Among 113 patients, 67 (59.3%) showed good response to medical therapy, while 46 (40.7%) had partial or no response requiring repeated lumber puncture (LP) or ventriculoperitoneal (VP) shunt placement. Univariate analysis identified severe ophthalmological findings (p<0.01), high CSF pressure (p=0.04), severe radiological changes, like flattened globes (p=0.03), intraocular protrusions (p=0.04), and surgical interventions (p<0.01) as predictors of poor response, whereas improved headache severity (p<0.01) and bilateral sixth nerve palsy (p=0.03) predicted good outcomes. Multivariate analysis confirmed severe ophthalmological findings (OR: 7.11, 95% CI: 2.41–21.0; p<0.01), repeated LP (OR: 5.68, 95% CI: 1.24–25.99; p=0.02), VP shunt placement (OR: 1.91, 95% CI: 1.06–3.47; p=0.03) as independent predictors of poor response, while improved headache severity (OR: 0.13, 95% CI: 0.05–0.34; p<0.01) and  bilateral sixth nerve palsy (OR: 0.18, 95% CI: 0.04–0.77; p=0.02) independently predicted good response.

Severe ophthalmological involvement and the need for repeated CSF drainage or surgical intervention are key indicators of poor medical response in patients with IIH. Conversely, early improvement in headache severity and the presence of bilateral sixth nerve palsy predict favorable treatment outcomes.  These findings highlight the importance of early recognition of severe visual and radiological features to guide timely and individualized management strategies.