Reversal of benign intracranial hypertension by surgically induced weight loss

Abstract

Weight loss is recommended in the treatment of benign intracranial hypertension (BIH) but is difficult to achieve because of the administration of steroids. A 24-year-old morbidly obese woman with BIH presented with headache, a cerebrospinal fluid pressure of 300 mm H2O, enlargement of the blind spot in the right eye, and bilateral papilledema. Treatment with steroids for one year produced an increase in weight with worsening symptoms and visual findings. Gastric exclusion surgery produced a 37-kg weight loss in six months that was associated with cessation of symptoms, reduction in cerebrospinal fluid pressure to 170 mm H2O, marked improvement in visual fields, and resolution of papilledema. This raises the possibility that gastric exclusion surgery may be an effective means to achieve weight loss and ultimately a remission in obese patients with BIH.