Acetazolamide in Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) is defined by the existence of intracranial pressure greater than 15 mm Hg sustained. The clinical signs revealing an IIH are above all, headaches that are resistant to analgesics, jet vomiting and visual disturbances (papilledema, diplopia).

The objective of our study is to evaluate the use of acetazolamide in the management of IIH in hospitalized patients in our neurosurgery department. We retrospectively collected data from all patients admitted and managed for IIH from January 2007 to December 2020. 72 Patients were diagnosed with IIH, aged between 09 and 57 years old with an average age of 28 years old, 36% of our patients were aged between 20 and 30 years old. The sex ratio f/h was 8/1. Clinical manifestations of the IIH are those of any intracranial hypertension. Headache with nausea and/or vomiting is one of the major initial manifestations in most series as it was in ours: 88% headache, 12% vomiting and 10% diplopia.

Visual disorders are the most common complications of IIH, bilateral decrease in visual acuity was found in 49 patients (68% of our population) and one patient having bilateral blindness, bilateral papilledema was observed in 28 patients (46%) of which grades II, III, IV were 9%, 22%, 16% respectively, 7 patients had optic atrophy (9%). The fundus was without abnormality in 10 patients (11%). Brain MRI showed no abnormality in 46 patients (63%), cerebral imaging revealed an empty Sella turcica in 7 patients (7%), an arachnoidocele in 3 patients (4.5%), and an optic nerve anomaly in 4 patients (5.5%). acetazolamide was sufficient to normalize ICP in 6 patients. But surgical treatment had to be associated, it was necessary to perform a lumbar-peritoneal shunt in 47 patients (65.2%) and ventriculo-peritoneal shunt (VPS) in 17 patients (23.6%) due to the very high intracranial pressure (> 50CmH2O) and/or because of  the visual impairment risk . When facing an abrupt appearance of papillary edema and oculomotor disturbances, associated with normal neuroradiological investigations, we must consider the diagnosis of IIH, start the treatment as quickly as possible in order to preserve the visual function.

 

Key words: pseudotumor cerebri ; papillary edema, acetazolamide, lumbar peritoneal shunt