Idiopathic Intracranial Hypertension: Prognostic Factors and Multidisciplinary Management

Abstract

Background Idiopathic intracranial hypertension (IIH) mostly affects young obese women and can lead to permanent visual impairment. However, prognostic factors and therapeutic strategy remain unclear. Methods We retrospectively collected data from all patients diagnosed and managed for IIH in our university center from January 2001 to December 2016. Results Seventy-nine patients were diagnosed with IIH. Bilateral transverse sinus stenosis (TSS) was found in 74% of the population. Visual outcome at 6 months was poor for 46% of patients, including all patients presenting weight gain of at least 5% since diagnosis (p < 0.001), whereas mean body mass index at diagnosis was not different between patients with poor versus good outcome (32.9 ± 7.7 versus 34.6 ± 9.4 kg·m−2). Other significant factors of poor prognosis were bilateral TSS (OR = 5.2; 95 CI: 1.24–24.9; p = 0.024). Thirteen patients with poor outcome after 6-month assessment underwent unilateral TSS stenting leading to visual improvement in 11 cases. Conclusion Weight gain, rather than initial weight, emerged as the leading factor of poor visual outcome in patients with IIH, followed by presence of bilateral TSS. Consequently, first-line treatment must include dietary measures to control weight. Unilateral stenting appears to be a safe second-line treatment option for patients with bilateral TSS.

“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

“…The mean opening CSF pressure at the time of diagnosis varies; in the current study, it was 38.2 cmH 2 O, which was similar to the result reported in Patsalides et al [14] study, which was 37 cmH 2 O. Chan [16] reported a higher value for the opening CSF pressure of 41.4 cmH 2 O; on the other hand, Smith and Friedman [17] and Chagot et al [15] obtained lower values, namely, 34.3 cmH 2 O and 28.5 cmH 2 O, respectively.…”

“…IIH is common in overweight persons, and the mean body mass index of most studies was more than 25 kg/m 2 . In the current study, the mean body mass index was 33.2 kg/m 2 , and it was 35.4 kg/m 2 , 35 kg/m 2 , 34.8 kg/m 2 , and 27.1 kg/m 2 in Patsalides et al [14], Chagot et al [15], Saber et al [12], and Agarwal et al [13], respectively.…”

Endovascular stenting for idiopathic intracranial hypertension with venous sinus stenosis

“…No significant impact of weight change on visual outcome was detected during follow‐up. Chagot et al have suggested that weight gain, rather than initial weight, is a leading factor of poor visual outcome in patients with IIH using first‐line treatment (Chagot et al, ). We propose that venous sinus stenting may be a powerful covariate that affects the outcome.…”

“…In our study, we found that the trans-stenotic pressure gradient increased with escalating BMI prior to treatment and that baseline BMI was associated with the capacity of stenting to change intracerebral pressure and the trans-stenotic pressure gradient. (Chagot et al, 2017). We propose that venous sinus stenting may be a powerful covariate that affects the outcome.…”

“…Idiopathic intracranial hypertension (IIH), also known as primary pseudotumor cerebri, is a complicated syndrome that includes elevated intracranial pressure of unidentified etiology (Sundholm et al, 2017). IIH generally manifests with debilitating headaches, nausea, vision loss, impaired visual fields, diplopia, and pulse-synchronous tinnitus, and it primarily affects overweight women of childbearing age at a rate of 12-28 per 100,000 persons annually (Chagot et al, 2017). Permanent vision loss may affect up to 30% of patients due to IIH-associated chronic papilledema (Andrews, Liu, & Ko, 2014;Liu et al, 2017).…”