Update on the pathophysiology and management of idiopathic intracranial hypertension

Abstract

Idiopathic intracranial hypertension is a disease of unknown aetiology, typically affecting young obese women, producing a syndrome of increased intracranial pressure without identifiable cause. Despite a large number of hypotheses and publications over the past decade, the aetiology is still unknown. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue and cerebral venous abnormalities are areas of active study regarding the pathophysiology of idiopathic intracranial hypertension. There continues to be no evidence based consensus or formal guidelines regarding management and treatment of the disease. Treatment studies show that the diagnostic lumbar puncture is a valuable intervention beyond its diagnostic importance, and that weight management is critical. However, many questions remain regarding the efficacy of acetazolamide, CSF shunting procedures and cerebral transverse venous sinus stenting.

Figure 1

Mechanism by which transverse sinus stenosis leads to increase intracranial pressure.

Figure 2

Magnetic resonance imaging findings in idiopathic intracranial hypertension.

Figure 3

Resolution of bilateral transverse sinus stenosis after lumboperitoneal shunt in a young obese woman with idiopathic intracranial hypertension.