How can I effectively monitor a patient with idiopathic intracranial hypertension for potential complications?

Effective monitoring of a patient with idiopathic intracranial hypertension (IIH) for potential complications requires a structured approach focusing on regular clinical assessment, visual function monitoring, and symptom surveillance to detect disease progression or complications early. Regular ophthalmological assessment is essential to monitor for visual impairment, as IIH can lead to optic nerve damage and vision loss; this includes formal visual field testing and optic disc evaluation. Symptom monitoring should focus on headache characteristics, visual changes, and signs of raised intracranial pressure such as pulsatile tinnitus or transient visual obscurations. Neuroimaging (typically MRI with venography) is used initially to exclude secondary causes and may be repeated if clinical deterioration occurs. Measurement of intracranial pressure via lumbar puncture can be part of diagnosis and occasionally for monitoring if symptoms worsen. Risk stratification based on clinical features and visual function helps tailor the frequency of follow-up, with more frequent reviews for those with visual impairment or rapid progression. Patient education on symptom recognition and prompt reporting of worsening vision or headache is critical. Multidisciplinary involvement including neurology, ophthalmology, and potentially neurosurgery is important for comprehensive care and timely intervention if complications arise. This approach aligns with stratification strategies proposed in recent literature emphasizing individualized monitoring intensity based on risk of progression (Onyia et al., 2019; Markey et al., 2023) and the need for vigilant visual surveillance to prevent permanent vision loss (Biousse, 2012). Although UK guidelines do not provide a specific IIH monitoring protocol, principles from related neurological and neuro-ophthalmological care recommend these key elements ¹.