Review details Idiopathic Intracranial Hypertension pathophysiology, diagnostic advances, and GLP-1-based therapies.

Idiopathic Intracranial Hypertension (IIH), or pseudotumor cerebri, is a neurological disorder causing elevated intracranial pressure (ICP) without a structural cause, primarily affecting young obese women. It leads to headaches, visual disturbances, and potential irreversible vision loss. Current treatments often fall short, necessitating deeper understanding of its complex pathophysiology, which involves venous hypertension, glymphatic dysfunction, CSF dynamics, and metabolic/hormonal imbalances. This review addresses gaps in understanding and managing this multifactorial condition.

This comprehensive review synthesizes recent research on Idiopathic Intracranial Hypertension (IIH), integrating findings from neuro-ophthalmological assessments, lumbar puncture, and advanced imaging modalities like MRI, MRV, and OCT. It critically evaluates current understanding of IIH pathophysiology, diagnostic criteria, and emerging therapeutic strategies, including pharmacological interventions targeting GLP-1 pathways. The review identifies persistent challenges in standardizing diagnostic and therapeutic approaches.

The review highlights a complex interplay in IIH pathophysiology, involving venous hypertension, glymphatic dysfunction, impaired CSF reabsorption, and obesity-related hormonal dysregulation. Transverse sinus stenosis is identified as both a cause and consequence of elevated ICP. > Diagnostic advancements integrate neuro-ophthalmological assessments, lumbar puncture, and imaging (MRI, MRV, OCT) to detect key findings like transverse sinus stenosis, optic nerve sheath dilation, and papilledema severity. Emerging non-invasive methods, such as ultrasound-based optic nerve sheath diameter (ONSD) measurement and machine learning-based ICP estimation, offer potential for safer, real-time monitoring. Pharmacological interventions targeting pathways like glucagon-like peptide-1 (GLP-1) show promise in managing refractory cases, indicating a shift towards more targeted therapies. The review underscores the multifactorial nature of IIH and the need for multidisciplinary approaches.