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  1. Ghaniah Hassan-Smith1,2,
  2. Susan Mollan2,
  3. Brendan Davies3,
  4. Simon Shaw3,
  5. Bhawisha Swarupsinh Chavda2,
  6. Anita Krishnan4,
  7. Conor Mallucci5,
  8. Nicholas Silver4,
  9. Benjamin Wakerley6,7,
  10. Alexandra Sinclair1,2
  1. 1University of Birmingham
  2. 2University Hospitals Birmingham
  3. 3University Hospital North Midlands NHS Trust
  4. 4The Walton Centre
  5. 5Alder Hey Children's NHS Foundation Trust
  6. 6Nuffield Department of Clinical Neurosciences, Oxford
  7. 7Gloucestershire Hospitals NHS Foundation Trust


Management of Idiopathic Intracranial Hypertension (IIH) is not standardised. A multidisciplinary Special Interest Group (SIG) was established to develop a uniform investigation and treatment strategy according to disease severity based on current literature and expert consensus.

Methods A systematic literature review of “IIH”;“Benign IH” and “pseudotumour cerebri” was followed by a SIG meeting, to identify the population, interventions, controls and outcomes (PICO) questions. Discrepant views were reflected in a questionnaire disseminated though a modified Delphi approach to district general and tertiary hospital interdisciplinary specialists.

Results 44/66 questionnaires were returned. 51% would image (CT/MRI) patients with definite papilloedema <24 hrs and 40% would image between 24–48 hrs. In these patients 84% would then proceed to venography (50:50, MRV:CTV), conducted within 48 hrs in 74% respondents.79% never diagnosed IIH in those with a lumbar puncture pressure <25 cm CSF. Referral for neurosurgical intervention was predominantly for visual deterioration (83%) with only 2% referring exclusively for headache management. Neurosurgical procedures varied: 48% ventriculoperitoneal shunting, 33% lumboperitoneal shunting, 5% optic nerve sheath fenestration, 14% other and 0% venous stenting. A consensus on follow-up times, according to papilloedema severity and visual function (perimetry), was obtained.

Conclusions Evidence for IIH management is minimal. Consensus on many aspects of management was demonstrated which will help establish a practical guideline.

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