Idiopathic intracranial hypertension. A retrospective study of 20 cases.

Purpose We conducted a retrospective study in 20 cases of idiopathic intracranial hypertension (IIH) referred to the ophthalmology out-patients department at the Centre Hospitalier Universitaire of Fort de France. The objectives were to characterize symptomatology, severity, disease course and to discuss treatment. Methods We performed a complete ophthalmological and neurological examination, calculated the body mass index (BMI) and evaluated visual field. Each patient underwent a CT scan with injection and a lumbar punction with measurement of cerebrospinal fluid pressure. We also specified the treatment chosen and its duration, and the number of recurrences. Results This study included 20 cases, 19 women and 1 man, with a mean follow-up of 28.6 months. The average BMI was of 32.2 kg/m2. Fifteen patients out of 20 were obese (75%), all of them women, so 79% of the women were obese. Sixteen patients had headache (80%), 15 a loss of visual acuity (75%) and 5 transient visual loss (25%). For all the clinical examination showed bilateral papilloedema. Visual field disturbances were observed in 11 patients (73.3%). Papilloedema disappeared after medical treatment of a mean 2.4 months duration for each access. In 9 cases of 18 (50%) recurrences were observed after gradual treatment with-drawal. Conclusion The long-term treatment, the side effects, the possible severity of the ocular disease, the difficulties of dietary restriction and the high rate of recurrence, would, for us, indicate a need to reconsider surgical treatment. We propose to perform lumboperitoneal shunt or optic nerve sheath-decompression if medical treatment fails at the first onset of IIH or in case of severe visual loss, pregnancy or recurrence.