IIH – Weight Loss for Remission — SCE Neurology MCQ

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EasyCerebrovascular DiseaseIIH – Weight Loss for RemissionSCE Neurology

A 40-year-old woman presents with idiopathic intracranial hypertension. She has papilloedema and headache but well-preserved visual fields. Her BMI is 38. Acetazolamide has been started. What is the ONLY intervention shown to achieve long-term remission of IIH?

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Correct answer: C — Sustained weight loss — a weight reduction of ≥5–10% of body weight can achieve remission of IIH in the majority of patients

Weight loss is the only intervention with evidence for long-term remission of IIH. The IIH Weight Trial demonstrated that weight loss of ≥5% significantly reduces ICP, papilloedema, and headache. A loss of ≥15% often achieves complete remission. Bariatric surgery may be considered for patients with BMI >40 or BMI >35 with comorbidities who cannot achieve adequate weight loss through lifestyle measures. All other treatments (acetazolamide, LP, ONSF, shunt) are symptomatic — they do not address the underlying cause. A: Acetazolamide reduces ICP but does not cause remission. C: LPs provide temporary relief. D: ONSF protects vision but doesn't treat underlying cause. E: Shunt diverts CSF but doesn't address cause.

Reference: ABN IIH Guidelines (2018); IIH Weight Trial (Sinclair et al.)