![]() ![]() 1 Contraindications include uncontrolled electrolyte imbalances, untreated or severe adrenal insufficiency, closed-angle glaucoma, hepatic disease, renal disease, and renal failure. Precautions for acetazolamide include patient anaphylaxis-type reactions to sulfa medications and concomitant use with interacting medications. 4 Children’s dosing typically starts at 25 mg/kg per day in divided doses, and is titrated slowly to a maximum of 100 mg/kg per day or 2 grams per day, whichever is less. The current drug of choice, by the Neuro-Ophthalmology Research Disease Investigator Consortium, is acetazolamide with an adult starting dose of 500 mg twice daily and titrated up, based on patient tolerance, to a maximum of 4 grams in divided doses daily. 6 In addition to ruling out cranial nerve abnormalities, abnormal brain parenchyma, abnormal CSF constituents, and other potential causes such as lesions, infections, malignancies, and hydrocephaly. The DANDY diagnostic criteria ( Table 1) includes the presence of papilledema with elevated cerebral spinal fluid (CSF) opening pressure of more than 250 mm of water in adults and 280 mm of water in children and adolescents. ![]() 3 A neuro-ophthalmologist typically makes a definitive diagnosis using MRI brain imaging and lumbar puncture to rule out other causes such as malignancies, inflammatory disorders, and infections such as meningitis. ![]() 2 Patients often describe other symptoms, such as flashes of light in the field of vision and a consistent “swishing” or “heartbeat” sound in the ears.Ĭlinical presentation of IIH includes optic-disc swelling (papilledema), visual field loss, and patient-reported symptoms with unknown causes. 2 IIH is a condition that presents with symptoms such as persistent headaches, eye pain, double vision, vision loss, and pulsatile tinnitus. IIH, formerly known as pseudotumor cerebri, was previously considered a rare condition with an incidence of 1 in 100,000 people however, its prevalence is increasing in parallel with obesity in patient populations. ![]()
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