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Comment on: ‘The expanding spectrum of idiopathic intracranial hypertension’

Eye volume 37, page 3049 (2023)Cite this article

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We would like to congratulate Drs Biousse and Newman for their thoughtful review of the current challenges faced by people with idiopathic intracranial hypertension (IIH) [1]. In the United Kingdom there has been a stepwise increase in IIH and we are discovering the associated long-term morbidity [2, 3]. Their review offers insights to the complexity of the clinical spectrum of IIH with the widening radiological evidence of raised intracranial pressure (ICP) and an increasing number of people with cerebrospinal fluid (CSF) leaks being evaluated for primary raised ICP. Both situations are important for ophthalmologists to navigate [1].

Drs Biousse and Newman have a reputation for excellence in IIH care and reducing overdiagnosis. We would like to recommend to the readers of Eye the Association of British Neurologists’s commissioned consensus guidelines regarding the investigation of papilloedema and management of IIH [4]. We believe this document provides a framework for clinicians to ensure a definite diagnosis and timely exclusion of secondary pseudotumor cerebri.

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References

  1. Biousse V, Newman NJ. The expanding spectrum of idiopathic intracranial hypertension. Eye (Lond). 2022. https://doi.org/10.1038/s41433-022-02361-3.

  2. Adderley NJ, Subramanian A, Perrins M, Nirantharakumar K, Mollan SP, Sinclair AJ. Headache, opiate use, and prescribing trends in women with idiopathic intracranial hypertension: a population-based matched cohort study. Neurology. 2022. https://doi.org/10.1212/WNL.0000000000201064

  3. Thaller M, Homer V, Hyder Y, Yiangou A, Liczkowski A, Fong AW, et al. The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes. J Neurol. 2022. https://doi.org/10.1007/s00415-022-11402-6.

  4. Mollan SP, Davies B, Silver NC, Shaw S, Mallucci CL, Wakerley BR, et al. Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry. 2018;89:1088–100.

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  5. Mitchell J, Mollan S, Walker J, Buckham R, Lyons H, Yiangou A, et al. A randomised controlled, trial of the GLP-1 receptor agonist exenatide in idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry. 2022;93:A98.

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Funding

There was no funding for this publication. AJS reports research funding from the Medical Research Council, National Institute for Health Research, Sir Jules Thorn Trust and the UK Space Agency. SPM reports research funding from the UK Space Agency.

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Authors and Affiliations

  1. Ophthalmology Department, University Hospitals Birmingham, Birmingham, B15 2TH, UK

    Edward J. Bilton

  2. Translation Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    Alexandra J. Sinclair & Susan P. Mollan

  3. Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK

    Alexandra J. Sinclair

  4. Birmingham Neuro-Ophthalmology, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK

    Susan P. Mollan

Authors
  1. Edward J. Bilton
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  2. Alexandra J. Sinclair
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  3. Susan P. Mollan
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Contributions

EJB: Literature review, and first draft of the letter. AJS: Critical review of the manuscript. SPM: Concept and design, supervision and critical review of the manuscript.

Corresponding author

Correspondence to Susan P. Mollan.

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Competing interests

EJB has no conflicts of interests to declare. AJS reports honoria for speaker events from Teva. Consulting fees from Invex therapeutics; salary and stockholding with Invex therapeutics. SPM reports consultancy fees (Invex Therapeutics); advisory board fees (Invex therapeutics; Gensight) and speaker fees (Heidelberg engineering; Chugai-Roche Ltd; Allergan; Santen; Chiesi; and Santhera).

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Bilton, E.J., Sinclair, A.J. & Mollan, S.P. Comment on: ‘The expanding spectrum of idiopathic intracranial hypertension’. Eye 37, 3049 (2023). https://doi.org/10.1038/s41433-023-02456-5

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