What is the first step in evaluating idiopathic intracranial hypertension (IIH)?

The first step in evaluating idiopathic intracranial hypertension (IIH) is fundoscopy. This examination is crucial because it allows the clinician to assess for signs of papilledema, which is the swelling of the optic nerve head due to increased intracranial pressure. Papilledema is a hallmark finding in IIH and is essential for diagnosing the condition.

While brain imaging, lumbar puncture, and neurological examination are all important components of the evaluation process, fundoscopy provides the immediate evidence of possible increased intracranial pressure that is relevant to IIH. If papilledema is observed during fundoscopy, it supports the suspicion of elevated intracranial pressure and may warrant further investigations like imaging or lumbar puncture to explore other causes and to confirm the diagnosis.