Management strategies for idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is a debilitating medical condition with an unknown cause. Its a diagnosis of exclusion and alternative etiologies of raised increased intracranial pressure should be investigated. Unfortunately, to date, there have been no clinical trials to guide treatment of IIH. Current treatment consists of medical and surgical therapy. Medical therapy with weight loss and diuretics, for example, acetazolamide, is typically the mainstay of treatment for IIH. Patients who fail medical therapy due to intolerance, non-compliance, or patients with fulminant IIH may require further surgical treatment. The decision of which surgical procedure is optimal depends on the patient's predominant symptoms (refractory headache vs risk of vision loss), the availability of local oculoplastic/neurosurgical expertise (optic nerve sheath fenestration or shunting) and patient preference. In this review the authors provide an overview of the different treatment options and outline the latest advances and strategies in the treatment of IIH.