The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri)

To determine the weight loss associated with resolution of papilledema from idiopathic intracranial hypertension (IIH). A retrospective study. Fifteen consecutive female patients with IIH associated with obesity were studied. Patients underwent weight loss and treatment with acetazolamide during a 24-week period. The severity of papilledema was graded: absent (grade 0), mild (grade 1), moderate (grade 2), and marked (grade 3), based on a predetermined grading system (“gold standard”) using stereoscopic photographs and the Frisén classification. The 15 patients, with mean age of 31.3 ± 8.8 years, had a mean weight of 110.5 ± 28.7 kg and mean body mass index of 40.7 ± 13.0 kg/m2. Eleven (73.3%) patients had improved papilledema during the 24-week study period, of which 10 (66.7%) had complete resolution of papilledema within a median time of 8.5 weeks. An average of 3.3% weight loss (±0.5% standard error of the mean) was observed among patients having a one-grade change in papilledema. Weight loss of 6.2% ± 0.6% standard error of the mean was associated with a three-grade change in papilledema (i.e., complete resolution of marked papilledema). Nine of the ten patients with complete resolution of papilledema also took acetazolamide. However, none (26.7%) of the four patients without weight loss had improvement in papilledema despite similar treatment with acetazolamide. Approximately 6% weight loss was associated with resolution of marked papilledema in these authors’ patients. The benefit of acetazolamide in IIH is questioned since weight loss, rather than acetazolamide, appeared to have been the catalyst for reducing the severity of papilledema.