How can we preserve the visual function in idiopathic intracranial hypertension?

Hlavacova P., Vlkova E., Doskova H.

FN Brno, Department of Ophthalmology

Case report 1

• 34-year old obese woman• Headaches, pulsatile tinnitus, visual obscurations

of the right eye• Neurological status and MRI scan: no patology• Opening pressure of cerebrospinal fluid (CSF) 400

mm H2O; CSF: no pathology • Visual acuity (VA): OD 0,9; OS 1,0• Perimetry: OD blind spot enlargment, OS

physiological

Therapy: Acetazolamide 1,5g/dayOptic nerve sheaths decompression (ONSD) of the right eye

18 months after the surgery VA is 1,0 and VF is physiological

Case report 2

• 51-year old healthy man• Headaches, pulsatile tinnitus, visual obscurations

of the right eye• Neurological status and MRI scan: no pathology, • Opening pressure 700 mm H2O; CSF: no

pathology• VA OD 0,9; OS 1,25• Perimetry OD blind spot enlargement, OS

physiological

Therapy: ONSDAcetazolamide 3g/day failed and ventriculoperitoneal shunt input

18 months after the surgeries VA is 1,0 and perimetry showed enlargement of blind spot

Case report 3

• 54-year old woman• Idiopathic intracranial hypertension for 4 years, therapy:

Acetazolamide 250 mg/day• Progressive visual loss of both eyes, esp. left eye• Intermittent headaches, pulsatile tinnitus• Opening pressure 500 mm H2O; CSF: no pathology• Neurological status: no pathology, MRI scan: the slit

ventricles• VA OD 0,9, OS light perception• Perimetry OD tapered nasally to 30˚, OS concetric

tapering of VF to 20˚

Valve and programmer of LP shunt

Therapy :ONSD of the right eyeAcetazolamide 3 g/day failed and LP shunt input

12 months after the surgeries VA and perimetry remain unchanged.

Conclusion:

• ONSD appears to be an efficient method in early treatment of papilloedema in IIH

• There are different ways how can we preserve visual function in IIH. Patient´s compliance and neurosurgical cooperation is very important.