Obesity Abstracts

Idiopathic intracranial hypertension (IIH) classically occurs in women with obesity and is characterised by raised intracranial pressure. Weight loss leads to reduction in intracranial pressure. We present a case of a 35-year-old female who was urgently referred to Imperial Weight Centre. She had recently undergone revision of a right ventriculoperitoneal shunt for longstanding IIH which had not resolved her high-pressure symptoms and continued to require therapeutic lumbar punctures (LPs) for worsening headache and vision loss. She had a BMI of 37.6kg/m² (107.3kg) with no history of childhood obesity or binge eating disorder. Over the last decade, her weight had gradually increased from a 70kg baseline following two pregnancies and concurrent deterioration in her mental health (post-natal psychosis, post-traumatic stress disorder). The long-term use of Quetiapine, and also Mirtazapine, were additional contributors to weight gain given the orexigenic effect with increasing her hunger. She was also on Levothyroxine for previous hypothyroidism. Previous attempts for weight loss intervention included a gastric balloon where she achieved 14kg loss, but it was removed due to pancreatitis and she regained weight thereafter. Her case was discussed at the Imperial Weight Centre MDT and bariatric surgery was recommended versus pharmacotherapy in view of previous pancreatitis. She underwent a laparoscopic sleeve gastrectomy shortly after multidisciplinary review (pre-operative weight 108kg) with no immediate post-operative complications. Three months later, she achieved 16.3% weight loss (92.1kg) and reported fewer headaches with less frequent therapeutic LPs required. She unfortunately required a laparoscopic cholecystectomy for pancreatitis secondary to gallstones after presenting with sudden, severe epigastric pain and amylase of 2,431unit/L. This case illustrates the significant impact of obesity on IIH and the important role of weight loss in clinical management. In this case, the weight loss intervention prevented vision loss, reduced hospital admissions for repeat LPs and neurosurgery. Quality of life and mental health also improved, and the patient can now look forward to resuming her daily activities. In addition to weight loss surgery, we now have pharmacotherapy options e.g. semaglutide, which patients suffering with IIH will significantly benefit from and their accessibility should be implemented as part of the treatment pathway.