Several studies have investigated factors associated with visual deterioration in BIIP patients. Severe papilledema, delayed diagnosis, high CSF opening pressure, obesity, and visual field defects have been associated with poor prognosis.

Optical Coherence Tomography has emerged as a valuable tool for monitoring retinal nerve fiber layer changes and detecting optic nerve damage. MRV abnormalities, particularly transverse sinus stenosis, have also gained increasing attention.

Recent literature emphasizes the importance of multidisciplinary management involving neurosurgeons, neurologists, ophthalmologists, and radiologists.

Inclusion Criteria:

• •Patients fulfilling modified Dandy criteria.

  • Age above 18 years.
  • Confirmed diagnosis of IIH:

• Elevated opening pressure on lumbar puncture (>25 cm H2o) in lateral decubitus position).

• Unremarkable neuroimaging (MRI/MRV) ruling out mass lesions, hydrocephalus, or venous sinus thrombosis.

• Presence of papilledema documented by a neuro-ophthalmologist.

Exclusion Criteria:-Secondary causes of intracranial hypertension. (Evidence of an intracranial mass, hydrocephalus, or structural lesion on neuroimaging).

• Cerebral venous sinus thrombosis.
• Intracranial space occupying lesions.
• Previous optic nerve diseases.
• Severe systemic illness affecting vision.
• Pregnancy (due to restricted medication options like Topiramate).
• Previous intracranial surgery or CSF shunting procedures