Key Points
- Confirm with elevated opening pressure and normal CSF chemistry.
- Weight loss plus acetazolamide are first‑line therapies.
- Protect vision with close ophthalmic follow‑up; escalate when threatened.
Algorithm
- Primary survey and stabilization; focused history and exam.
- Order high‑yield tests first; escalate imaging as indicated.
- Initiate disease‑specific therapy and supportive care.
- Reassess clinical response; arrange consultation and disposition.
Clinical Synopsis & Reasoning
Obese woman of childbearing age with daily headache and papilledema—consider idiopathic intracranial hypertension (IIH). Lumbar puncture opening pressure ≥25 cm H2O with normal CSF composition confirms diagnosis after MRI/MRV exclude secondary causes. Vision protection and headache morbidity drive therapy.
Treatment Strategy & Disposition
Weight loss is disease‑modifying; start acetazolamide and escalate to topiramate if needed. Ophthalmology monitors visual fields. Urgent CSF diversion or venous sinus stenting for fulminant vision loss/non‑response.
Epidemiology / Risk Factors
- Epidemiology varies by setting; see citations for details.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| MRI/MRV brain | Exclude secondary causes/venous thrombosis | Empty sella, transverse sinus stenosis | — |
| LP with opening pressure | Confirm IIH | ≥25 cm H2O | Normal CSF studies |
| Automated perimetry/OCT | Quantify visual function/edema | Field defects, RNFL swelling | Trend over time |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Acetazolamide | Carbonic anhydrase inhibitor | Hours | First‑line to reduce CSF | Paresthesias, kidney stones |
| Topiramate | Carbonic anhydrase activity | Days | Adjunct/weight loss benefit | Cognitive effects, teratogenicity |
Prognosis / Complications
- Prognosis depends on timeliness of diagnosis, comorbid disease, and response to therapy.
Patient Education / Counseling
- Explain expected course, warning signs requiring urgent care, and follow‑up testing.
- Review medication use, interactions, and monitoring parameters.