Three Current Controversies in Idiopathic Intracranial Hypertension

Abstract

Idiopathic intracranial hypertension (IIH), or pseudotumour cerebri, is a condition of increased intracranial pressure without space-occupying lesion, cerebrospinal fluid abnormalities or venous sinus thrombosis. This manuscript will discuss three controversies in IIH: (1) its nomenclature; (2) existence without papilloedema; and (3) therapeutic venous stenting. The name pseudotumour cerebri is controversial; idiopathic intracranial hypertension, idiopathic intracranial pressure or primary and secondary intracranial hypertension are preferred terms. Some do not believe the condition exists without papilloedema. Our evaluation found idiopathic intracranial hypertension without papilloedema (IIHWOP) in ∼6% of cases. IIHWOP patients had more diagnostic lumbar punctures and non-physiological visual field constriction; 93% of IIH patients had venous sinus stenosis. Others suggest treating venous sinus narrowing with stenting, which may be viable in rare cases but should not be first-line treatment.

Keywords:

• Idiopathic intracranial hypertension
• pseudotumour cerebri
• increased intracranial pressure
• papilloedema
• venous sinus stenosis