New horizons for idiopathic intracranial hypertension: advances and challenges

Abstract

Introduction: Idiopathic intracranial hypertension (IIH) is becoming a recognized condition due to the increasing incidence linked to a global obesity epidemic.

Sources of data: All English papers on PubMed, Cochrane and Scholar between inception until 1 March 2020 were considered.

Areas of agreement: Studies suggest central adiposity has a pathogenic role. Recent weight gain is a risk factor and weight loss has a key role in management.

Areas of controversy: Interpretation of abnormal lumbar puncture opening pressure is debated. There is an increasing recognition of obesity stigma and how this should be approached.

Growing points: Further evidence is required for the choice of surgical intervention for fulminant IIH. Education regarding IIH should be evidence based.

Areas timely for developing research: Novel research of the pathology of IIH is influencing development of therapies such as glucagon-like peptide-1 receptor agonists and targeting unique androgen signatures. The newly discovered cardiovascular risk requires further attention.

Keywords: GLP-1; androgens; headache; idiopathic intracranial hypertension; obesity; papilloedema; pseudotumour cerebri; raised intracranial pressure.