Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience

Abstract

Background: Idiopathic intracranial hypertension (IIH) affects predominantly obese females during their reproductive age period. The demographics of this condition has not been studied in Kuwait before. Objectives: To determine the demographics, clinical features, risk factors, and treatment modalities of IIH in the main neurology tertiary referral hospital in Kuwait and to compare our data with literature. Methods: A retrospective study was conducted to identify cases of IIH seen between January 1, 2018, and December 31, 2018. Patients were diagnosed in and referred from the neurology and neuro-ophthalmology clinics. Results: Our cohort consisted of 139 patients. We estimated a crude annual incidence rate of IIH of 3.28 per 100,000 population. Female-to-male ratio was 9.6:1. Mean age was 32.1 ± 10.8 years. Mean age of males was 31.46 ± 12.63 and that of females was 32.11 ± 10.67. The median of the duration from the first symptoms till diagnosis was 6 weeks (2-10 weeks). Headache was the most common symptom in 134 (96.4%) patients, followed by visual disturbances in 85 (61.2%) patients, transient visual obscurations (TVOs) in 84 (60.4%) patients, pulsatile tinnitus in 72 (51.8%) patients, diplopia in 22 (15.8%) patients, other symptoms (e.g., nausea, vomiting, radicular neck, and back pain) in 19 (13.7%) patients, and 1 (0.7%) patient had facial weakness. High body mass index (BMI) was seen in 89.9% of patients, either overweight or obese, and it was the most common risk factors in both males (46.2%) and females (61.1%). Anemia was found in 38.1%; 21.6% of patients used OCPs and 7.9% used vitamin A. Bilateral transverse sinus stenosis (BTSS) was detected in 47 (33.8%) patients. Only 2 (1.4%) patients developed "fulminant IIH" characterized by rapidly progressive disease. All the patients received medical treatment and only 12 (8.6%) needed surgical management. Al-Hashel et al. Idiopathic Intracranial Hypertension in Kuwait Conclusion: Incidence of IIH in Kuwait is similar to other regional studies but higher than Western studies. Demographics and clinical features of IIH in our study are comparable to international and regional figures. Most of our patients had a benign course. IIH is more prevalent in females and strongly associated with obesity.

Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre

“…11 Similar to previous studies, female predominance was found in our IIH patients. 10,14 Despite similar risk factors and age-group, female preponderance was found among IIH patients in the study of Bruce et al 15 Hormonal etiology could be a predisposing factor for IIH in the female during the fertility period. Previous studies had shown an association of OCP and IIH which was not found to be related in a recent study by Kilgore et al 16 Headache characteristics in IIH are nonspecific.…”

“…However, most of the previous studies have shown the positive relation of IIH with higher BMI and weight gain. 5,[10][11][12] Majority of our patients had BMI>25, however, none had BMI >30. Our results were similar to Kim et al, in contrast to western studies where the obesity percentage in IIH was higher.…”

“…Tinnitus is another typical finding of IIH; however, it was just reported in our 3 patients. 10 Transient visual symptoms are important findings of IIH, and progressive visual loss needs to be prompt evaluation and treatment. 17 Cranial nerve involvement is not frequent, but like ours, involvement of the abducent nerve has been found in most studies.…”

“…17 Cranial nerve involvement is not frequent, but like ours, involvement of the abducent nerve has been found in most studies. 10 High CSF opening pressure is an important diagnostic criterion and frequently correlates with the severity of IIH, especially visual symptoms. 7 Few of our patients were probable IIH with normal CSF opening pressure.…”

Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia

“…17 The incidence of IIH has been reported to be approximately 0.03-2.36/100 000 in a recent meta-analysis, however marked heterogeneity was noted. 6 There is significant regional variation in incidence, [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] with rates from as low as 0.03/100 000 in Japan 36 Open access 3.6/100 000 in Fife (Scotland). 37 Higher incidence rates are consistently reported in women, particularly women of childbearing age, 18-20 22 23 25 28-31 with the highest rates reported in women with obesity.…”