Idiopathic intracranial hypertension

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c2836 (Published 07 July 2010) Cite this as: BMJ 2010;341:c2836
  1. Kathleen B Digre, professor of ophthalmology and neurology
  1. 1Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT 84132, USA
  1. kathleen.digre{at}hsc.utah.edu

    Weight loss may be effective, but confirmation is needed from randomised trials

    In the linked prospective cohort study (doi:10.1136/bmj.c2701), Sinclair and colleagues observed intracranial pressure in patients with idiopathic intracranial hypertension who follow a low energy diet.1 This condition is often chronic and is characterised by symptoms and signs of intracranial hypertension, with no cause found by adequate imaging studies, and normal cerebrospinal fluid.2 Visual loss from papilloedema is the most feared visual complication.2 Headaches (which are difficult to treat) and depression are common, and quality of life is often reduced.3 4

    Medical treatment of idiopathic intracranial hypertension consists of acetazolamide and other diuretics, which are thought to reduce the formation of cerebrospinal fluid.5 Because most affected people are obese, weight loss has been suggested. When visual loss occurs, surgical cerebrospinal fluid drainage procedures such as lumbar or ventriculo-peritoneal shunting or optic nerve sheath fenestration are performed. A recent systematic review found no randomised or controlled trials of treatment of the condition and called for such evidence.6

    The risk of this condition …

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