Neuro-ophthalmological biomarkers of visual outcome in newly diagnosed idiopathic intracranial hypertension

Abstract

Background: Idiopathic intracranial hypertension (IIH) is a disorder of unidentified etiology characterized by raised intracranial pressure (ICP) without clinical, laboratory, or radiological evidence of intracranial pathology. The aim of this work was to determine the visual outcome in newly diagnosed IIH patients. Methods: The study included 68 IIH patients; 59 responded to medical treatment and nine needed lumboperitoneal shunting (LPS). Patients were submitted to papilledema grading using Frisén Scale, water CSF manometry, brain MRI/ MRV, mean deviation of visual field examination (MD-VFE), optic nerve sheath diameter (ONSD), average optic disc optical coherence tomography-retinal nerve fiber layer (OCT-RNFL) thickness, and pattern-reversal visual evoked potential (VEP). Results: Patients needed LPS showed statistically significant increase in baseline papilledema grade, MD-VFE, ONSD, average OCT-RNFL thickness, and P100 VEP latency. On the other hand, both studied groups showed statistically nonsignificant differences regarding the patients' ages and opening CSF pressure. Conclusion: Newly diagnosed IIH patients' evaluation must be based on multimodality neuro-ophthalmological assessment where papilledema grade, MD-VFE, and OCT-RNFL are valuable biomarkers of PVD while P100 VEP latency delay is a predictor of poor visual outcome and ONSD is an early indicator of elevated ICP regression after LPS surgery.

Diagnostic value of brain MR imaging and its correlation with clinical presentation and cognitive functions in idiopathic intracranial hypertension patients

“…This manifestation coincides with other previous studies [32,33]. The etiology of pulsatile tinnitus is not completely elucidated, but it is supposed that stenosis in the transverse sinus, which were commonly observed in patients of this study, may produce audible turbulences in blood flow [5,34].…”

“…In this study, headache of increased ICP was the core symptom presents in all patients and was the leading cause for asking medical advice as reported in other many studies; however, headache characters were nonspecific in the current study [5,29]. As regards headache type, continuous headache was the main presenting complaint followed by chronic then episodic type, and this was consistent with Yri and Jensen [30] and inconsistent with Skau and colleagues; they reported that episodic headache was the main presentation followed by continuous type [31].…”

“…Neuro-ophthalmic evaluation is essential for diagnosis of IIH patients including headache, visual symptoms, olfactory dysfunction, pulsatile tinnitus, and sixth nerve palsy (6th NP) [5][6][7][8]. Although cognition is not screened routinely during clinical evaluation of IIH, many recent researches were done for assessment of cognitive function and reported cognitive impairment (CI) in these patients [9].…”

Should Lumbar Puncture Be Required to Diagnose Every Patient With Idiopathic Intracranial Hypertension?

“…As most neuro-ophthalmologists are aware though, the LP in a patient who is in a typical demographic group for IIH (women of childbearing age with increased BMI) will demonstrate expected results: elevated OP and normal CSF composition. We know that OP during LP does not correlate with the severity of the disease nor with visual prognosis (6,7). Neuroimaging, which would have been performed before an LP, should demonstrate indirect neuroimaging signs in nearly all patients suspected of having IIH.…”