Over the course of the semester, our trainees are reviewing webinars in their given fields and preparing abstracts to help colleagues outside their discipline make an informed choice about watching them. As our program bridges diverse disciplines, these abstracts are beneficial for our own group in helping one another gain key knowledge in each other’s fields. We are happy to share these here for anyone else who may find them helpful.
Dr. Abhay Moghekar
Johns Hopkins Department of Neurology
Dr. Moghekar begins his webinar with a summary of the current state of understanding about IIH (Idiopathic Intracranial Hypertension). The first thing to understand about IIH is that it is not simply one disease. Increased intracranial pressure (ICP) experienced by a patient can be the result of multiple pathologies such as head trauma, tumors, or other known etiologies. These other possible causes of ICP must first be eliminated before someone can be diagnosed with IIH.
Early methods of diagnosis for IIH were invasive. Increased intracranial pressure is a common feature of a brain tumor, but after surgical exploration those with IIH showed no signs of tumor induced pressure leading to IIH’s initial name of “pseudotumor cerebri.” Advances in imaging have greatly improved the diagnosis of IIH and reduced the need for such invasive procedures. Prior to imaging it’s important to know what symptoms a patient may present with.
The most common symptoms of IIH are headaches, problems with vision, pulsatile tinnitus (which is a sort of rushing sound in one’s ears), as well as fluid coming from the ears and or nose. Fluid from the nose only can be easily mistaken for allergies or a mild cold and must be tested to confirm that the fluid is cerebrospinal fluid (CSF).
Once IIH is diagnosed there are a few effective treatments. The easiest and often first method of treatment is weight loss for those with a BMI over 30. This weight loss may need to be coupled with other forms of medication if there is an immediate concern for vision loss and those with a BMI under 30 will receive little to no benefit from weight loss. Next, those with IIH may be prescribed Diamox/Acetazolamide to help reduce the production of CSF and thus reduce ICP. Should these previous treatments fail the implantation of a lumbar, ventricle, or venous shunt can help reduce ICP.
Dr. Moghekar goes on to say that researching the link between sex hormones in the brain and IIH occurrence is ongoing (women suffer more than men from IIH at a 9:1 ratio) as well as a possible genetic predisposition to weakened arterial and venous walls leading to a constriction of CSF flow and increased ICP. New treatments for IIH include a wider adoption of venous shunts and the use of semaglutide (already approved by the FDA for those with diabetes) to treat IIH patients with a BMI over 30.
IIH is, by definition, not a well understood pathology and many mechanisms producing it may still be unknown or simply not well understood. Future research will help improve the lives of many afflicted by this condition who can suffer extreme headaches and permanent vision loss.