Chen John J, Mollan Susan P
Continuum (Minneap Minn). 2025 Jun 1;31(3):728-756. doi: 10.1212/cont.0000000000001586.
This article reviews the management of idiopathic intracranial hypertension (IIH), which is essential to neurology practice.
The incidence and prevalence of IIH have risen because of the worldwide obesity epidemic. Evidence suggests that IIH has a unique systemic metabolic phenotype. Clinical history, examination, and visual fields remain the cornerstone for monitoring people with IIH. Optical coherence tomography demonstrates structural changes that aid decision-making. The principles of IIH management include protecting vision and escalating to surgical interventions when it is threatened, addressing the role of obesity in the condition, and providing advice on headache therapeutics. There are no labeled therapies for IIH; however, acetazolamide remains the most common medication prescribed. A glucagon-like peptide-1 receptor agonist was recently shown to reduce intracranial pressure independent of weight reduction in a phase II randomized controlled trial in people with IIH, suggesting it could be a promising treatment for IIH. In patients with IIH requiring surgery, there has been an increase in venous sinus stenting.
Neurologists are central in the management pathway for people with IIH. Ongoing coordinated care between ophthalmologists and neurologists is essential for optimal care of these patients.
本文综述特发性颅内高压（IIH）的管理，这对神经科实践至关重要。
由于全球肥胖流行，IIH的发病率和患病率有所上升。有证据表明，IIH具有独特的全身代谢表型。临床病史、检查和视野检查仍然是监测IIH患者的基石。光学相干断层扫描可显示有助于决策的结构变化。IIH管理的原则包括保护视力，在视力受到威胁时升级至手术干预，解决肥胖在该病中的作用，并提供头痛治疗方面的建议。目前尚无针对IIH的标记疗法；然而，乙酰唑胺仍然是最常用的处方药。在一项针对IIH患者的II期随机对照试验中，一种胰高血糖素样肽-1受体激动剂最近被证明可独立于体重减轻而降低颅内压，这表明它可能是一种有前景的IIH治疗方法。在需要手术的IIH患者中，静脉窦支架置入术有所增加。
神经科医生在IIH患者的管理流程中起着核心作用。眼科医生和神经科医生之间持续的协调护理对于这些患者的最佳护理至关重要。
