Disease activity in idiopathic intracranial hypertension: a 3-month follow-up study

Abstract

Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure (ICP) in the absence of identifiable pathology. The purpose of this study was to evaluate the clinical presentation and monitor a 3-month course using frequent optical coherence tomography (OCT) evaluations, visual field testings and lumbar opening pressure measurements. A longitudinal study of 17 patients with newly diagnosed IIH and 20 healthy overweight controls were included in the study. Peripapillary retinal nerve fiber layer thickness (RNFLT) and retinal thickness (RT) measurements (Stratus OCT-3, fast RNFL 3.4 protocol), and Humphrey visual field testing were evaluated at regular intervals. Repeat lumbar puncture was performed at final visit (n = 13). The diagnostic delay was 3 months and initial symptoms were headache (94%), visual blurring (82%) and pulsatile tinnitus (65%). Complete clinical remission was achieved in 65%, partial in 29% and unchanged symptoms in 6%. Total average RNFLT and RT decreased significantly during the follow-up period (p < 0.0001 and p < 0.0001, respectively). Changes in RNFLT and RT correlated with improvements in visual field mean deviation (MD) (RNFLT: p = 0.006; RT: p = 0.03) and pattern standard deviation (PSD) (RNFLT: p = 0.002; RT: p = 0.003). In patients with weight-loss >3.5% of BMI, ICP decreased significantly (p = 0.0003). In patients with weight-loss <3.5% of BMI, changes in ICP were insignificant (p = 0.6). OCT combined with visual field testing may be a valuable objective tool to monitor IIH patients and the short term IIH outcome is positive. Weight-loss is the main predictor of a favorable outcome with respect to CSF pressure.

OCT measurements of optic nerve head changes in idiopathic intracranial hypertension

“…OCT has made possible detection of abnormalities of peripapillary retinal nerve fiber layer (RNFL) in newly diagnosed and chronic IIH. RNFL thickness above normal was also reported in patients with acute relapse or newly diagnosed IIH [7,8], while significantly reduced RNFL thickness was observed in chronic IIH or in patients with treated IIH [9]. Degree of ONH swelling correlates with papillary RNFL thickness [10] and total retinal-optic nerve volume [11].…”

“…This is why increased peripapillary RNFL thickness and total retinal thickness are proposed as useful markers for quantification of papilledema severity [10,11,13]. These measures may associate with reduced ICP and improvements in visual field in newly diagnosed IIH [7,8]. But they are not sensitive enough for monitoring ICP in chronic IIH [8], especially in those IIH patients who have decreased macular ganglion cell layer (GCL) or retrograde optic nerve damage [14].…”

Idiopathic intracranial hypertension is not benign: a long-term outcome study

“…At baseline patients entered a course of dietary recommendations and follow-up visits resulting in an overall initial weight loss [37]. Despite continuous information of the correlation between weight loss and prognosis the longterm effect was poor.…”

“…Exclusion criteria were other significant medical, psychiatric or ocular disorders. A group of 20 healthy individuals, matched in terms of age, gender and body mass index (BMI) served as control [37].…”

Headache prevalence and clinical features in patients with idiopathic intracranial hypertension (IIH)

“…In fact, clear data on this topic are not available as only recently some reports have focused on the evaluation of the possible correlations between some clinical and instrumental aspects in the follow up of IIH patients [8][9][10][11].…”