Idiopathic intracranial hypertension: a literature review

Raymundo Solís-Gómez, Department of Neurological Education and Training, National Institute of Neurology and Neurosurgery; Section of Postgraduate and Research Studies, School of Medicine of the National Polytechnic Institute; Mexico City, Mexico
Ricardo Vázquez-López, Medicina Interna, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Mexico City, Mexico
Andrea Salgado-Alvear, Departamento de Cirugía General, Centro Médico American British Cowdray (ABC), Mexico City, Mexico
Brenda Cazares-Ruiz, Department of Neurological Education and Training, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
Itzel Xotlanihua-Xotlanihua, Dirección de Enseñanza, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Pablo E. Irigoyen-Ruíz, Department of Neurological Education and Training, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
Luis D. Milpas-Muñoz, Departamento de Medicina Interna, Fundación Clínica Médica Sur, Mexico City, Mexico
Natalia Dávalos-Cabral, Departamento de Medicina Interna, Fundación Clínica Médica Sur, Mexico City, Mexico
Fabiola E. Serrano-Arias, Department of Neurological Education and Training, National Institute of Neurology and Neurosurgery; Stroke Clinic, National Institute of Neurology and Neurosurgery. Mexico City, Mexico

Idiopathic intracranial hypertension is a syndrome characterized by increased intracranial pressure without an identifiable cause. It primarily affects young women and is associated with obesity. Its pathophysiology involves alterations in cerebrospinal fluid (CSF) dynamics, vascular dysfunction, and hormonal and metabolic factors. The main symptoms include headache, papilledema, and visual disturbances, although neuropsychiatric manifestations and sleep disorders may also occur. Diagnosis is based on clinical criteria, neuroimaging such as magnetic resonance imaging and magnetic resonance venography, and measurement of CSF pressure. Diagnostic tools such as optical coherence tomography and transorbital ultrasound have proven useful for diagnosis and monitoring. Treatment varies according to severity and includes lifestyle modification, pharmacological therapy with acetazolamide and topiramate, and, in cases refractory to medical treatment, surgical procedures such as CSF shunting, venous sinus stenting, or optic nerve sheath fenestration. During follow-up, both clinical outcomes and findings from diagnostic tools should be regularly assessed. This narrative review summarizes current evidence and highlights the need for standardized protocols and clearly defined therapeutic goals to improve visual prognosis.

Keywords: Idiopathic intracranial hypertension. Intracranial pressure. Papilledema. Headache. Ventriculoperitoneal shunt.