Factors affecting visual loss and visual recovery in patients with pseudotumor cerebri syndrome

Abstract

Purpose: To investigate the frequency of visual loss (VL), possible predictive factors of VL, and improvement in patients with pseudotumor cerebri (PTC) syn drome. Methods: We reviewed 50 PTC patients (43 females, seven males) who underwent neuro-ophthalmic examination at the time of diagnosis and after treatment. Demographic data, body mass index (BMI), time from symptom onset to diagnosis (TD), maximum intracranial pressure (MIP), occurrence of cerebral venous thrombosis (CVT), and treatment modalities were reviewed. VL was graded as mild, moderate, or severe on the basis of visual acuity and fields. Predictive factors for VL and improvement were assessed by regression analysis. Results: The mean ± SD age, BMI, and MIP were 35.2 ± 12.7 years, 32.0 ± 7.5 kg/cm², and 41.9 ± 14.5 cmH 2 O, respectively. Visual symptoms and CVT were present in 46 and eight patients, respectively. TD (in months) was <1 in 21, 1-6 in 15, and >6 in 14 patients. Patients received medical treatment with (n=20) or without (n=30) surgery. At presentation, VL was mild in 16, moderate in 12, and severe in 22 patients. Twenty-eight patients improved and five worsened. MIP, TD, and hypertension showed a significant correlation with severe VL. The best predictive factor for severe VL was TD >6 months (p=0.04; odds ratio, 5.18). TD between 1 and 6 months was the only factor significantly associated with visual improvement (p=0.042). Conclusions: VL is common in PTC, and when severe, it is associated with a delay in diagnosis. It is frequently permanent; however, improvement may occur, particularly when diagnosed within 6 months of symptom onset.

Clinical and Neuro-ophthalmologic Predictors of Visual Outcome in Idiopathic Intracranial Hypertension

“…There are however, controversies as to whether BMI can predict the final visual outcome in these patients. 18 In the current study also, 80% patients (32/40) had a BMI of ≥25, 70% were overweight and 10% were frankly obese. In this series, however, Body mass index did not show any correlation with the final visual outcome.…”

“…13,14 The current study was a hospital based study which included only newly diagnosed cases of IIH While various studies have attempted to find predictors of visual outcome in patients of IIH, there are controversies in the available literature. [15][16][17][18] In the current study, headache was the most common symptom at presentation (85%) followed by transient visual obscurations (52.5%). 22.5% of the patients had diplopia as time of presentation and 25% had significant visual deficits at presentation.…”

“…These findings are in concordance with available literature on the subject. 17,18 From the above discussion it is evident that though high CSF opening pressure, worsening vision/ papilledema, greater RNFL thickness and abnormal P100 latency on VEP may be some of the alarming signs for physicians, but none of these parameters in isolation can be used as predictor for visual outcome. Visual loss at presentation is probably the most important predictor of the final vision in these patients.…”

Idiopathic Intracranial Hypertension After Surgical Treatment of Cushing Disease: Case Report and Review of Management Strategies

“…Vision loss is common and if the delay in diagnosis is longer than 6 months it can be permanent. 18 A literature review resulted in identification of 16 cases of IHH after treatment of CD 8 ; 12 in children 7,19 and four in adults. 8,20,21 CD treatment included TSS, medications and adrenalectomy.…”

Higher cerebrospinal fluid (CSF) opening pressure in patients with idiopatic intracranial hypertension (IIH) with permanent visual impairment

“…In the current study we evaluated a cohort of patients with IIH and evaluated variables associated with permanent visual loss. [5][6][7]…”