Idiopathic Intracranial Hypertension - Challenges and Pearls

Knowledge and diagnostic confidence of general practitioners in managing idiopathic intracranial hypertension: A nationwide survey from the Northern regions of Oman

BACKGROUND

Idiopathic intracranial hypertension (IIH) is a rare but potentially vision-threatening condition, often underrecognized in primary care settings. Timely diagnosis and effective management are critical to prevent complications, yet knowledge gaps among general practitioners (GPs) may hinder optimal care. This study assessed the knowledge and diagnostic confidence of GPs in Oman regarding IIH.

METHODS

A cross-sectional survey was conducted among 150 GPs in the Al Batinah region and Muscat. The survey evaluated familiarity with IIH, recognition of clinical symptoms, diagnostic practices, and confidence in managing the condition. Descriptive statistics, chi-square tests, and ordinal regression analyses were used to assess associations between knowledge levels, professional background, and confidence in IIH management.

RESULTS

While 95.3 % of respondents accurately defined IIH, only 20.7 % could identify its symptoms, and 11.3 % were aware of appropriate treatment options. Significant associations were found between higher knowledge scores and international medical training (p = 0.001), as well as internship location (p = 0.001). Confidence in diagnosing IIH was strongly associated with clinical exposure to IIH patients (p < 0.001).

CONCLUSIONS

The study highlights critical knowledge gaps and low diagnostic confidence among GPs in Oman regarding IIH, particularly in recognizing symptoms and management strategies. Findings suggest that international training and clinical exposure enhance IIH knowledge and confidence, underscoring the need for targeted educational interventions to improve diagnosis and patient outcomes.

A Case Report of Idiopathic Intracranial Hypertension With Left-Sided Facial Spasm

Idiopathic intracranial hypertension (IIH) typically presents with increased intracranial pressure of an unknown origin. Facial spasms are an uncommon manifestation of IIH. We report a 56-year-old female patient displaying atypical IIH symptoms of left-sided facial spasm. Clinical examination and imaging confirmed the diagnosis of IIH, and the patient received treatment with acetazolamide. This case highlights the importance of considering IIH as a potential diagnosis in patients with facial spasms, especially when accompanied by other neurological symptoms. Early recognition, a high level of suspicion, and appropriate management are crucial for optimizing outcomes in IIH cases. Furthermore, collaboration among neurologists, neurosurgeons, radiologists, and ophthalmologists is essential for the comprehensive evaluation and management of IIH patients.

Idiopathic Intracranial Hypertension Preceding Tumefactive Multiple Sclerosis

Idiopathic intracranial hypertension (IIH) and multiple sclerosis (MS) are rare neurological disorders that largely affect females within the reproductive age group. The clinical pictures of both diseases can overlap, which therefore places great importance on accurately studying and reporting their concurrence. Therein, we report a case of IIH presenting and progressing simultaneously with MS. This young, previously healthy female presented with the primary complaint of a severe right-sided headache associated with blurred vision and a finding of papilledema. The initial investigations including a lumbar puncture (LP) that revealed high opening pressure (more than 25 mm H2O) with normal cerebrospinal fluid (CSF) analysis led to an impression of idiopathic intracranial hypertension, and she was treated accordingly with acetazolamide and scheduled for regular follow-ups with both neurology and neuro-ophthalmology. However, about two months after the initial presentation, she complained of unusual headaches, and a neuro-ophthalmology clinical evaluation revealed complete right homonymous hemianopia, suggesting a lesion in the left temporo-parietal occipital region. The patient was thus admitted as a case of cerebral edema following an urgent brain magnetic resonance imaging (MRI). After obtaining thorough imaging and workup, the patient was given steroids and markedly improved, favoring a diagnosis of tumefactive MS with IIH.