British Medical Bulletin Advance Access originally published online on January 22, 2007
British Medical Bulletin 2006 79-80(1):233-244; doi:10.1093/bmb/ldl019
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Idiopathic intracranial hypertension and visual function
Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery London, and Neuro-Ophthalmology and Strabismus Service, Moorfields Eye Hospital, London, UK
* Correspondence to: James F. Acheson, Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. E-mail: james.acheson{at}uclh.nhs.uk
Background: Idiopathic intracranial hypertension is a relatively common condition (incidence up to 19/100 000/year in the high-risk group of obese women in reproductive age range) causing headaches with papilloedema. Detailed investigations are required to exclude other causes of raised intracrainal pressure. The condition may be self-limiting or enter a chronic phase with significant morbidity because of headache and visual loss.
Methods and results: This includes an overview of literature and internal audit date.
Discussion and conclusions: Management of hypertension is initially medical, utilizing a combination of managed weight reduction and diuretic therapy. Cerebrospinal fluid (CSF) diversion surgery may be required to stabilize vision. Options include neurosurgical shunting by lumbar-peritoneal of ventriculo-peritoneal routes or by optic nerve sheath fenestration or both. High category evidence from randomized trials to guide management decisions is lacking. This article sets out to guide current best practice.
Keywords: idiopathic intracranial hypertension • papilloedema • visual loss
Accepted for publication December 13, 2006.