Idiopathic intracranial hypertension in atypical demographics

Donaldson, Laura; Jhaveri, Aaditeya; Micieli, Jonathan A; Margolin, Edward

doi:10.1016/j.jns.2022.120271

Cited by 3 publications

(6 citation statements)

References 17 publications

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“…Within the literature, there are few large cohorts describing the longitudinal course of IIH [ 13 , 23 – 25 ]. Most were performed retrospectively or focus on particular interventions[ 26 , 27 ] or investigate specific risks such as sex or ethnicity [ 11 , 28 ]. There is a need for large prospective cohort studies evaluating the real-world clinical course of IIH.…”

Section: Introductionmentioning

confidence: 99%

The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

et al. 2022

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Background There are limited longitudinal data evaluating outcomes in idiopathic intracranial hypertension (IIH). We aimed to evaluate the long-term outcomes in a real-world cohort of patients with IIH and sought to establish the prognostic factors. Methods A longitudinal prospective cohort study was conducted over 9 years (2012–2021). Data included demographics and disease status. All consenting patients with IIH were recruited. Visual outcomes included visual acuity, Humphrey visual field and optical coherence tomography (OCT) imaging measurements. Headache frequency, severity, and impact were noted. We analysed the key variables impacting visual and headache outcomes. Results The cohort contained 490 patients with a confirmed IIH diagnosis. 98% were female with a mean body mass index (BMI) of 38 kg/m2. Those with the highest OCT retinal nerve fibre layer had the worst visual outcomes. We noted a delayed decline, in the visual field and OCT ganglion cell layer after 12 months. In the medically managed cohort (n = 426), we found that disease duration and change in BMI had the greatest influence on visual outcomes. There was a high burden of headache, with a daily headache at presentation and prior migraine history influencing long-term headache prognosis. Conclusions There is a delayed decline in visual outcomes in those with the most severe papilloedema. Disease duration and change in BMI were the key visual prognostic factors, therefore those with the more acute disease may require closer monitoring. Improving prognosis in IIH should focus on the potentially modifiable factor of weight management.

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Section: Introductionmentioning

confidence: 99%

The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

et al. 2022

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“…Only a small number of literature reports about IIH in non-obese young women. Other instances of rare cases of IIH are familial or genetic predisposition, including atypical demographics such as men and older people [7,8]. One study reported that IIH may be diagnosed in older patients with normal Body Mass Index (BMI) because there is a lower suspicion index in the normal BMI population [8].…”

Section: Discussionmentioning

confidence: 99%

“…Other instances of rare cases of IIH are familial or genetic predisposition, including atypical demographics such as men and older people [7,8]. One study reported that IIH may be diagnosed in older patients with normal Body Mass Index (BMI) because there is a lower suspicion index in the normal BMI population [8]. Associated conditions related to IIH were also reported, such as systemic diseases, vitamin deficiencies, or excess and anaemia; however, they were not directly linked.…”

Section: Discussionmentioning

confidence: 99%

Headache with Isolated Sixth Cranial Nerve Palsy in an Overweight Woman: A Case of Idiopathic Intracranial Hypertension

Goe Xian Jeff,

Sharifah Najwa Syed Mohamad,

Siti Noorfaezah Abdul Kadir

et al. 2024

MJoSHT

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Idiopathic intracranial hypertension (IIH), also known as pseudotumour cerebri, has an estimated incidence of 1 to 2 in 100,000 people per year. IIH commonly affects obese young women, where its pathogenesis, however, is not clearly understood. Patients present to the emergency department with a wide array of presentations. In light of this, we present a case of isolated sixth cranial nerve palsy in a non-obese young woman due to IIH in which brain imaging studies showed no abnormality; however, lumbar puncture reveals an opening pressure of more than 50 cmH2O. This case would help to alert physicians to consider IIH as one of the differential diagnoses when encountering such cases, as an uncommon presentation in the non-obese patient, and prompt referral is important to avoid unnecessary delay in the treatment of IIH.

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“…A smaller study did not find an association with IIH but instead with younger age, headache and elevated BMI [13] (Table 1). In those with established comorbid psychiatric disorders compared to those without, visual outcomes in IIH were found to be worse, both at baseline and after a further 6 months [14][15][16][17][18][19][20][21] (Table 1).…”

Section: Epidemiologymentioning

confidence: 99%

“…Donaldson et al [18] (Table 1) looked further into the characteristics of the atypical IIH cohort demonstrating a lower prevalence of headaches in older patients. Men also tended to have worse visual fields at presentation, but final visual outcomes were no different to the typical IIH patient.…”

Section: Epidemiologymentioning

confidence: 99%

Idiopathic intracranial hypertension: expanding our understanding

Markey,

Hutchcroft,

Emsley

2023

Current Opinion in Neurology

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Purpose of review Idiopathic intracranial hypertension (IIH) affects predominantly overweight women of childbearing age, causing chronically disabling headaches and visual loss. Weight loss remains the most effective management strategy, but innovative treatments and randomized control trials (RCTs) remain few. This paper will review recent IIH research. Recent findings Pregnancy-related complications, but not losses, are increased in IIH, while symptom severity is not affected. Weight loss of 24% results in normalization of intracranial pressure (ICP) and improvement in papilledema. Prolonged periods of papilledema results in delayed thinning of the ganglion cell layer. Less-invasive telemetry has improved understanding of the positional effects on ICP with rises seen in the supine and lateral decubitus. Exenatide, a GLP-1 agonist, may reduce ICP and improve symptoms. Venous sinus stenting is increasingly popular but its benefits over CSF diversion remains unclear. Summary Early involvement of obstetric care is recommended with pregnancy in IIH. Early intervention is required to avoid chronic papilledema that confers worse visual outcomes. Positional changes may affect ICP readings. The use of novel ICP telemetric devices has significant potential in future disease monitoring. The dual benefits of weight loss and ICP reduction with exenatide have significant potential in IIH management. Surgical RCTs are still required.

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Idiopathic intracranial hypertension in atypical demographics

Cited by 3 publications

References 17 publications

The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

Headache with Isolated Sixth Cranial Nerve Palsy in an Overweight Woman: A Case of Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension: expanding our understanding

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