Presumptive Idiopathic Intracranial Hypertension Based on Neuroimaging Findings: A Referral Pattern Study

Aung, Andre B; Chen, Benson; Wicks, Jaime; Bruce, Beau B; Meyer, Benjamin I.; Dattilo, Michael; Kedar, Sachin; Saindane, Amit M.; Newman, Nancy J.; Biousse, Valérie

doi:10.1097/wno.0000000000001660

Cited by 7 publications

(3 citation statements)

References 43 publications

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“…Limited access to neuroophthalmological assessment has been emphasized by a group of American neurologists advocating for the initiation of IIH‐directed treatment based on clinical suspicion alone before any neuroophthalmological assessment has occurred [12]. With expanding possibilities for neuroimaging, neuroophthalmologists are often burdened with rule‐out referrals for IIH suspicion [13]. It is argued that the COMPASS system candidates as a beneficial replacement of a doubtful ophthalmoscopic assessment of papilledema, improving patient care by facilitating faster initial optic disc assessments of higher quality.…”

Section: Discussionmentioning

confidence: 99%

“…With expanding possibilities for neuroimaging, neuroophthalmologists are often burdened with rule-out referrals for IIH suspicion [13]. It is argued that the COMPASS system candidates as a beneficial replacement of a doubtful ophthalmoscopic assessment of papilledema, improving patient care by facilitating faster initial optic disc assessments of higher quality.…”

Section: Discussionmentioning

confidence: 99%

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Fundus imaging and perimetry in patients with idiopathic intracranial hypertension—an intermethod and interrater validity study

Rissan

Hansen

Carlsen

et al. 2023

Euro J of Neurology

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Background and purpose: There is a need to improve the diagnostic process of patients suspected of papilledema. In patients with known or suspected idiopathic intracranial hypertension a fundus imaging and perimetric visual field assessment system (COMPASS) performed at a headache center was validated in comparison to an assessment (Topcon plus OCTOPUS) at a neuroophthalmological clinic.Methods: For intermethod assessment, blinded fundus images and perimetry from COMPASS versus Topcon plus OCTOPUS were assessed by a neuroophthalmologist. For interrater assessment, fundus images and perimetry obtained by the COMPASS system were assessed by an untrained medical doctor, a trained neurologist and a trained medical student and compared to the neuroophthalmologist's assessments. Results:For the intermethod variation of the presence of papilledema on fundus images, a kappa value of 0.60, sensitivity of 87% and specificity of 73% were found. The interrater variation of the presence of papilledema on fundus images showed kappa values ranging from 0.43 to 0.74, sensitivity values ranging from 70% to 96% and specificity values ranging from 46% to 93% when comparing the assessments made by the headache center staff with neuroophthalmologist's assessments. The COMPASS showed a 59% sensitivity and moderate agreement in detecting visual field defects compared with OCTOPUS. The visual field assessment showed only slight to fair agreement from 0.19 to 0.31 between assessments made by the headache center staff and the neuroophthalmologist. Conclusion:The COMPASS system can be used with reasonable sensitivity in the assessment of papilledema in patients suspected of idiopathic intracranial hypertension at a tertiary headache center.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fundus imaging and perimetry in patients with idiopathic intracranial hypertension—an intermethod and interrater validity study

Rissan

Hansen

Carlsen

et al. 2023

Euro J of Neurology

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show abstract

“…It is crucial that clinicians do not immediately associate incidentally detected RAD-IH with a presumptive diagnosis of IIH, as these findings can also be seen in those with unrelated disorders or may indicate a state of previous intracranial hypertension [ 7 ]. The vast majority of patients with incidentally detected RAD-IH do not have papilledema and, therefore, do not have IIH [ 8 ]. Proceeding to lumbar puncture or empiric treatment with acetazolamide has the potential to cause patient harm [ 9 ].…”

Section: Typical Presentations Of Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

Expanding the clinical spectrum of idiopathic intracranial hypertension

Chen

Britton

2022

Current Opinion in Neurology

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Purpose of reviewIdiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure (ICP). Although the majority of patients with IIH present classically with headache and papilledema, some patients may have unusual presentations or manifestations. Recent advancements in neuroimaging have facilitated the identification of other presentations associated with IIH. This review provides an overview of the expanding clinical spectrum of IIH. Recent findingsPresentations of IIH that are considered unusual include highly asymmetric or unilateral papilledema, IIH without papilledema, and IIH associated with cranial nerve involvement. These presentations likely reflect differences in the way cerebrospinal fluid (CSF) pressure is transmitted intracranially. Radiological signs of intracranial hypertension are increasingly recognized in patients with IIH and provide further insights into the effects of raised ICP on intracranial structures. Osseous changes in the skull base leading to formation of meningoceles and encephaloceles have been identified in patients with IIH, spontaneous skull base CSF leak, and drug-resistant temporal lobe epilepsy, suggesting a possible association. SummaryClinicians should be familiar with the expanding clinical spectrum of IIH and the implications for the management of these presentations. Keywords idiopathic intracranial hypertension, MRI, raised intracranial pressure, spontaneous cerebrospinal fluid leak, temporal lobe epilepsy ]. Papilledema is an 'outstanding objective finding' of IIH [2] and is the key diagnostic criterion in

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Novel Approaches to the Treatment of Idiopathic Intracranial Hypertension

Subramanian

2024

Curr Neurol Neurosci Rep

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Presumptive Idiopathic Intracranial Hypertension Based on Neuroimaging Findings: A Referral Pattern Study

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 7 publications

References 43 publications

Fundus imaging and perimetry in patients with idiopathic intracranial hypertension—an intermethod and interrater validity study

Fundus imaging and perimetry in patients with idiopathic intracranial hypertension—an intermethod and interrater validity study

Expanding the clinical spectrum of idiopathic intracranial hypertension

Novel Approaches to the Treatment of Idiopathic Intracranial Hypertension

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