Benign Intracranial Hypertension

Question 1

Risk factors

Answer 1

Female

High BMI

Question 2

Management

Answer 2

First line management of idiopathic intracranial hypertension (and the only intervention supported by good evidence) is weight loss.

Failing this, patients often try carbonic anhydrase inhibitors, such as acetazolamide, but its extensive profile of side effects (peripheral paraesthesia, anorexia and metallic dysgeusia) mean that it is poorly tolerated.

Topiramate and furosemide are also commonly tried.

More invasive strategies to lower CSF pressure including therapeutic lumbar punctures and surgical CSF shunting are tried in resistant cases.

In patients with prominent visual symptoms (but otherwise manageable headache), optic nerve sheath fenestration may protect against visual loss.