The expanding spectrum of idiopathic intracranial hypertension

Biousse, Valérie; Newman, Nancy J.

doi:10.1038/s41433-022-02361-3

Cited by 14 publications

(3 citation statements)

References 29 publications

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“…This population is likely to have elevated intracranial pressure that is undiagnosed and, therefore, undertreated. Recent data suggests that it is advantageous to consider IIH on a spectrum (13,43,44). This is backed by the importance of the radiological findings and uncertainties surrounding the accuracy of the LPOP.…”

Section: Resultsmentioning

confidence: 99%

Radiological signs supporting idiopathic intracranial hypertension in symptomatic patients with lumbar puncture opening pressure < 250 mm.

Horev,

Eliav,

Sherer

et al. 2024

Preprint

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Objective Lumbar puncture opening pressure (LPOP) exceeding 250mmH2O stands as a pivotal criterion in diagnosing idiopathic intracranial hypertension (IIH), according to the revised Friedman’s criteria. However, many studies discuss the variability of LPOP, while others highlight the accuracy of radiological findings as a credible diagnostic tool for IIH. We have encountered many symptomatic patients who did not meet the LPOP criteria (with or without papilledema), despite having IIH-related symptoms and neuroimaging findings. This study aimed to investigate the radiological findings and clinical symptoms in patients suspected of having IIH without meeting the LPOP criteria. Methods We retrospectively evaluated cerebral venous sinus stenosis using the conduit Farb score (CFS) as well as other radiological findings suggestive of IIH by computed tomography venography and magnetic resonance venography in female patients ≥18 years of age with chronic headaches and suspected IIH with an LPOP <250mm. Results Our cohort comprised eighty-eight women (56 with LPOP < 200 mm H2O and 32 with LPOP ranging between 200-250 mmH2O). Among patients with LPOP in the 200-250 mmH2O range, 40% (12 patients) exhibited three or more radiological findings supporting IIH, compared to 17% (8 patients) in the LPOP < 200 mmH2O group (p=0.048). Furthermore, cerebral venous stenosis, as measured by a Conduit Farb Score (CFS) of 5 or lower, was observed in 80% (24 patients) of the LPOP 200-250 mmH2O group, contrasting with 40% (19 patients) in the LPOP < 200 mmH2O group (p<0.001). Conclusion Cerebral venous stenosis, as well as other supportive radiological findings, were significantly more common in patients with LPOP 200-250 mmH2O than LPOP<200 mmH2O. These findings suggest that given supportive clinical and radiological evidence, patients with LPOP between 200-250 mmH2O, with or without papilledema, may benefit from treatment for IIH.

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Section: Resultsmentioning

confidence: 99%

Radiological signs supporting idiopathic intracranial hypertension in symptomatic patients with lumbar puncture opening pressure < 250 mm.

Horev,

Eliav,

Sherer

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…For many years, IIH has been regarded as a condition with well-defined criteria and a clearly delineated patient population. In recent years, however, an increasing number of publications have emphasized the necessity of viewing IIH as being on a spectrum of several subpopulations [ 26 ]. Our data support existing studies that indicate a significant variability in the IIH patient population.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

Horev,

Ben-Arie,

Zlotnik

et al. 2024

JCM

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While the typical patient with idiopathic intracranial hypertension (IIH) is an obese female of childbearing age, there are unique patient populations, such as non-obese females, that have not been well studied. Characterizing this subpopulation may increase awareness our of it, which may prevent underdiagnosis and improve our understanding of IIH’s underlying pathophysiology. We retrospectively reviewed electronic medical records and compared the clinical and radiological characteristics of non-obese (BMI < 30) and obese (BMI > 30) female patients with IIH. Two hundred and forty-six patients (age 32.3 ± 10) met our inclusion criteria. The non-obese patients (n = 59, 24%) were significantly younger than the obese patients (29.4 ± 9.9 vs. 33.2 ± 10.2, p = 0.004) and had higher rates of severe papilledema (Friesen 4–5; 25.4% vs. 11.8%, p = 0.019), scleral flattening (62.7% vs. 36.9%, p = 0.008), and optic nerve dural ectasia (78.0% vs. 55.6%, p = 0.044). Non-obese patients also had a tendency to have a higher lumbar puncture opening pressure (368 ± 92.7 vs. 344 ± 76.4, p = 0.062). Non-obese patients were three times more likely to present with a combination of scleral flattening and optic nerve dural ectasia (OR = 3.00, CI: 1.57–5.72, χ2 = 11.63, α < 0.001). Overall, non-obese females with IIH were found to have a more fulminant presentation, typified by higher rates of severe papilledema and radiological findings typical for IIH.

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“…These include impaired fertility, complications during pregnancy, OSA, reduced cognitive function, and various adverse mental health outcomes. 63 , 186 , 187 , 188 , 189 In 2014, Chen and Wall categorized the numerous risk factors for IIH identified in previous studies into four categories: (1) highly likely risk factors: female sex, obesity/weight gain, endocrine disorders, etc. ; (2) probable risk factors: hormone replacement therapy, tetracycline and its derivatives, etc.…”

Section: Discussionmentioning

confidence: 99%

Progress and recognition of idiopathic intracranial hypertension: A narrative review

Zhou,

Liu

et al. 2024

CNS Neurosci Ther

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BackgroundIdiopathic intracranial hypertension (IIH) mainly affects obese young women, causing elevated intracranial pressure, headaches, and papilledema, risking vision loss and severe headaches. Despite weight loss as the primary treatment, the underlying mechanisms remain unclear. Recent research explores novel therapeutic targets.AimsThis review aimed to provide a comprehensive understanding of IIH's pathophysiology and clinical features to inform pathogenesis and improve treatment strategies.MethodsRecent publications on IIH were searched and summarized using PubMed, Web of Science, and MEDLINE.ResultsThe review highlights potential pathomechanisms and therapeutic advances in IIH.ConclusionIIH incidence is rising, with growing evidence linking it to metabolic and hormonal disturbances. Early diagnosis and treatment remain challenging.

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The expanding spectrum of idiopathic intracranial hypertension

Cited by 14 publications

References 29 publications

Radiological signs supporting idiopathic intracranial hypertension in symptomatic patients with lumbar puncture opening pressure < 250 mm.

Radiological signs supporting idiopathic intracranial hypertension in symptomatic patients with lumbar puncture opening pressure < 250 mm.

Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

Progress and recognition of idiopathic intracranial hypertension: A narrative review

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