Idiopathic intracranial hypertension treatment overview

* Severe/fulminant disease is identified in patients with rapid progression of symptoms, severe papilledema (grade 3 or worse), substantial visual field and/or visual acuity loss, and/or more than 30 transient visual obscurations per month.
¶ Patients without vision loss may be monitored closely or started on acetazolamide depending on risk factors and severity of papilledema.
Δ Acetazolamide adult initial dosing is 500 mg orally twice daily advancing as required up to 2 to 4 grams per day in 2 to 3 divided doses, as tolerated. In young children, initial dosing is 25 mg/kg per day in 2 to 3 divided doses; adjust as needed and tolerated to a maximum of 100 mg/kg or 2 grams per day, whichever is less. Refer to UpToDate topic on the treatment of idiopathic intracranial hypertension for other details of medication dosing.
◊ Patients with rapidly deteriorating vision may receive temporizing treatments such as lumbar drain if other intervention is delayed. Venous shunting may be an alternative to shunt or optic nerve sheath fenestration.