Idiopathic Intracranial Hypertension

1. IDIOPATHIC INTRACRANIAL HYPERTENSION (IIH)
ADE WIJAYA, MD – JUNE 2018

2. OUTLINE
 Introduction
 Epidemiology
 Pathogenesis
 Etiology (for secondary IIH)
 Clinical presentation
 Diagnostic criteria
 Management
 Algorhytm
 Prognosis
 Summary

3. INTRODUCTION
Elevated ICP
Obese young
women
Papilloedema
Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, et al. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol

4. EPIDEMIOLOGY
 12–20 per 100 000 people per year in young obese women
 0·5–2 per 100 000 people per year in the general population
Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. The Lancet Neurology. 2016 Jan 1;15(1):78-91.

5. PATHOGENESIS
Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. The Lancet Neurology. 2016 Jan 1;15(1):78-91.

6. ETIOLOGY (FOR SECONDARY IIH)
Beri S, Chandratre S, Chow G. Familial idiopathic intracranial hypertension with variable phenotype. Eur J Paediatr Neurol 2011; 15: 81–83.

7. CLINICAL PRESENTATION
Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. The Lancet Neurology. 2016 Jan 1;15(1):78-91.

8. DIAGNOSTIC CRITERIA
Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81: 1159–65.

9. Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. The Lancet Neurology. 2016 Jan 1;15(1):78-91.

10. MANAGEMENT
Disease
modification
Surgical
Drugs
Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. The Lancet Neurology. 2016 Jan 1;15(1):78-91.

11. ALGORHYTM
Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension:
mechanisms, management, and future directions. The Lancet Neurology. 2016 Jan 1;15(1):78-91.

12. PROGNOSIS
 Visual prognosis generally good, but permanent in some male patients, early-onset reduced visual
acuity, and black ethnic origin
 Headache predominant  long-term disability
 High-grade papilloedema  poor prognostic factor
 Early age of onset and high diagnostic ICP were associated with a good prognosis after 1 year. High ICP
might be associated with a shorter diagnostic latency and early treatment initiation
Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. The Lancet Neurology. 2016 Jan 1;15(1):78-91.

13. SUMMARY
 Elevated ICP, papilloedema, obese young women
 Headache and visual lose
 Management: weight loss, acetazolamide, surgery
 Bariatric surgery?