A Comparison of Idiopathic Intracranial Hypertension With and Without Papilledema

Abstract

Objective To compare clinical features, visual characteristics, and treatment of idiopathic intracranial hypertension patients with and without papilledema. Background Idiopathic intracranial hypertension does not often occur without papilledema. This study estimates the prevalence and compares the clinical characteristics of idiopathic intracranial hypertension patients with and without papilledema. Methods We performed a cross-sectional analysis of all idiopathic intracranial hypertension patients diagnosed at the University of Utah Neuro-Ophthalmology Unit between 1990 and 2003. Patient records were reviewed for presence of papilledema and other signs, symptoms, and treatment characteristics. Each patient without papilledema was matched to the patient with papilledema who was closest to his/her age and sex. McNemar’s and Wilcoxon-signed rank sum tests were used to compare characteristics between matched pairs. Results Among all patients (n = 353), the prevalence of those without papilledema was 5.7% (n = 20). Patients without papilledema reported photopsias (20%), and were found to have spontaneous venous pulsations (75%) and non-physiologic visual field constriction (20%) more often than did those with papilledema. Mean opening pressure, although above normal, was lower in patients without papilledema (mean = 309 mm cerebrospinal fluid) compared with those with papilledema (mean = 373 mm cerebrospinal fluid, P = .031). Idiopathic intracranial hypertension patients without papilledema had more frequent diagnostic lumbar punctures than did patients with papilledema. Visual acuities and treatment were similar between groups. Conclusions The clinical presentation of idiopathic intracranial hypertension without papilledema is only somewhat different from that of idiopathic intracranial hypertension with papilledema. The lower opening pressure in patients without papilledema may explain variations in symptoms and signs between the 2 groups. When there are visual field changes in idiopathic intracranial hypertension without papilledema, non-physiologic visual loss should be considered.

Quantitative analysis of optic nerve damage in idiopathic intracranial hypertension (IIH) at diagnosis

“…Many studies showed a strong association between the amount of papilledema and severity of visual loss in patients with newly diagnosed IIH [7]. However, information provided by SD-OCT may diverge from analysis of visual function; compared to SAP, that is a sensitive test for visual loss, SD-OCT abnormalities can reveal early optic nerve damage also in cases without papilledema or visual field loss or when papilledema is not reversed.…”

MR Imaging of Papilledema and Visual Pathways: Effects of Increased Intracranial Pressure and Pathophysiologic Mechanisms

“…It is therefore natural that those who are primarily concerned in the conservation of the patient's sight should demand early or immediate operation, for it is only by operation that permanent relief of pressure can be obtained." 3 Papilledema has gained increasing interest in recent years among neuro-ophthalmologists as the result of several clinical studies demonstrating that it may have not only diagnostic potential as a measure of increased ICP [4][5][6][7] but also therapeutic potential as a measure of disease severity and response to treatment. 8 In attempting to detect and diagnose papilledema as early as possible in patients, MR imaging is becoming a useful noninvasive method.…”

Migraine headache in patients with idiopathic intracranial hypertension

“…11 However, it seems that in any patients with chronic migraine headache that is refractory and do not respond to usual prophylactic migraine headache, it is essential that done spinal tap for rule out of idiopathic intracranial hypertension without papilledema. 12 In our study obesity was frequent in IIH patients with and without migraine, the relation between obesity and IIH remains unclear. It is seem that Healthy overweight individuals may have CSF pressure above the normal range and also the obesity associated with increased severity and frequency of migraine attacks.…”