Idiopathic Intracranial Hypertension: Prognostic Factors and Multidisciplinary Management

N/AActive Not RecruitingNCT07707544

Sohag University30 enrolled

Overview

Several studies have investigated factors associated with visual deterioration in BIIP patients. Severe papilledema, delayed diagnosis, high CSF opening pressure, obesity, and visual field defects have been associated with poor prognosis. Optical Coherence Tomography has emerged as a valuable tool for monitoring retinal nerve fiber layer changes and detecting optic nerve damage. MRV abnormalities, particularly transverse sinus stenosis, have also gained increasing attention. Recent literature emphasizes the importance of multidisciplinary management involving neurosurgeons, neurologists, ophthalmologists, and radiologists.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Idiopathic Intracranial Hypertension

Interventions

Conservative Management: Centered on lifestyle modifications for weight reduction, alongside targeted medical therapies including carbonic anhydrase inhibitors (e.g., acetazolamide) and/or topiramate.DRUG

Eligibility

Sex: ALLMin age: 18 MonthsMax age: 60 MonthsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * •Patients fulfilling modified Dandy criteria. * Age above 18 years. * Confirmed diagnosis of IIH: * Elevated opening pressure on lumbar puncture (\>25 cm H2o) in lateral decubitus position). * Unremarkable neuroimaging (MRI/MRV) ruling out mass lesions, hydrocephalus, or venous sinus thrombosis. * Presence of papilledema documented by a neuro-ophthalmologist. Exclusion Criteria:-Secondary causes of intracranial hypertension. (Evidence of an intracranial mass, hydrocephalus, or structural lesion on neuroimaging). * Cerebral venous sinus thrombosis. * Intracranial space occupying lesions. * Previous optic nerve diseases. * Severe systemic illness affecting vision. * Pregnancy (due to restricted medication options like Topiramate). * Previous intracranial surgery or CSF shunting procedures

Outcomes

Primary Outcomes

visual outcome.

* Visual Acuity (VA): Best-corrected visual acuity using the Snellen chart (converted to LogMAR for statistical analysis). * Funduscopy: Grading of papilledema using the Frisén Scale (Grades 0-5). * Visual Field Testing: Automated perimetry (Humphrey Visual Field, 24-2 or 30-2 program) to detect blind spot enlargement or peripheral field loss Optical Coherence Tomography (OCT): Measuring Retinal Nerve Fiber Layer (RNFL) thickness and total macular volume to objectively quantify axonal swelling.

Time frame: 6 months

Secondary Outcomes

Requirement for surgical intervention.

Surgical Interventions: Reserved for patients presenting with fulminant or progressive vision loss, or those exhibiting failure of maximal medical therapy. Surgical options include ventriculoperitoneal (VP) shunt, lumboperitoneal (LP) shunt

Time frame: 6months