Idiopathic Intracranial Hypertension

Background Intracranial hypertension is a very commonly syndrome mainly presented with headache, vomiting, papilloedema. If cranial capacity was fixed, anything added to intracranial volume, i.e. cerebral edema, excessive CSF, increased cerebral blood volume, or occupied disease would be expected to elevated ICP. Nevertheless, some have unknown clearly aetiologies, are termed idiopathic intracranial hypertension.As the diagnostic techniques have more developed, the more knowledge we know about IIH, since Quincke had originally described in 1893.The pathophysiology of IIH is still not fully understood, hence no real causal treatment exists. The current symptomatic treatments are often insufficient. It once was seemed benign but now has recognized as a potentially disabling disease.Objective The aim is to provide an updated overview of this condiction. The history, aetiology, diagnosis, and therapy are reviewed. Theories of pathogenesis are considered, the clinical presentation is described, and diagnostic criteria and treatment strategies are discussed.Methods An extensive literature review of idiopathic and secondary intracranial hypertension was performed. The history, epidemiology characteristics, theories of pathophysiology, the diagnosis, medical and surgical approaches to treatment, and prognosis are reviewed. Available outcome studies are presented.Results IIH is a relatively rare condition, typically seen in obese women of childbearing age. As neuroimaging and ICP monitoring techniques developing, its nomenclature simplified and diagnostic criteria turned to more standard, some conditions that formerly fitted into the diagnosis, such as cerebral venous sinus thrombosis of IIH, have now been excluded. Multiple potential causes contributing to increase ICP must be identified as secondary intracranial hypertension. Weight gain recently and obesity are the only risk factors demonstrated in case-control studies. Endocrinological dysfunction could occur in intracranial hypertension either idiopathic or secondary. There were many studies about pathophysiology of IIH but not always had come to consistence.The clinic presentation caused by elevated ICP most include headache, tinnitus, vision blurring, diplopia, and papilloedema. When diagnosis is established, thoroughly examination should be executed to expel clinical, laboratory or radiological abnormality. No causal treatment is yet known, thus the existing treatment is symptomatic to normalize ICP, to prevent or arrest progressive visual loss. However, not only medical therapies but also surgical therapies are rarely completely sufficient to render all patients asymptomatic.In the course of diagnosis and treatment procedure, detailed schedules should be formulated. Follow-up is so important that more effective therapeutic measure can be taken promptly when the states get worse. IIH is generally said to be a self-limiting disease with good prognosis. However, some patients undertake recurrence or chronic course. Some experience chronic severe headache and visual disturbances for years that influences their normal social lives and work. Permanent visual defects are serious and not infrequent complications.Conclusion More standardize the nomenclature and diagnostic criteria, more developing the diagnostic techniques and treatment measures, more prospective studies performed, more knowledge of IIH we can acquire. Prompt diagnosis and thorough evaluation and treatment are crucial for preventing visual loss and improving associated symptoms. However, to identify the aetiologic factors and explore the pathophysiology, to raise the therapeutic satisfaction and life quantity are tough problems urgently needed to solve.