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idiopathic_intracranial_hypertension_treatment

Idiopathic intracranial hypertension treatment

Idiopathic intracranial hypertension (IIH) is still a grey area in the knowledge of the aetiology, diagnosis and management of neurosurgical diseases.

Until now there is no Level of Evidence 1 guideline to which our decision-making can be based on for the management of IIH. A lack of systematic reviews and randomized controlled trials has been noted 1).

Treatment typically consists of weight loss (including bariatric surgery in morbidly obese patients if needed) 2).

Medical treatment

Is often ineffective.

A trial of bumetanide (0.25 mg daily) monotherapy was successful in resolution of a patient's symptoms. These results suggest bumetanide could be effective in the treatment of idiopathic intracranial hypertension, perhaps by restoring the balance between cerebrospinal fluid formation and absorption and/or by altering the volume or ionic composition of the brain's extracellular fluid compartment 3).

Acetazolamide

Acetazolamide and weight loss effectively improve Retinal nerve fiber layer (RNFL) thickness, total retinal thickness (TRT), and optic nerve (ONH) volume swelling measurements resulting from papilledema. In contrast to the strong correlation at baseline, optical coherence tomography (OCT) measures at 6 months show only moderate correlations with papilledema grade 4).

Idiopathic intracranial hypertension surgical treatment

1)
Portelli M, Papageorgiou PN. An update on idiopathic intracranial hypertension. Acta Neurochir (Wien). 2016 Dec 24. doi: 10.1007/s00701-016-3050-7. [Epub ahead of print] PubMed PMID: 28013373.
2)
Fridley J, Foroozan R, Sherman V, Brandt ML, Yoshor D. Bariatric surgery for the treatment of idiopathic intracranial hypertension. J Neurosurg. 2011 Jan;114(1):34-9. doi: 10.3171/2009.12.JNS09953. Review. PubMed PMID: 20095788.
3)
Kahle KT, Walcott BP, Staley KJ. Resolution of headache and papilledema in idiopathic intracranial hypertension associated with inhibition of Na+-K+-2Cl- cotransport. J Child Neurol. 2011 Feb;26(2):205-8. doi: 10.1177/0883073810391264. PubMed PMID: 21285039.
4)
The Optical Coherence Tomography Substudy Committee And The Nordic Idiopathic Intracranial Hypertension Study Group. Papilledema Outcomes from the Optical Coherence Tomography Substudy of the Idiopathic Intracranial Hypertension Treatment Trial. Ophthalmology. 2015 Jul 18. pii: S0161-6420(15)00549-7. doi: 10.1016/j.ophtha.2015.06.003. [Epub ahead of print] PubMed PMID: 26198807.
idiopathic_intracranial_hypertension_treatment.txt · Last modified: 2017/11/10 12:36 by administrador