Idiopathic Intracranial Hypertension and Anemia: A Matched Case–Control Study

Lin, Weijie; Berry, Shauna; Nakawah, Mohammad Obadah; Sadaka, Ama; Lee, Andrew G.

doi:10.1097/wno.0000000000000872

Cited by 19 publications

(22 citation statements)

References 28 publications

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“…Table 2 summarizes the studies that investigated prevalence of anemia among patients with IIH (4,11,(20)(21)(22)(23). The weighted incidence of anemia in patients with IIH among 7 studies was 195/1,073 (18.2%).…”

Section: Results Of Larger Prevalence Studiesmentioning

confidence: 99%

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Anemia and Idiopathic Intracranial Hypertension: A Systematic Review and Meta-analysis

Waisberg²,

Kwok³

et al. 2021

Journal of Neuro-Ophthalmology

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Background:Idiopathic intracranial hypertension (IIH) is a condition typically affecting young, obese women. Although anemia is recognized as a risk factor of IIH from case reports, their relationship remains controversial as several comparative studies showed no significant association. This study aimed to examine the relationship between anemia and IIH.Methods:MEDLINE, Embase, Cochrane Library, and grey literature were searched to September 2020. Primary studies on patients with diagnoses of anemia of any kind and IIH were included. Primary outcomes included the total number of cases of anemia and IIH. A meta-analysis on the prevalence of anemia in IIH compared with control patients was conducted. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to rate the quality of evidence.Results:Overall, 62 cases and 5 observational or case–control studies were included. Pooled incidence of anemia in patients with IIH was 195/1,073 (18.2%). Patients with IIH (n = 774) had a significantly higher prevalence of anemia compared with controls (n = 230,981) (RR 1.44 [95% confidence interval 1.08–1.92]). Patients were 67.7% females and had a mean age of 22.4 years. The mean opening pressure was 37.9 cmH2O. Anemia was most commonly caused by iron deficiency (51.6%) and aplastic anemia (19.4%). Most patients (59.7%) showed improvement or resolution with anemia treatment only without intracranial pressure-lowering therapy. Evidence was limited because of high risk of reporting bias from the large number of case reports and case–control studies.Conclusions:Anemia is significantly more common in IIH compared with control patients, and case reports suggest a direct relationship. Complete blood counts should be considered in all patients with papilledema, particularly in atypical presentations (male, nonobese, nonperipapillary retinal hemorrhages, prominent risk factor for anemia) or in treatment-refractory IIH.

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Section: Results Of Larger Prevalence Studiesmentioning

confidence: 99%

“…However, the relationship between anemia and IIH remains controversial as iron deficiency anemia is also common in young women of childbearing age. In addition, larger controlled studies have failed to reveal an association between anemia and IIH despite numerous case reports supporting their causal relationship (4,11).…”

mentioning

confidence: 99%

Anemia and Idiopathic Intracranial Hypertension: A Systematic Review and Meta-analysis

Waisberg²,

Kwok³

et al. 2021

Journal of Neuro-Ophthalmology

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“…In a retrospective study from China, anemia with IIH (22/153) was associated with shorter disease duration and better visual outcome following correction of anemia [13]. In another case-control study, no significant difference was observed between anemic patients with IIH and matched controls with other ophthalmic diagnoses [14]. Our patient also required additional treatment with carbonic anhydrase inhibitors, steroids, and serial lumbar punctures as the symptoms did not alleviate with the initial blood transfusion.…”

Section: Discussionmentioning

confidence: 66%

Abortion and Fulminant Idiopathic Intracranial Hypertension

Selvaraj

Veeranki

Kommaraju

et al. 2021

Cureus

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Idiopathic intracranial hypertension (IIH) causes visual involvement secondary to papilledema but rarely presents with acute gross diminution of vision. Anemia is associated with IIH. Acute hemorrhage-related anemia causing severe sudden onset bilateral visual loss due to IIH has not been previously reported. A 28year-old female attempted the first-trimester abortion by self-administration of oral drugs. She presented with bleeding per vaginum, followed by bilateral visual loss. Symptoms pertaining to intracranial hypertension were mild. Examination revealed pallor, normal hemodynamic parameters, bilaterally dilated pupils, bilateral lateral rectus palsy, and only perception of light in both eyes. Lumbar puncture demonstrated high pressures; neuroimaging was noncontributory. Blood transfusion and supportive therapy in the form of acetazolamide and pulse methylprednisolone improved her vision in the right eye to six of 24; optic nerve sheath fenestration was performed in the left eye. During follow-up, her vision improved to six of 24 (right) and two of 60 (left), respectively. The IIH can present with severe acute onset bilateral visual loss even if features of raised intracranial pressure are minimal or absent. Immediate correction of anemia and supportive measures may significantly improve visual outcomes in fulminant IIH without the necessity of surgery.

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“…Although IIH most commonly affects anemic menstruating women, the causation between anemia and raised ICP could not be explained by a retrospective, matched case-control study conducted by Lin et al In their study, no statistically significant association was found between the complete blood count values in patients diagnosed with IIH compared with the controls [ 14 ]. However, there is substantial evidence in literature where symptomatic resolution of papilledema was seen with the prompt correction of anemias [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Papilledema and Anemia: A Rare Association

Prakash¹,

Basavaraju²,

Gowda³

2022

Cureus

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Papilledema is the swelling of the optic disc due to the transmission of intracranial pressure through the optic nerve. It can occur as a symptom of various intracranial pathologies that elevate the intracranial pressure. Even though anemia has been described as an association with raised intracranial pressure, the exact causal relationship between the two has not been well established in the literature. We present one such unusual case wherein a 21-year-old female patient, who complained of headaches, was found to have papilledema and severe anemia. After an unyielding workup for secondary causes, the rare association between papilledema and anemia was considered and prompt hemoglobin correction was ensued. Subsequently, resolution of papilledema and improvement in the visual acuity of the patient was observed. Although the causal relationship between anemia and papilledema has not been thoroughly explained, appropriate workup and correction of anemia play an integral role in the management of patients with papilledema and the prevention of long-term ocular complications.

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Idiopathic Intracranial Hypertension and Anemia: A Matched Case–Control Study

Cited by 19 publications

References 28 publications

Anemia and Idiopathic Intracranial Hypertension: A Systematic Review and Meta-analysis

Anemia and Idiopathic Intracranial Hypertension: A Systematic Review and Meta-analysis

Abortion and Fulminant Idiopathic Intracranial Hypertension

Papilledema and Anemia: A Rare Association

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