An evaluation of the treatment and prognosis of patients with idiopathic intracranial hypertension at the national Institute of Neurology and Neurosurgery, Mexico

Abstract

Idiopathic intracranial hypertension (IIH) is a neurological disorder more frequently observed in obese women of childbearing age. It is characterized by papilledema, headache, pulse-synchronous tinnitus, transient visual obscurations and visual field loss. In some cases, it may be considerably disabling. Weight loss is the mainstay of its treatment. Acetazolamide is the initial drug but, in refractory cases, interventional treatment may be necessary. The clinical course of the disease is not well defined, as some patients may have occasional relapses, while other develop progressive disease. The objective of this study is to describe the frequency of the treatments used and the prognosis in IIH patients. This is a retrospective, descriptive and analytical study. We included 74 patients with IIH at the National Institute of Neurology and Neurosurgery, from 1995 to 2013. We recorded demographic, laboratory and clinical variables, as well as different treatments. We compared groups with good vs poor clinical outcomes (recurrence, neurologic sequelae, response to treatment) were compared. The most common treatment was acetazolamide (75.7%), followed by lumbo-peritoneal shunt. Women presented a better response to treatment (80% vs 50%; p=0.063). Among the clinical characteristics, smoking was significantly associated with a less favorable and late response (p=0.019). According to these results we could propose a treatment protocol with better patient selection, considering an early intensive medical (or interventionist) and a closer surveillance in men and patients with a recent history of smoking.