2026 American Academy of Neurology Abstract Website

Objective:

To evaluate clinical and radiological factors, associated with medical treatment response in patients with idiopathic intracranial hypertension. (IIH)

Background:

IIH is characterized by elevated intracranial pressure (ICP), with normal cerebrospinal fluid (CSF) composition and neuroimaging. Although multiple treatment options exist, reliable predictors of treatment response remain unclear.

Design/Methods:

This cross-sectional study included patients diagnosed with IIH according to the modified Dandy criteria. Treatment response was evaluated using four parameters: headache severity, degree of papilledema, visual field status, and CSF opening pressure. Each improved parameter was assigned 1 point (total score 0–4), and patients were classified as good responders (score 3–4), partial responders or non-responders (score 0–2).

Results:

Among 113 patients, 67 (59.3%) showed good response to medical therapy, while 46 (40.7%) had partial or no response requiring repeated lumber puncture (LP) or ventriculoperitoneal (VP) shunt placement. Univariate analysis identified severe ophthalmological findings (p<0.01), high CSF pressure (p=0.04), severe radiological changes, like flattened globes (p=0.03), intraocular protrusions (p=0.04), and surgical interventions (p<0.01) as predictors of poor response, whereas improved headache severity (p<0.01) and bilateral sixth nerve palsy (p=0.03) predicted good outcomes. Multivariate analysis confirmed severe ophthalmological findings (OR: 7.11, 95% CI: 2.41–21.0; p<0.01), repeated LP (OR: 5.68, 95% CI: 1.24–25.99; p=0.02), VP shunt placement (OR: 1.91, 95% CI: 1.06–3.47; p=0.03) as independent predictors of poor response, while improved headache severity (OR: 0.13, 95% CI: 0.05–0.34; p<0.01) and bilateral sixth nerve palsy (OR: 0.18, 95% CI: 0.04–0.77; p=0.02) independently predicted good response.

Conclusions:

Severe ophthalmological involvement and the need for repeated CSF drainage or surgical intervention are key indicators of poor medical response in patients with IIH. Conversely, early improvement in headache severity and the presence of bilateral sixth nerve palsy predict favorable treatment outcomes. These findings highlight the importance of early recognition of severe visual and radiological features to guide timely and individualized management strategies.