Treatment of idiopathic intracranial hypertension?

By | January 21, 2015

Which of the following is used to preserve vision in patients with idiopathic intracranial hypertension (IIH)?

A. Optic nerve sheath decompression (ONSD)

B. Intracranial venous sinus stent placement

C. Ventriculoperitoneal shunt placement

D. Lumboperitoneal shunt placement

E. All of the above

The answer is E. Optic nerve sheath decompression (ONSD), which is also called optic nerve sheath fenestration, as well as intracranial venous sinus stent placement, ventriculoperitoneal shunt placement, and lumboperitoneal shunt placement, are all surgical techniques used for the management of visual loss in IIH, which is unresponsive to usual medical treatment and weight loss. In one study of the techniques, visual outcomes from ONSD appeared to be superior to other surgical techniques for management of IIH. However, ONSD was the most commonly used technique in idiopathic intracranial hypertension with the most follow-up data in treated patients. Less information is available on visual outcomes after intracranial venous stent placement and cerebrospinal fluid (CSF) diversion procedures for IIH. (Feldon, Neurosurg Focus 2007)

Which of the following medications may be an alternative to acetazolamide for the treatment of IIH?

A. Carbamazepine (Tegretol)

B. Gabapentin (Neurontin)

C. Topiramate (Topamax)

D. Lamotrigine (Lamictal)

E. Divalproex sodium (Depakote)

The answer is C. Topiramate (Topamax) can be used to treat idiopathic intracranial hypertension with efficacy that is probably comparable to acetazolamide (Diamox). Weight reduction and decreased CSF formation are possible mechanisms of action for topiramate in the treatment of IIH. Aggressive weight loss, which may be enhanced by topiramate, is indicated for the obesity characteristically seen in patients with IIH. (Celebisoy, Gokcay, Sirin, & Akyiirekli, Acta Neurol Scand 2007)