Monitoring
Some 11 - 35% of people recover spontaneously; in others, management is variable.
Some people do very well on a regime of diuretics and steroids but must be monitored symptomatically, and by CSF pressure measurement to protect the eyesight.
There is little evidence that drug therapy improves the long-term outcome, although a short (two week) course of steroids may be enough to re-open venous pathways so that the IH resolves.
Where sight is affected, it may be necessary to fenestrate the optic nerve (slit the sheath surrounding the nerve): everyone should be under the care of an opthalmic surgeon.
Some people need repeated lumbar punctures to remove excess CSF, or the excess CSF may need to be diverted by means of a surgically inserted shunt.
In theory, a lumbar peritoneal shunt is the shunt of choice. In practice, the patient may undergo frequent shunt revision, including changing to a ventriculo-peritoneal shunt, or insertion of a lumbar reservoir.