Racial differences in idiopathic intracranial hypertension

Bruce, Bonnie; Preechawat, Pisit; Newman, Nancy J.; Lynn, Michael; Biousse, Valérie

doi:10.1212/01.wnl.0000304746.92913.dc

Cited by 83 publications

(74 citation statements)

References 23 publications

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“…We present the only study, to our knowledge, which examines the relationship between clinical course and TSS among patients with IIH. Our quantitative measures of the TSs were not predictive of the clinical course of patients with IIH, suggesting that other factors such as those previously associated with poor outcomes in IIH 14,31,32 (i.e., black race, male sex, anemia, recent weight gain, and morbid obesity) are more relevant than the anatomic degree of TSS. Most importantly, our study does not support the notion that patients with IIH with high-grade stenosis on MRV require TS stenting or need different management than patients with IIH without severe TSS in order to prevent poor outcomes.…”

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confidence: 57%

“…This was surprising given the prevailing assumption that TSS is on a pathologic feedback loop that would be expected to increase ICP and thus lead to poorer outcomes. 3,14 Prior studies have attempted to describe the stenoses seen in patients with IIH, in some cases semiquantitatively. [15][16][17][18] Varying frequencies of TSS in patients with IIH have been reported, with generally a very high prevalence (65%-100%).…”

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confidence: 99%

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Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis

et al. 2013

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Objective: Transverse sinus stenosis (TSS) is common in idiopathic intracranial hypertension (IIH), but its effect on the course and outcome of IIH is unknown. We evaluated differences in TSS characteristics between patients with IIH with "good" vs "poor" clinical courses.Methods: All patients with IIH seen in our institution after September 2009 who underwent a high-quality standardized brain magnetic resonance venogram (MRV) were included. Patients were categorized as having a good or poor clinical course based on medical record review. The location and percent of each TSS were determined for each patient, and were correlated to the clinical outcome. Results:We included 51 patients. Forty-six patients had bilateral TSS. The median average percent stenosis was 56%. Seventy-one percent of patients had stenoses .50%. Thirty-five of the 51 patients (69%) had no final visual field loss. Eight patients (16%) had a clinical course classified as poor. There was no difference in the average percent stenosis between those with good clinical courses vs those with poor courses (62% vs 56%, p 5 0.44). There was no difference in the percent stenosis based on the visual field grade (p 5 0.38). CSF opening pressure was not associated with either location or degree of TSS. Conclusion: TSS is common, if not universal, among patients with IIH, and is almost always bilateral.There is no correlation between the degree of TSS and the clinical course, including visual field loss, among patients with IIH, suggesting that clinical features, not the degree of TSS, should be used to determine management in IIH. Idiopathic intracranial hypertension (IIH) is a syndrome of isolated elevated intracranial pressure (ICP) of unknown etiology, responsible for visual loss from papilledema in about 25% of cases.

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confidence: 57%

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confidence: 99%

Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis

et al. 2013

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“…29 Recently, some racial disparities in outcome have been noted, in which black patients are more than 3 times as likely to have severe visual loss, even with equivalent access to treatment; severe visual loss was present in 23% of black patients versus 7% of nonblack patients. 43 Patients with PTC also appear to have depression and anxiety to a greater extent than weight-matched controls and healthy controls. 44 Health-related quality-of-life scores are also affected in PTC, with patients reporting significantly lower general health than controls and patients with other neuro-ophthalmologic conditions.…”

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confidence: 95%

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

Degnan

Levy

2011

AJNR Am J Neuroradiol

239

179

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SUMMARY: PTC is a clinical entity of uncertain etiology characterized by intracranial hypertension. The syndrome classically manifests with headaches and visual changes in women with obesity. Traditionally, imaging ruled out secondary causes of elevated CSF pressure but now may reveal findings frequently seen in patients with PTC, including the following: flattening of the globe, an empty sella, an enlarged ONS, protrusion and enhancement of the optic nerve head, and increased tortuosity of the optic nerve. Novel imaging methods, including MR venography, have additionally identified sinovenous stenosis as a potential indicator of PTC.ABBREVIATIONS: BMI ϭ body-mass index; CN ϭ cranial nerve; HIV ϭ human immunodeficiency virus; ICP ϭ intracranial pressure; IIH ϭ idiopathic intracranial hypertension; ISF ϭ interstitial fluid; MRI ϭ MR imaging; ONS ϭ optic nerve sheath; ONSF ϭ optic nerve sheath fenestration; IOP ϭ intraocular pressure; PCOS ϭ polycystic ovary syndrome; PTC ϭ pseudotumor cerebri syndrome

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“…Although it is mostly described as a disease affecting young overweight women, there is an increasing incidence in overweight men and children, parallelto the rising prevalence of obesity. (1,5,6,7) In Romania, according to the latest statistics, 19.1% of the women aged 18 to 44 years are overweight, which is more than twice the value reported in 1980 when the rate of obesity in the general population was only 8.6%. (8) …”

Section: Epidemiologymentioning

confidence: 92%

Optic Neuropathy in Idiopathic Intracranial Hypertension

Merticariu¹,

Baltă²,

Merticariu³

et al. 2017

JTMR

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Adult patients who present with papilloedema and symptoms of raised intracranial pressure need urgent multidisciplinary assessment including neuroimaging, to exclude life-threatening causes. Where there is no apparent underlying cause for the raised intracranial pressure, patients are considered to have idiopathic intracranial hypertension (IIH). Objectives: This review encompasses the newly revised diagnostic criteria for PTCS in adults and children and the role of obesity in the epidemiology, etiology, and management of IIH.Furthermore, this paper tries to offer a practical approach to assessing patients with papilloedema, the investigations and the subsequent management of patients with IIH. Methodology: PubMed was used to search for IIH and Pseudotumor Cerebri. The vast majority of the literature consisted of cohort studies, case control studies, systematic reviews and other narrative reviews. Conclusion: Idiopathic intracranial hypertension (IIH), also known as primary Pseudotumor Cerebri syndrome (PTCS), is a condition of unknown etiology which affects primarily overweight, reproductive-aged women and causes increased intracranial pressure (ICP). This review discusses the recently revised diagnostic criteria for IIH for adults and children and the controversial issues in its diagnosis and management.

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Racial differences in idiopathic intracranial hypertension

Cited by 83 publications

References 23 publications

Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis

Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

Optic Neuropathy in Idiopathic Intracranial Hypertension

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