Idiopathic intracranial hypertension in adolescents with severe visual impairment: Long-term outcome and the beneficial effects of weight loss and psychological support.

The aim of this manuscript is to evaluate retrospectively, the symptoms, treatment and long-term outcome of idiopathic intracranial hypertension (IIH) in adolescents with severe visual impairment, particularly in relation to body weight and compliance to treatment. We reviewed the clinical notes of adolescent patients treated in our department for IIH through a one-year period. From January 2004 to Feb 2005 four patients, aged between 12 and 13 years were diagnosed with IIH. Inclusion criteria were cerebrospinal fluid (CSF) opening pressure greater than 250 mmH2O, normal CSF composition, severe visual impairment, normal brain imaging and nonfocal neurological examination except for sixth nerve palsy. All patients were followed for a minimum of 3 years. All patients were either overweight or obese. The sex distribution was 3 girls, 1 boy. The most common presenting symptom was headache. Visual field abnormalities were present in all cases with severe visual loss. All patients were treated with acetazolamide while two of them received steroids in conventional dose and one needed high-dose methylprednisolone. The use of transcranial Doppler (TCD) was available only after treatment with minimum impact on results. Adolescents represent an age group with special emotional and biological needs leading in difficulties when compliance to specific treatment is necessary. Although IIH in adolescents is rare, it could lead in permanent visual loss. Especially in obese patients, successful weight management in combination with good compliance to treatment seems important for a favorable long-term outcome.