BACKGROUND: Idiopathic intracranial hypertension (IIH) is a relatively common neurologic condition characterized by elevated intracranial pressure in the absence of intracranial disease. Symptoms include headache, transient vision loss, tinnitus and diplopia. Papilledema with enlarged blind spots are common presenting signs. Persistent papilledema can lead to optic nerve axonal death with optic atrophy and ultimately, blindness. Therefore, treatment to lower intracranial pressure is important. Weight loss and carbonic anhydrase inhibitors are therapeutic mainstays with the former often difficult and the latter associated with unpleasant side effects. Surgical procedures are indicated when medical therapy fails and vision is threatened.
CASE REPORT(S): A 37 year old female with a known history of IIH noted an exacerbation in her symptoms. In order to avoid subjecting herself to an unpleasant diagnostic work-up and re-instatement of her medication, she instead began smoking marijuana to alleviate her headaches. She noted improvement in her headaches as well as resolution of her tinnitus and transient vision loss. Symptoms returned upon discontinuing marijuana use and were relieved with the oral use of the synthetic cannabinoid dronabinol. Improvement was also documented clinically with resolution of her papilledema and enlarged blind spots. She continues to remain in remission one year later.
CONCLUSIONS: Delta-9-tetrahydrocannibinol is the active ingredient in marijuana and dronabinol. This patient noted the resolution of her symptoms without the unpleasant side effects of previously utilized carbonic anhydrase inhibitors and continues to be symptom free one year later. While its mechanism of intracranial pressure reduction is not fully understood, its safety is known and raises important questions regarding the need for controlled clinical trials for its potential use in IIH.