Idiopathic "benign" intracranial hypertension: Case series and review

Idiopathic "benign" intracranial hypertension is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken t o review our experience in the diagnosis and management of idiopathic intra cranial hypertension, giving special attention to treatments used. A retros pective chart review was conducted on 32 patients diagnosed with idiopathic intracranial hypertension between 1984 and 1995. Subjects included 23 fema les and ranged in age from 2 to 17.5 years. Headache was the most common sy mptom, followed by nausea and vomiting, double vision, and visual loss. Pap illedema was the most common sign. Others were VIth cranial nerve palsy and compromised visual acuity at or within 3 months of presentation. Managemen t included administration of acetazolamide or corticosteroids, lumboperiton eal shunt, optic nerve fenestration, and repeat lumbar puncture. Treatment combinations were used in 40% of cases. During follow-up, headache, papille dema, and decreased visual acuity persisted for longer than 10 months in a significant number of patients. We conclude that idiopathic intracranial hy pertension causes significant short- and long-term morbidity with no proven effective treatment available. A prospective study is needed to establish the indications for treatment and the efficacy of the treatments used.