Idiopathic intracranial hypertension

A thorough assessment of vision with special attention to formal visual field testing is the cornerstone to decision making in idiopathic intracranial hypertension. After the diagnosis of idiopathic intracranial hypertension has been established, vision should be thoroughly assessed. If there is no visual loss, the patient can be followed carefully. In patients with symptoms and only a few signs (eg, mild blind-spot enlargement), acetazolamide, 1 to 2 g, or another diuretic should be initiated. In patients with progressive visual loss in whom maximal diuretic therapy fails and in those who on initial evaluation have significant recent visual loss that does not respond to maximal diuretic therapy, optic nerve sheath decompression or lumbar peritoneal shunting should be carried out. With all treatments, weight loss should be encouraged. All patients should be evaluated regularly with visual field testing.