Background: an epidemic of obesity spreads across the globe. Obesity has numerous co-morbidities including airway disease, insulin resistance, type 2 diabetes, cardiovascular disease, atherosclerosis,degenerative neurological disease, cognitive dysfunction, and cancer. Inflammatory cytokine suggested playing a role in obesity and its complications. The current study aimed to estimate the expression and serum visfatin concentrations in obese Egyptian women. Moreover, we aimed to evaluate the possible association between visfatin gene expression and serum levels with idiopathic intracranial hypertension (IIH) and cognitive dysfunction Subjects and Methods: This cross-sectional study enrolled60obese women and 40 lean healthy women as controls. Obese women classified according to grades of obesity to three groups.All subjects underwent full clinical, neurological and psychiatric examination.Idiopathic intracranial hypertension (IIH) group included patients with intracranial pressure > 25 cm H2O (opening pressure measured during lumber puncturein lateral decubitus position).Cognitive function was evaluated by using Montreal Cognitive Assessment scale (MoCA), Arabic version.Estimation of visfatin expression levels was determined by real-time polymerase chain reaction (RT-PCR) and serum visfatin concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Results: Our results revealed that obese women had higher values of visfatin expression (1.44±0.29)and serum levels (124.1±) compared to lean women (1.01±0.3) and (46.1±33.8) respectively.The visfatinexpression and serum levels were significantly positively correlated with obesity indices, metabolic risks,Montreal cognitive assessment (MoCA), and cerebrospinal fluid (CSF) opening pressure, and cognitive dysfunction. Linear regression test showed that BMI, CSF opening pressure and MoCA were the main predictors ofboth serum and expression levelsof visfatinin obese women. The receiver operating characteristic curve (ROC) analysis revealed that the power of serumvisfatin levels was higher than visfatin expression in differentiating obese women from lean ones. Conclusion: there was a strong independent association between higher visfatin expression and serum levels with obesity indices, metabolic risks, IIH and cognitive dysfunction in obese Egyptian women.