What is the role of acetazolamide in neurological disorders?

• A. A diuretic that increases CSF production.
• B. Carbonic anhydrase inhibitor used to reduce CSF production in idiopathic intracranial hypertension and certain edema conditions; caution with electrolyte balance.
• C. An opioid analgesic used for pain.
• D. A calcium channel blocker used for migraine.

Answer: (B)

Acetazolamide works by inhibiting carbonic anhydrase, an enzyme needed to form bicarbonate. In the choroid plexus this reduces bicarbonate and fluid production, so cerebrospinal fluid (CSF) formation drops and intracranial pressure can decrease. This makes acetazolamide useful in conditions with elevated CSF pressure, especially idiopathic intracranial hypertension (pseudotumor cerebri) and certain types of cerebral edema where lowering CSF production helps relieve pressure. It also acts as a mild diuretic, but the loss of bicarbonate can lead to metabolic acidosis and electrolyte disturbances, so electrolyte balance must be monitored. It’s not an opioid analgesic or a calcium channel blocker, and it doesn’t increase CSF production.