Abstract: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, presents a diagnostic challenge in ophthalmology due to its diverse clinical manifestations and unclear etiology. This article provides a comprehensive review of IIH, exploring its pathogenesis, clinical features, diagnostic modalities, management strategies, and recent innovations. By deepening our understanding of IIH, ophthalmologists can enhance patient care and outcomes in this complex condition.

Introduction: Idiopathic intracranial hypertension is characterized by elevated intracranial pressure without an identifiable cause. Despite its name, IIH is associated with significant morbidity, particularly ocular complications such as papilledema and visual disturbances.

Pathogenesis: The exact etiology of IIH remains elusive, but it is believed to involve dysregulation of cerebrospinal fluid dynamics, impaired venous drainage, and altered intracranial compliance. Obesity and female gender are significant risk factors for IIH.

Clinical Features: Patients with IIH commonly present with symptoms such as headache, transient visual obscurations, pulsatile tinnitus, and visual field defects. Ophthalmic examination may reveal papilledema, optic disc edema, and sixth nerve palsy.

Diagnostic Modalities: Diagnosis of IIH requires a combination of clinical assessment, neuroimaging, and lumbar puncture to measure cerebrospinal fluid pressure. Imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) can help exclude secondary causes.

Management Strategies: Management of IIH aims to reduce intracranial pressure, alleviate symptoms, and preserve visual function. Treatment options include weight loss, diuretic therapy, optic nerve sheath fenestration, and cerebrospinal fluid diversion procedures.

Recent Advances: Recent innovations in IIH management include the use of acetazolamide and other medications to reduce intracranial pressure, minimally invasive surgical techniques for optic nerve decompression, and emerging therapies targeting underlying pathophysiological mechanisms.

Conclusion: Idiopathic intracranial hypertension poses challenges in diagnosis and management, requiring a multidisciplinary approach involving ophthalmologists, neurologists, and neurosurgeons. By staying abreast of the latest research and innovations, clinicians can improve outcomes for patients with IIH.

For further reading and reference:

• American Academy of Ophthalmology – Idiopathic Intracranial Hypertension: https://www.aao.org/eye-health/diseases/idiopathic-intracranial-hypertension
• International Headache Society – Idiopathic Intracranial Hypertension: https://www.ihs-headache.org/education/idiopathic-intracranial-hypertension
• Journal of Neuro-Ophthalmology – Recent Advances in Idiopathic Intracranial Hypertension Research: https://journals.lww.com/jneuro-ophthalmology/pages/default.aspx