gms | German Medical Science

I. Worst case : discontinuation of therapy by the patient (in our study 23 of 86 patients – 14 treated by medication, mostly acetazolamid, 5 by shunting, 4 by stenting).

II. Insufficient efficiency control of different therapeutic options. Patients refused control of spinal tap due to traumatising experiences in the past ( 21 of 86). Insufficient recall system.

III. Insufficient weight loss

IV. Deficits of interdisciplinary coordination and cooperation ( “nobody feels responsible”), misinterpretation of papillary finding leading to the erroneous impression of successful reduction of intracranial pressure in patients who do not redevelop papilledema after previous papilledema when intracranial pressure raises again.

I. Better instruction and care of patients. Better coordination of interdisciplinary cooperation. Improved recall-systems.

II. Technical improvement of spinal tap.

III. Better instruction, organisation and financial support of weight reduction. Better motivation by psychotherapeutic and social support.

IV. More intensive interdisciplinary cooperation in diagnosis and initial therapy preferably in specialized centres. Better control of efficiency of different therapeutic options. Better care of the individual patient including psychotherapeutic measures of the “non compliant” IIH patient, who has frequently a history of previous traumatisation and suffers from difficult social conditions.