visual loss 2, 3, 5.
- Other medical treatments: Other medical treatments can be added or substituted when acetazolamide is insufficient as monotherapy or poorly tolerated 2, 3.
Surgical Treatment
- Optic nerve sheath fenestration: This procedure is effective and safe, and may be repeated if initially unsuccessful 3, 6.
- Lumboperitoneal shunting: This procedure is also an option, especially if symptoms of headache are prominent and refractory to medical therapy, but it has significant complication and failure rates 3, 6.
- Venous sinus stenting: This procedure has been performed on selected patients with pseudotumor, especially those with venous sinus occlusive disease, but its role remains unclear 2, 6.
- Cerebrospinal fluid shunting: This procedure may be required to prevent further irreversible visual loss when visual loss is more severe or rapidly progressive 2.