I read the article by Mollan et al.1 regarding weight loss and intracranial hypertension (IH) with interest. Gastric bypass results in decreased dicarbonyl stress (DS).2 DS-related compounds, such as methylgloxal, are associated with the breakdown of the blood-brain barrier,3 as seen in IH through the glycation of biomolecules and the production of advanced glycation end products (AGEs).3,4 Inhibiting semicarbazide-sensitive amine oxidase, which causes DS, with caffeine may lead to decreased weight gain and AGEs.5
Rapid weight loss through gastric surgery may alleviate the complications of IH; however, fenestration of the optic nerve sheath to avoid visual loss should be considered when there is progressive visual loss. Medical management of obesity may have more application in the future with continued progress in this field.
Footnotes
Author disclosures are available upon request (journal@neurology.org).
References
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