Clinical treatment of Idiopathic Benign Intracranial Hypertension (IIH): case report

Introduction: Headache is one of the most common complaints in medicine, being divided into primary or secondary. Idiopathic Benign Intracranial Hypertension (IBIH) is one of the causes of secondary headache, where there is an increase in intracranial pressure in the absence of an expansive process. Goals: To present the management of IBIH refractory to conventional treatment. Methodology: Clinical evaluation of the patient, review of her medical record and review of literature related to the topic. Case report: RMC, female, 55 years old, short stature, BMI 48, presented in 2018 repetitive pictures of severe headache, without improvement factors, associated with visual disturbances that evolved to amausore, sporadic loss of balance and slowing pupillary reflexes, mood disorders and easy cry. Magnetic resonance and fundscopy were inconclusive, and CSF puncture found an opening pressure of 20 cm of water. After CSF puncture, the patient showed instantaneous vision improvement, and therapy with Acetazolamide was introduced, which controlled and kept her ophthalmological symptoms stable. Angina conditions were only resolved with the introduction of Lamotrigine. RESULTS: The most commonly prescribed medication for IBIH, Acetazolamide, controlled the reported patient’s ophthalmological condition, but not the pain episodes. When this medication alone cannot control the condition, the association of other medications or surgical conduct is indicated. The association of Acetazolamide with Lamotrigine was extremely important to solve the patient’s pain episodes, making her clinical management positive. Conclusion: The combination of Lamotrigine and Acetazolamide has been shown to be an excellent form of outpatient treatment for IBIH.