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Semin Neurol 2019; 39(06): 682-691
DOI: 10.1055/s-0039-1698744
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension

Sarah R. Ahmad
1   Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
,
Heather E. Moss 
1   Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
2   Department of Ophthalmology, Stanford University, Palo Alto, California
› Author Affiliations
Further Information

Publication History

Publication Date:
17 December 2019 (online)

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Abstract

Advances in ophthalmic diagnostics and results of interventional clinical trials are shifting diagnosis and management of idiopathic intracranial hypertension (IIH) to be more technology- and evidence-based. In this article, the evidence supporting current diagnostic criteria, evaluation, and medical and surgical management of IIH are reviewed.

Keywords

Idiopathic intracranial hypertension - pseudotumor cerebri - papilledema
 

  • References

  • 1 Quincke HI. Über meningitis serosa. Sammlung klinischer Vortrag. Neue Folge, Nr. 67 [Innere Medicin, Nr. 23] 1893; 23: 655-694
    PubMedSearch in Google Scholar
  • 2 Dandy WE. Intracranial pressure without brain tumor: diagnosis and treatment. Ann Surg 1937; 106 (04) 492-513
    CrossrefPubMedSearch in Google Scholar
  • 3 Foley J. Benign forms of intracranial hypertension; toxic and otitic hydrocephalus. Brain 1955; 78 (01) 1-41
    CrossrefPubMedSearch in Google Scholar
  • 4 Corbett JJ, Thompson HS. The rational management of idiopathic intracranial hypertension. Arch Neurol 1989; 46 (10) 1049-1051
    CrossrefPubMedSearch in Google Scholar
  • 5 Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81 (13) 1159-1165
    CrossrefPubMedSearch in Google Scholar
  • 6 Wall M, Corbett JJ. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2014; 83 (02) 198-199
    PubMedSearch in Google Scholar
  • 7 Mollan SP, Davies B, Silver NC. , et al. Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry 2018; 89 (10) 1088-1100
    CrossrefPubMedSearch in Google Scholar
  • 8 Rowe FJ, Sarkies NJ. The relationship between obesity and idiopathic intracranial hypertension. Int J Obes Relat Metab Disord 1999; 23 (01) 54-59
    CrossrefPubMedSearch in Google Scholar
  • 9 Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol 2016; 15 (01) 78-91
    CrossrefPubMedSearch in Google Scholar
  • 10 Szewka AJ, Bruce BB, Newman NJ, Biousse V. Idiopathic intracranial hypertension: relation between obesity and visual outcomes. J Neuroophthalmol 2013; 33 (01) 4-8
    CrossrefPubMedSearch in Google Scholar
  • 11 Daniels AB, Liu GT, Volpe NJ. , et al. Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol 2007; 143 (04) 635-641
    CrossrefPubMedSearch in Google Scholar
  • 12 Wall M, McDermott MP, Kieburtz KD. , et al; NORDIC Idiopathic Intracranial Hypertension Study Group Writing Committee. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 2014; 311 (16) 1641-1651
    CrossrefPubMedSearch in Google Scholar
  • 13 Friedman DI, McDermott MP, Kieburtz K. , et al; NORDIC IIHTT Study Group. The idiopathic intracranial hypertension treatment trial: design considerations and methods. J Neuroophthalmol 2014; 34 (02) 107-117
    CrossrefPubMedSearch in Google Scholar
  • 14 Wall M, Kupersmith MJ, Kieburtz KD. , et al; NORDIC Idiopathic Intracranial Hypertension Study Group. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 2014; 71 (06) 693-701
    CrossrefPubMedSearch in Google Scholar
  • 15 Thambisetty M, Lavin PJ, Newman NJ, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology 2007; 68 (03) 229-232
    CrossrefPubMedSearch in Google Scholar
  • 16 Friedman DI, Quiros PA, Subramanian PS. , et al; NORDIC IIHTT Study Group. Headache in idiopathic intracranial hypertension: findings from the idiopathic intracranial hypertension treatment trial. Headache 2017; 57 (08) 1195-1205
    CrossrefPubMedSearch in Google Scholar
  • 17 Friedman DI. Headaches due to low and high intracranial pressure. Continuum (Minneap Minn) 2018; 24 (4, Headache): 1066-1091
    PubMedSearch in Google Scholar
  • 18 Corbett JJ, Savino PJ, Thompson HS. , et al. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol 1982; 39 (08) 461-474
    CrossrefPubMedSearch in Google Scholar
  • 19 Orcutt JC, Page NG, Sanders MD. Factors affecting visual loss in benign intracranial hypertension. Ophthalmology 1984; 91 (11) 1303-1312
    CrossrefPubMedSearch in Google Scholar
  • 20 Giuseffi V, Wall M, Siegel PZ, Rojas PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology 1991; 41 (2 (Pt 1)): 239-244
    CrossrefPubMedSearch in Google Scholar
  • 21 Sadun AA, Currie JN, Lessell S. Transient visual obscurations with elevated optic discs. Ann Neurol 1984; 16 (04) 489-494
    CrossrefPubMedSearch in Google Scholar
  • 22 Kaiboriboon K, Piriyawat P, Selhorst JB. Light-induced amaurosis fugax. Am J Ophthalmol 2001; 131 (05) 674-676
    CrossrefPubMedSearch in Google Scholar
  • 23 Bruce BB, Newman NJ, Biousse V. Ophthalmoparesis in idiopathic intracranial hypertension. Am J Ophthalmol 2006; 142 (05) 878-880
    CrossrefPubMedSearch in Google Scholar
  • 24 Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int 2013; 110 (26) 451-458
    CrossrefPubMedSearch in Google Scholar
  • 25 Bassan H, Berkner L, Stolovitch C, Kesler A. Asymptomatic idiopathic intracranial hypertension in children. Acta Neurol Scand 2008; 118 (04) 251-255
    PubMedSearch in Google Scholar
  • 26 Bandyopadhyay S, Jacobson DM. Clinical features of late-onset pseudotumor cerebri fulfilling the modified dandy criteria. J Neuroophthalmol 2002; 22 (01) 9-11
    CrossrefPubMedSearch in Google Scholar
  • 27 Galvin JA, Van Stavern GP. Clinical characterization of idiopathic intracranial hypertension at the Detroit Medical Center. J Neurol Sci 2004; 223 (02) 157-160
    CrossrefPubMedSearch in Google Scholar
  • 28 Rowe FJ, Sarkies NJ. Assessment of visual function in idiopathic intracranial hypertension: a prospective study. Eye (Lond) 1998; 12 (Pt 1): 111-118
    CrossrefPubMedSearch in Google Scholar
  • 29 Kupersmith MJ, Sibony PA, Feldon SE, Wang JK, Garvin M, Kardon R. ; OCT Sub-Study Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial. The effect of treatment of idiopathic intracranial hypertension on prevalence of retinal and choroidal folds. Am J Ophthalmol 2017; 176: 77-86
    CrossrefPubMedSearch in Google Scholar
  • 30 Sibony PA, Kupersmith MJ, Feldon SE, Wang JK, Garvin M. ; OCT Substudy Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial. Retinal and choroidal folds in papilledema. Invest Ophthalmol Vis Sci 2015; 56 (10) 5670-5680
    CrossrefPubMedSearch in Google Scholar
  • 31 Jacks AS, Miller NR. Spontaneous retinal venous pulsation: aetiology and significance. J Neurol Neurosurg Psychiatry 2003; 74 (01) 7-9
    CrossrefPubMedSearch in Google Scholar
  • 32 Degnan AJ, Levy LM. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 2011; 32 (11) 1986-1993
    CrossrefPubMedSearch in Google Scholar
  • 33 Kelly LP, Saindane AM, Bruce BB. , et al. Does bilateral transverse cerebral venous sinus stenosis exist in patients without increased intracranial pressure?. Clin Neurol Neurosurg 2013; 115 (08) 1215-1219
    CrossrefPubMedSearch in Google Scholar
  • 34 Ranganathan S, Lee SH, Checkver A. , et al. Magnetic resonance imaging finding of empty sella in obesity related idiopathic intracranial hypertension is associated with enlarged sella turcica. Neuroradiology 2013; 55 (08) 955-961
    CrossrefPubMedSearch in Google Scholar
  • 35 Corbett JJ, Mehta MP. Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. Neurology 1983; 33 (10) 1386-1388
    CrossrefPubMedSearch in Google Scholar
  • 36 Gilland O, Tourtellotte WW, O'Tauma L, Henderson WG. Normal cerebrospinal fluid pressure. J Neurosurg 1974; 40 (05) 587-593
    CrossrefPubMedSearch in Google Scholar
  • 37 Tourtellotte WW. A selected review of reactions of the cerebrospinal fluid to disease. In: Fields WS. , ed. Neurological Diagnostic Techniques. Springfield, IL: Charles C Thomas; 1966: 25-26
    Search in Google Scholar
  • 38 Whiteley W, Al-Shahi R, Warlow CP, Zeidler M, Lueck CJ. CSF opening pressure: reference interval and the effect of body mass index. Neurology 2006; 67 (09) 1690-1691
    CrossrefPubMedSearch in Google Scholar
  • 39 Avery RA, Shah SS, Licht DJ. , et al. Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 2010; 363 (09) 891-893
    CrossrefPubMedSearch in Google Scholar
  • 40 Schwartz KM, Luetmer PH, Hunt CH. , et al. Position-related variability of CSF opening pressure measurements. AJNR Am J Neuroradiol 2013; 34 (04) 904-907
    CrossrefPubMedSearch in Google Scholar
  • 41 Abel AS, Brace JR, McKinney AM. , et al. Effect of patient positioning on cerebrospinal fluid opening pressure. J Neuroophthalmol 2014; 34 (03) 218-222
    CrossrefPubMedSearch in Google Scholar
  • 42 Andresen M, Hadi A, Petersen LG, Juhler M. Effect of postural changes on ICP in healthy and ill subjects. Acta Neurochir (Wien) 2015; 157 (01) 109-113
    CrossrefPubMedSearch in Google Scholar
  • 43 Smith JL. Whence pseudotumor cerebri?. J Clin Neuroophthalmol 1985; 5 (01) 55-56
    PubMedSearch in Google Scholar
  • 44 Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. ; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35 (03) 664-670
    CrossrefPubMedSearch in Google Scholar
  • 45 Ferro JM, Canhão P, Stam J. , et al; ISCVT Investigators. Delay in the diagnosis of cerebral vein and dural sinus thrombosis: influence on outcome. Stroke 2009; 40 (09) 3133-3138
    CrossrefPubMedSearch in Google Scholar
  • 46 Dinkin M, Moss HE. Should magnetic resonance venography be performed routinely in all patients undergoing evaluation for idiopathic intracranial hypertension?. J Neuroophthalmol 2015; 35 (04) 431-437
    CrossrefPubMedSearch in Google Scholar
  • 47 Kwon BJ, Han MH, Kang HS, Chang KH. MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns. AJNR Am J Neuroradiol 2005; 26 (10) 2500-2507
    PubMedSearch in Google Scholar
  • 48 Rekate HL. Why would a spinal tumor cause increased intracranial pressure?. J Neuroophthalmol 2002; 22 (03) 197-198
    CrossrefPubMedSearch in Google Scholar
  • 49 Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002; 59 (10) 1492-1495
    CrossrefPubMedSearch in Google Scholar
  • 50 Digre KB, Nakamoto BK, Warner JEA, Langeberg WJ, Baggaley SK, Katz BJ. A comparison of idiopathic intracranial hypertension with and without papilledema. Headache 2009; 49 (02) 185-193
    CrossrefPubMedSearch in Google Scholar
  • 51 Kerr NM, Chew SS, Eady EK, Gamble GD, Danesh-Meyer HV. Diagnostic accuracy of confrontation visual field tests. Neurology 2010; 74 (15) 1184-1190
    CrossrefPubMedSearch in Google Scholar
  • 52 Wall M. The importance of visual field testing in idiopathic intracranial hypertension. Continuum (Minneap Minn) 2014; 20 (4 Neuro-ophthalmology): 1067-1074
    PubMedSearch in Google Scholar
  • 53 Hayreh SS. Optic disc edema in raised intracranial pressure. V. Pathogenesis. Arch Ophthalmol 1977; 95 (09) 1553-1565
    CrossrefPubMedSearch in Google Scholar
  • 54 Tso MO, Hayreh SS. Optic disc edema in raised intracranial pressure. III. A pathologic study of experimental papilledema. Arch Ophthalmol 1977; 95 (08) 1448-1457
    CrossrefPubMedSearch in Google Scholar
  • 55 Keltner JL, Johnson CA, Cello KE, Wall M. ; NORDIC Idiopathic Intracranial Hypertension Study Group. Baseline visual field findings in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Invest Ophthalmol Vis Sci 2014; 55 (05) 3200-3207
    CrossrefPubMedSearch in Google Scholar
  • 56 Corbett JJ, Jacobson DM, Mauer RC, Thompson HS. Enlargement of the blind spot caused by papilledema. Am J Ophthalmol 1988; 105 (03) 261-265
    CrossrefPubMedSearch in Google Scholar
  • 57 Frisén L. Swelling of the optic nerve head: a staging scheme. J Neurol Neurosurg Psychiatry 1982; 45 (01) 13-18
    CrossrefPubMedSearch in Google Scholar
  • 58 Sinclair AJ, Burdon MA, Nightingale PG. , et al. Rating papilloedema: an evaluation of the Frisén classification in idiopathic intracranial hypertension. J Neurol 2012; 259 (07) 1406-1412
    CrossrefPubMedSearch in Google Scholar
  • 59 Bruce BB, Lamirel C, Biousse V. , et al. Feasibility of nonmydriatic ocular fundus photography in the emergency department: Phase I of the FOTO-ED study. Acad Emerg Med 2011; 18 (09) 928-933
    CrossrefPubMedSearch in Google Scholar
  • 60 Bruce BB, Biousse V, Newman NJ. Nonmydriatic ocular fundus photography in neurologic emergencies. JAMA Neurol 2015; 72 (04) 455-459
    CrossrefPubMedSearch in Google Scholar
  • 61 Kelly LP, Garza PS, Bruce BB, Graubart EB, Newman NJ, Biousse V. Teaching ophthalmoscopy to medical students (the TOTeMS study). Am J Ophthalmol 2013; 156 (05) 1056-1061.e10
    CrossrefPubMedSearch in Google Scholar
  • 62 Thulasi P, Fraser CL, Biousse V, Wright DW, Newman NJ, Bruce BB. Nonmydriatic ocular fundus photography among headache patients in an emergency department. Neurology 2013; 80 (05) 432-437
    CrossrefPubMedSearch in Google Scholar
  • 63 Bruce BB, Thulasi P, Fraser CL. , et al. Diagnostic accuracy and use of nonmydriatic ocular fundus photography by emergency physicians: phase II of the FOTO-ED study. Ann Emerg Med 2013; 62 (01) 28-33.e1
    CrossrefPubMedSearch in Google Scholar
  • 64 Fischer WS, Wall M, McDermott MP, Kupersmith MJ, Feldon SE. ; NORDIC Idiopathic Intracranial Hypertension Study Group. Photographic reading center of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT): Methods and Baseline Results. Invest Ophthalmol Vis Sci 2015; 56 (05) 3292-3303
    CrossrefPubMedSearch in Google Scholar
  • 65 Biousse V, Bruce BB, Newman NJ. Ophthalmoscopy in the 21st century: The 2017 H. Houston Merritt Lecture. Neurology 2018; 90 (04) 167-175
    CrossrefPubMedSearch in Google Scholar
  • 66 Chen JJ, Trobe JD. Optical coherence tomography should be used routinely to monitor patients with idiopathic intracranial hypertension. J Neuroophthalmol 2016; 36 (04) 453-459
    CrossrefPubMedSearch in Google Scholar
  • 67 Scott CJ, Kardon RH, Lee AG, Frisén L, Wall M. Diagnosis and grading of papilledema in patients with raised intracranial pressure using optical coherence tomography vs clinical expert assessment using a clinical staging scale. Arch Ophthalmol 2010; 128 (06) 705-711
    CrossrefPubMedSearch in Google Scholar
  • 68 Huang-Link Y, Eleftheriou A, Yang G. , et al. Optical coherence tomography represents a sensitive and reliable tool for routine monitoring of idiopathic intracranial hypertension with and without papilledema. Eur J Neurol 2019; 26 (05) 808-e57
    CrossrefPubMedSearch in Google Scholar
  • 69 Chen JJ, Thurtell MJ, Longmuir RA. , et al. Causes and prognosis of visual acuity loss at the time of initial presentation in idiopathic intracranial hypertension. Invest Ophthalmol Vis Sci 2015; 56 (06) 3850-3859
    CrossrefPubMedSearch in Google Scholar
  • 70 Sibony P, Kupersmith MJ, Rohlf FJ. Shape analysis of the peripapillary RPE layer in papilledema and ischemic optic neuropathy. Invest Ophthalmol Vis Sci 2011; 52 (11) 7987-7995
    CrossrefPubMedSearch in Google Scholar
  • 71 Sheils CR, Fischer WS, Hollar RA, Blanchard LM, Feldon SE. ; NORDIC Idiopathic Intracranial Hypertension Study Group. The relationship between optic disc volume, area, and frisén score in patients with idiopathic intracranial hypertension. Am J Ophthalmol 2018; 195: 101-109
    CrossrefPubMedSearch in Google Scholar
  • 72 Gampa A, Vangipuram G, Shirazi Z, Moss HE. Quantitative association between peripapillary bruch's membrane shape and intracranial pressure. Invest Ophthalmol Vis Sci 2017; 58 (05) 2739-2745
    CrossrefPubMedSearch in Google Scholar
  • 73 Wang JK, Kardon RH, Ledolter J, Sibony PA, Kupersmith MJ, Garvin MK. ; OCT Sub-Study Committee and the NORDIC Idiopathic Intracranial Hypertension Study Group. Peripapillary retinal pigment epithelium layer shape changes from acetazolamide treatment in the idiopathic intracranial hypertension treatment trial. Invest Ophthalmol Vis Sci 2017; 58 (05) 2554-2565
    CrossrefPubMedSearch in Google Scholar
  • 74 Sinclair AJ, Burdon MA, Nightingale PG. , et al. Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study. BMJ 2010; 341: c2701
    CrossrefPubMedSearch in Google Scholar
  • 75 Manfield JH, Yu KK, Efthimiou E, Darzi A, Athanasiou T, Ashrafian H. Bariatric surgery or non-surgical weight loss for idiopathic intracranial hypertension? A systematic review and comparison of meta-analyses. Obes Surg 2017; 27 (02) 513-521
    CrossrefPubMedSearch in Google Scholar
  • 76 Ko MW, Chang SC, Ridha MA. , et al. Weight gain and recurrence in idiopathic intracranial hypertension: a case-control study. Neurology 2011; 76 (18) 1564-1567
    CrossrefPubMedSearch in Google Scholar
  • 77 Weil R, Kovacs B, Miller N. , et al; NORDIC Idiopathic Intracranial Hypertension Study Group. A 6-month telephone-based weight loss intervention in overweight and obese subjects with idiopathic intracranial hypertension. Obes Sci Pract 2016; 2 (02) 95-103
    CrossrefPubMedSearch in Google Scholar
  • 78 Moss HE. Bariatric surgery and the neuro-ophthalmologist. J Neuroophthalmol 2016; 36 (01) 78-84
    CrossrefPubMedSearch in Google Scholar
  • 79 Ottridge R, Mollan SP, Botfield H. , et al. Randomised controlled trial of bariatric surgery versus a community weight loss programme for the sustained treatment of idiopathic intracranial hypertension: the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT) protocol. BMJ Open 2017; 7 (09) e017426
    CrossrefPubMedSearch in Google Scholar
  • 80 Gücer G, Viernstein L. Long-term intracranial pressure recording in the management of pseudotumor cerebri. J Neurosurg 1978; 49 (02) 256-263
    CrossrefPubMedSearch in Google Scholar
  • 81 Wall M, Kupersmith MJ, Thurtell MJ, Moss HE, Moss EA, Auinger P. ; NORDIC Idiopathic Intracranial Hypertension Study Group. The longitudinal idiopathic intracranial hypertension trial: outcomes from months 6-12. Am J Ophthalmol 2017; 176: 102-107
    CrossrefPubMedSearch in Google Scholar
  • 82 ten Hove MW, Friedman DI, Patel AD, Irrcher I, Wall M, McDermott MP. ; NORDIC Idiopathic Intracranial Hypertension Study Group. Safety and tolerability of acetazolamide in the idiopathic intracranial hypertension treatment trial. J Neuroophthalmol 2016; 36 (01) 13-19
    CrossrefPubMedSearch in Google Scholar
  • 83 Celebisoy N, Gökçay F, Sirin H, Akyürekli O. Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand 2007; 116 (05) 322-327
    CrossrefPubMedSearch in Google Scholar
  • 84 Scotton WJ, Botfield HF, Westgate CS. , et al. Topiramate is more effective than acetazolamide at lowering intracranial pressure. Cephalalgia 2019; 39 (02) 209-218
    CrossrefPubMedSearch in Google Scholar
  • 85 Schoeman JF. Childhood pseudotumor cerebri: clinical and intracranial pressure response to acetazolamide and furosemide treatment in a case series. J Child Neurol 1994; 9 (02) 130-134
    CrossrefPubMedSearch in Google Scholar
  • 86 Chandran A, Pulhorn H, McMahon C. Idiopathic intracranial hypertension VISION (venous intervention versus shunting in IIH for optic nerve disc swelling) trial: patient perspective questionnaire. Br J Neurosurg 2019; 33 (01) 71-75
    CrossrefPubMedSearch in Google Scholar
  • 87 Gilbert AL, Chwalisz B, Mallery R. Complications of optic nerve sheath fenestration as a treatment for idiopathic intracranial hypertension. Semin Ophthalmol 2018; 33 (01) 36-41
    CrossrefPubMedSearch in Google Scholar
  • 88 Feldon SE. Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension. Neurosurg Focus 2007; 23 (05) E6
    PubMedSearch in Google Scholar
  • 89 Hickman SJ, Raoof N, Panesar H, McMullan JM, Pepper IM, Sharrack B. Visual outcomes from shunting for idiopathic intracranial hypertension. Neuroophthalmology 2014; 38 (06) 310-319
    CrossrefPubMedSearch in Google Scholar
  • 90 McGirt MJ, Woodworth G, Thomas G, Miller N, Williams M, Rigamonti D. Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes. J Neurosurg 2004; 101 (04) 627-632
    CrossrefPubMedSearch in Google Scholar
  • 91 Dinkin MJ, Patsalides A. Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial. J Neuroophthalmol 2017; 37 (02) 113-121
    CrossrefPubMedSearch in Google Scholar
  • 92 Lippa LM, Boker J, Duke A, Amin A. A novel 3-year longitudinal pilot study of medical students' acquisition and retention of screening eye examination skills. Ophthalmology 2006; 113 (01) 133-139
    CrossrefPubMedSearch in Google Scholar
  • 93 Bruce BB, Lamirel C, Wright DW. , et al. Nonmydriatic ocular fundus photography in the emergency department. N Engl J Med 2011; 364 (04) 387-389
    CrossrefPubMedSearch in Google Scholar
  • 94 Koerner JC, Friedman DI. Inpatient and emergency service utilization in patients with idiopathic intracranial hypertension. J Neuroophthalmol 2014; 34 (03) 229-232
    CrossrefPubMedSearch in Google Scholar
  • 95 Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ. The expanding burden of idiopathic intracranial hypertension. Eye (Lond) 2019; 33 (03) 478-485
    CrossrefPubMedSearch in Google Scholar
  • 96 Frohman LP. Neuro-ophthalmology: transitioning from old to new models of health care delivery. J Neuroophthalmol 2017; 37 (02) 206-209
    CrossrefPubMedSearch in Google Scholar