Weight loss remains a challenge for idiopathic intracranial hypertension patients: A retrospective case series from Kenya.

Background: Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by elevated intracranial CSF pressure without demonstratable evident causes. The mechanisms leading to a particular predilection for women of childbearing age who are overweight and obese or who have recent rapid weight changes remain imprecisely described. If undiagnosed, it can progress to disabling irreversible visual loss. Weight loss is useful in addition to medical therapy in treating the condition. There is a rise of obesity in sub-Saharan Africa (SSA) but there is little published on IIH. Methods: We conducted a retrospective cross-sectional study at our tertiary regional referral neurology centre in Nairobi, Kenya. Data were extracted from medical files of patients meeting the diagnostic criteria for IIH aged >18 years who were diagnosed or managed at AKUHN from January 2011 to December 2022. Results: We identified 152 patients: female-to-male ratio was 9:1, mean age 34.2 years. Mean body mass index (BMI) was 31.2 kgs/m2. Almost a third (32.2 %) had compromised vision at presentation in at least one eye. None had other medical comorbidities to precipitate IIH. H2O. 80.2 % had brain MRI, of which 78.4 % had ancillary IIH findings on imaging. Median cerebrospinal fluid opening pressure was 31 cm. Treatment was acetazolamide alone in 44 %, topiramate alone in 15 %, and combined in 30 %. 9.8 % were referred for neurosurgical evaluation, mainly due to refractory symptoms or intolerance/contraindications to medical therapy. Only 49.3 % had symptom improvement at one year. 52.6 % did not have a formal documented weight loss plan. Mean BMI at one year was 30.9 kg/m2. Conclusion: Our study describes the first cohort of IIH patients from the East Africa region. Demographics are concordant with those reported internationally. However, our patients failed to lose weight, and emphasizes the need to formally incorporate weight loss plans (diet and exercise) in IIH care.