الفهرس 
ObesityOnly 14 pages are availabe for public view
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Abstract
Idiopathic intracranial hypertension is a syndrome in which there is increased intracranial pressure (ICP) of unknown etiology. Previously known as “pseudotumor cerebri” or “benign intracranial hypertension”, this condition most frequently occurs in obese women of childbearing age. IIH is more common in women and obese individuals. Obese women with IIH might have a preferential accumulation of fat in the lower body relative to other obese women in the same age range.
Overweight and obesity are defined as ”abnormal or excessive fat accumulation that presents a risk to health”. Overweight and obesity are major risk factors for a number of chronic diseases, including; diabetes, cardiovascular diseases and cancer. Obesity is a leading preventable cause of death worldwide and its prevalence is increasing at an alarming rate. Obesity is most common in children and adult, women, minorities, rural populations and low income groups, but is increasing in all socioeconomic groups.
As the prevalence of obesity has increased in the United States, defining the association between obesity and IIH has become increasingly more urgent. In the most recent surveys among African countries, Egypt has the highest prevalence of overweight (44%) and obesity (39%).While obesity has not been shown to be a cause of IIH, obesity is clearly associated with IIH. The typical patient with IIH has been described as a young obese female, as the incidence of IIH rises to 20 per 100,000 in obese females. Interestingly, the risk of IIH increases with increasing BMI and morbidly obese patients with IIH may have even worse visual outcomes. Thus, morbidly obese individuals may be at particularly high risk for severe and permanent visual loss from IIH.
The pathophysiology of obesity and increased intracranial pressure is undetermined and the cause of IIH is unknown
Several reports support the notion that recent weight gain contributes to the development of IIH found that weight gain in previously non obese patients was as much of a risk factor for development of IIH as obesity itself.
The fact that weight loss improves or resolves signs and symptoms of IIH supports the strong association of obesity and IIH.
While the etiology of IIH remains unknown, there have been many postulated theories. Proposed mechanisms that could explain the elevated ICP in IIH include increased cerebral volume (either interstitial fluid, blood or tissue), increased CSF volume due to increased production or resistance to CSF outflow, loss of cerebral autoregulation resulting in elevated cerebral arterial pressure or increased cerebral venous pressure leading to increased CSF volume and decreased CSF outflow.
There is still uncertainty as to whether the degree of obesity affects the severity of symptoms and disease outcomes, particular visual field defects. According to multiple studies, it appears that those with morbid obesity (BMI >40) have worse visual outcomes and this further underscores the importance of aggressively pursuing weight loss options in extremely obese patients.
As a whole, the data supports the role of weight loss in the treatment of IIH. Although patients may require other treatment modalities, given the benefits of even modest weight loss on IIH disease progression and outcomes, this should be an area of emphasis for treating physicians.
Weight loss can lead to remission of the -symptoms of IIH. Management includes, but is not limited to, dietary and behavior modification incorporating routine physical activity. In fact, PTC/IIH in the setting of obesity may be curative with body weight loss of 10%.
Although a number of treatments have been advocated, currently there is no evidence-based management strategy.Symptom relief is the primary goal of management, but achieving this goal and preventing morbidity may require a multifocal approach. Preserving visual function and headache relief- are priorities. Best practice would include an interdisciplinary team collaborating closely with a neurologist and ophthalmologist.