The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri)

Objective: To determine the weight loss associated with resolution of papil ledema from idiopathic intracranial hypertension (IIH). Design: A retrospective study. Participants: Fifteen consecutive female patients with IIH associated with obesity were studied. Intervention: Patients underwent weight loss and treatment with acetazolami de during a 24-week period. Main Outcome Measures: The severity of papilledema was graded: absent (grad e 0), mild (grade 1), moderate (grade 2), and marked (grade 3), based on a predetermined grading system ("gold standard") using stereoscopic photograp hs and the Frisen classification. Results: The 15 patients, with mean age of 31.3 +/- 8.8 years, had a mean w eight of 110.5 +/- 28.7 kg and mean body mass index of 40.7 +/- 13.0 kg/m(2 ). Eleven (73.3%) patients had improved papilledema during the 24-week stud y period, of which 10 (66.7%) had complete resolution of papilledema within a median time of 8.5 weeks. An average of 3.3% weight loss (+/-0.5% standa rd error of the mean) was observed among patients having a one-grade change in papilledema, Weight loss of 6.2% +/- 0.6% standard error of the mean wa s associated with a three-grade change in papilledema (i,e,, complete resol ution of marked papilledema), Nine of the ten patients with complete resolu tion of papilledema also took acetazolamide. However, none (26.7%) of the f our patients without weight loss had improvement in papilledema despite sim ilar treatment with acetazolamide. Conclusions: Approximately 6% weight loss was associated with resolution of marked papilledema in these authors' patients. The benefit of acetazolamid e in IIH is questioned since weight loss, rather than acetazolamide, appear ed to have been the catalyst for reducing the severity of papilledema.