Case presentation: seizures as a presenting sign of idiopathic intracranial hypertension
Reviewed by Claire Howard

Idiopathic intracranial hypertension (IIH) is a syndrome of isolated elevated intracranial pressure of unknown cause. Neurological examination in IIH is typically normal except for papilloedema and possible cranial nerve six palsy, although rare, atypical symptoms and signs can occur. With the rising incidence of obesity worldwide and the associated increasing number of cases of IIH, the spectrum of IIH has evolved over the past decade to include isolated radiological changes secondary to chronically elevated intracranial pressure (ICP) and spontaneous skull base cerebrospinal fluid (CSF) leaks. Recent publications have highlighted skull base thinning and remodelling in patients with chronic IIH. Resulting skull base defects can cause meningo-encephalocoeles, which are potential epileptogenic foci. The authors present five patients with new-onset seizures from meningo-encephalooceles, most likely related to chronically elevated ICP from IIH spectrum disorder. This case series highlights meningo-encephalocoele related seizures as an unusual manifestation of unrecognised IIH.

Seizures as the initial manifestation of idiopathic intracranial hypertension spectrum disorder.
Al-Balushi N, Bouthour W, Banc A, et al.
NEURO-OPHTHALMOLOGY
2023;47(5–6):248–54.