INTEGRATIVE AYURVEDIC MANAGEMENT OF IDIOPATHIC INTRACRANIAL HYPERTENSION WITH CLASS III OBESITY: A CASE REPORT

Abstract

Idiopathic intracranial hypertension (IIH) mainly affects women with obesity, and papilledema threatens vision. Weight loss and carbonic anhydrase inhibitors are standard treatment, but drug intolerance is common. We report a 33-year-old woman with class III obesity (body mass index 44.3 kg/m²) and IIH diagnosed in 2018. After 4 years of acetazolamide (up to 1,500 mg/day), topiramate, and furosemide, she had disabling adverse effects, morning epistaxis, transient visual obscurations, falls, and moderate obstructive sleep apnea. These drugs were cross-tapered over 10 days while oral Ayurvedic medicines were introduced, and cerebrospinal fluid opening pressure at admission, after the taper, was 38.5 cm H₂O. She then received a 26-day, three-phase inpatient Panchakarma protocol with oral herbal and herbo-mineral medicines, followed by 30 days of oral medicines, a calorie-restricted diet, walking, and head-elevated sleep. At follow-up 86 days after admission, headache had fallen from 8/10 to 0/10 and epistaxis had stopped. Papilledema resolved from Frisén grades 3 (right) and 4 (left) to grade 0, retinal nerve fiber layer thickness fell from 168 and 214 µm to 94 and 91 µm, and visual field mean deviation improved from −4.85 and −8.40 dB to −1.05 and −1.60 dB. Opening pressure was 18.0 cm H₂O, weight fell by 10.5 kg (9.4%), and kidney and liver tests remained normal. Weight loss and natural fluctuation may have contributed to the pressure and papilledema changes, and drug withdrawal to the relief of adverse effects, so causality cannot be established. The case supports controlled studies with systematic safety monitoring.