Management of Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

Diagnostic Approach

The American College of Radiology recommends MRI brain with and without contrast as the preferred initial imaging within 24 hours to exclude secondary causes of raised intracranial pressure 2, 3, 4
CT or MR venography is mandatory to exclude cerebral sinus thrombosis within 24 hours, as suggested by the Journal of Neurology, Neurosurgery and Psychiatry 1, 4
Diagnostic criteria include papilledema, normal neurological examination, normal brain parenchyma on imaging, normal cerebrospinal fluid composition, and elevated lumbar puncture opening pressure, according to the American College of Radiology 2, 3, 5
Elevated lumbar puncture opening pressure is defined as >280 mm CSF in children (or >250 mm CSF if not sedated and not obese), as stated by the American College of Radiology 2, 3, 5

The Journal of Neurology, Neurosurgery and Psychiatry recommends that all patients with BMI >30 kg/m² should be counseled about weight management at the earliest opportunity 1
Target 5-15% weight loss, which has been shown to put IIH into remission, according to the Journal of Neurology, Neurosurgery and Psychiatry 1
Refer to community or hospital-based weight management program, as suggested by the Journal of Neurology, Neurosurgery and Psychiatry 1
Consider bariatric surgery for sustained weight loss in appropriate candidates, according to the Journal of Neurology, Neurosurgery and Psychiatry 1

Urgent surgical intervention is required for patients with imminent risk of visual loss or rapidly progressive visual decline, as stated by the Journal of Neurology, Neurosurgery and Psychiatry 1, 6
A temporizing lumbar drain may protect vision while planning definitive surgery, according to the Journal of Neurology, Neurosurgery and Psychiatry 1, 6
Ventriculoperitoneal (VP) shunt is the preferred CSF diversion procedure due to lower revision rates, as suggested by the Journal of Neurology, Neurosurgery and Psychiatry 6
Lumboperitoneal shunt is an alternative option, according to the Journal of Neurology, Neurosurgery and Psychiatry 6

Regular ophthalmologic assessments to monitor papilledema and visual function are recommended by the Journal of Neurology, Neurosurgery and Psychiatry 1
If significant deterioration of visual function occurs, consider diagnostic lumbar puncture, as suggested by the Journal of Neurology, Neurosurgery and Psychiatry 1

For non-obese patients, secondary causes should be thoroughly investigated, according to the Journal of Neurology, Neurosurgery and Psychiatry 1
Secondary causes include medications, endocrine disorders, and cerebral venous abnormalities, as stated by the American College of Radiology and the Journal of Neurology, Neurosurgery and Psychiatry 2, 3, 5