Idiopathic intracranial hypertension prognosis [Neurosurgery Wiki]

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====== Idiopathic intracranial hypertension prognosis ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/16K3KD07PcaaZGLpoCjZSn0-gadd5O_IJfxnV3tLF7mFp-s1GQ/?limit=15&utm_campaign=pubmed-2&fc=20240909112506}}

Delay of treatment can cause severe [[visual impairment]]
((Wen JX, Wei JJ. [Research Advances in Idiopathic Intracranial Hypertention]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2021 Apr 28;43(2):288-292. Chinese. doi: 10.3881/j.issn.1000-503X.12693. PMID: 33966712.)).

Few studies have directly compared headache and visual outcomes across treatment modalities.

A systematic analysis of case series was conducted to compare therapeutic efficacies among currently available interventions. The electronic databases from [[EMBASE]] (1980-17 September 2013), [[Medline]] (1980-17 September 2013), [[Cochrane]] [[database]]s, and references of [[review article]]s was searched. All [[publication]]s reporting headache and visual outcomes following intervention for IIH were included. A total of 457 manuscripts were selected and full text analysis produced 30 studies with extractable data. All studies constituted [[Class III evidence]]. Overall, 332 patients treated by [[optic nerve sheath fenestration]] (ONSF), 287 by [[lumboperitoneal shunt]] (LPS), 61 by [[ventriculoperitoneal shunt]] (VPS), and 88 by dural venous sinus stenting, were identified. 

Visual acuity improved in 49.3%, 56.6%, 67.2% and 84.6% of patients following VPS, LPS, ONSF, and stent placements, respectively. Resolution of papilledema was noted in 59.9% to 97.1%. Postoperative headache improved in 36.5%, 62.5%, 75.2%, and 82.9% of patients treated with ONSF, VPS, LPS, and stenting, respectively. Shunt revision was more frequent for LPS compared to VPS (46% versus 36%; p<0.2). Among the LPS revisions, 87.5% occurred within the first 12months following initial surgery. A pooled analysis indicated an overall similar improvement in visual outcomes across treatment modalities, and a modest improvement in headache following cerebrospinal fluid shunting and endovascular stent placement. Based on currently available literature, there is insufficient evidence to recommend or reject any treatments modalities for IIH
((Lai LT, Danesh-Meyer HV, Kaye AH. Visual outcomes and headache following
interventions for idiopathic intracranial hypertension. J Clin Neurosci. 2014
Oct;21(10):1670-1678. doi: 10.1016/j.jocn.2014.02.025. Epub 2014 Jun 25. Review. 
PubMed PMID: 24974193.)).

====Quality of Life====
IIH affects QOL at time of diagnosis even in patients with mild visual impairment. Vision-specific QOL in patients with newly diagnosed IIH may be as decreased as that for patients with other neuro-ophthalmic disorders. IIH treatment should target visual loss and other symptoms of increased intracranial pressure associated with reduced QOL. Reduced QOL does not simply reflect obesity, an underlying IIH risk factor
((Digre KB, Bruce BB, McDermott MP, Galetta KM, Balcer LJ, Wall M; NORDIC
Idiopathic Intracranial Hypertension Study Group. Quality of life in idiopathic
intracranial hypertension at diagnosis: IIH Treatment Trial results. Neurology.
2015 Jun 16;84(24):2449-56. doi: 10.1212/WNL.0000000000001687. Epub 2015 May 20. 
PubMed PMID: 25995055.
)).

Headache was the only clinical outcome that correlated with enhanced QOL. Effective headache management is required to improve QOL in IIH
((Mulla Y, Markey KA, Woolley RL, Patel S, Mollan SP, Sinclair AJ. Headache
determines quality of life in idiopathic intracranial hypertension. J Headache
Pain. 2015 Dec;16:521. doi: 10.1186/s10194-015-0521-9. Epub 2015 May 15. PubMed
PMID: 25982204; PubMed Central PMCID: PMC4436432.
)).

Patients with elevated CRP and patients with thrombophilia had an unfavorable visual outcome. Increased cortisol levels and abnormal calcium correlated with a higher rate of recurrence. The visual outcome of patients with elevated LDH was better than those with normal LDH. It seems that certain metabolic, inflammatory and coagulation abnormalities may influence the course of IIH. If confirmed in further studies, these findings could contribute to elucidation of the etiology and prognosis of IIH.
((Pollak L, Zohar E, Glovinsky Y, Huna-Baron R. The laboratory profile in idiopathic intracranial hypertension. Neurol Sci. 2015 Jul;36(7):1189-95. doi:10.1007/s10072-015-2071-y. Epub 2015 Jan 18. PubMed PMID: 25596710.)).