visual outcome

Association of MRI findings and visual outcome in idiopathic intracranial hypertension

Authors: Saindane AM, Bruce BB, Riggeal BD, Newman NJ, Biousse V.

OBJECTIVE. Patients with idiopathic intracranial hypertension (IIH) have elevated intracranial pressure (ICP) without an identifiable cause. The clinical course is variable, resulting in irreversible vision loss in some and a benign course in others. Although MRI findings have been described in IIH, their association with visual outcome has not been evaluated to date. MATERIALS AND METHODS. Forty-six patients with IIH underwent funduscopic evaluation, visual field testing, lumbar puncture with opening pressure (OP) measurement, and MRI. Patients were stratified into the following groups by visual outcome: group 1, no vision loss (n = 28); group 2, some vision loss (n = 10); and group 3, severe vision loss (n = 8). MRI findings in the orbits, pituitary gland, and optic canals and the frequency of skull base cephaloceles and of transverse sinus (TS) stenosis were assessed by a reviewer blinded to the patients' visual outcome. Demographic, clinical, and MRI findings were evaluated for association with visual outcome. RESULTS. Patients in group 3 (worst visual outcome) were significantly younger (p = 0.03) and had higher OP (p = 0.04) than patients in the other groups. There were no significant differences in sex, race, or body mass index. Despite worse visual outcomes and sometimes fulminant vision loss, there were no differences in the frequency of orbital MRI findings or TS stenosis, optic canal diameter, and pituitary appearance among the three groups. Group 3 had significantly lower cephalocele frequency than the other groups (p = 0.04). CONCLUSION. Although MRI findings may suggest elevated ICP and the diagnosis of IIH, they are not predictive of visual outcome in patients with IIH.

Idiopathic Intracranial Hypertension: Relation Between Obesity and Visual Outcomes

Authors: Szewka AJ, Bruce BB, Newman NJ, Biousse V.

BAKGROUND: Increased body mass index (BMI) has been associated with increased risk of idiopathic intracranial hypertension (IIH), but the relationship of BMI to visual outcomes in IIH is unclear.
METHODS: A retrospective chart review of all adult cases of IIH satisfying the modified Dandy criteria seen at our institution between 1989 and 2010 was performed. Demographics, diagnostic evaluations, baseline visit and last follow-up examination data, treatment, and visual outcome data were collected in a standardized fashion. Groups were compared, and logistic regression was used to evaluate the relationship of BMI to severe visual loss, evaluating for interaction and controlling for potential confounders.
RESULTS: Among 414 consecutive IIH patients, 158 had BMI ≥40 (World Health Organization Obese Class III) and 172 had BMI 30-39.9. Patients with BMI ≥40 were more likely to have severe papilledema at first neuro-ophthalmology encounter than those with a lower BMI (P = 0.02). There was a trend toward more severe visual loss in 1 or both eyes at last follow-up among those patients with BMI ≥40 (18% vs 11%, P = 0.067). Logistic regression modeling found that 10-unit (kilogram per square meter) increases in BMI increased the odds of severe visual loss by 1.4 times (95% confidence interval, 1.03-1.91, P = 0.03) after controlling for sex, race, diagnosed hypertension, and diagnosed sleep apnea.
CONCLUSION: Our finding of a trend for severe papilledema and visual loss associated with increasing BMI suggests that very obese IIH patients should be closely monitored for progression of visual field loss.

NASA: The Visual Impairment Intracranial Pressure Summit Report

Idiopathic intracranial hypertension in children: visual outcome and risk of recurrence

Authors: Soiberman U, Stolovitch C, Balcer LJ, Regenbogen M, Constantini S, Kesler A.

PURPOSE: Idiopathic intracranial hypertension (IIH) is a disorder associated with increased intracranial pressure without evidence of a space-occupying lesion and with normal cerebrospinal fluid constituents. The disease is rare in the pediatric population. In this study, we assessed the visual outcome of children with IIH and the risk of recurrence.

METHODS: This single-center observational retrospective cohort study included 90 children younger than 18 years of age who satisfied the modified Dandy criteria for the diagnosis of IIH. Upon follow-up, the treatment was discontinued when patients were free of symptoms such as headaches, transient visual obscurations or tinnitus, and when examination revealed no evidence of papilledema. The main outcome measures were visual acuity and visual field outcomes as well as risk of recurrence.

RESULTS: The mean follow-up was 30.65 months (range 1.15-172.6 months, standard deviation 27.47 months). Special grading scales were devised for visual acuity and visual field scores. The mean visual acuity score improved from 4.7 ± 0.62 to 4.87 ± 0.44 (p = 0.003).The mean visual field score improved from 3.41 ± 0.8 to 3.52 ± 0.75 (p = 0.21). The recurrence rate was 23.7%, and the risk of recurrence was highest within the first 18 months after diagnosis of IIH.

CONCLUSIONS: These study results suggest that pediatric patients with IIH have a favorable visual outcome in terms of both visual acuity and visual field. If there is any recurrence, it is most likely to occur during the first 18 months after diagnosis.

Long-term visual outcome in idiopathic intracranial hypertension

Authors: Baheti NN, Nair M, Thomas SV

OBJECTIVE: To characterize the course, outcome, and risk of relapse or late worsening in a clearly defined cohort of idiopathic intracranial hypertension (IIH) over a long period of follow-up.

MATERIALS AND METHODS: Retrospective chart review of patients with definite IIH was evaluated at the Sree Chitra Tirunal Institute for Medical Sciences and Technology between 1998 and 2006. Patients' demographic data, clinical, neuro-ophthalmic examinations, and treatment details were abstracted. Patients were further categorized into three groups based on whether they improved, worsened, or relapsed on follow-up. Final visual outcome of each patient was defined according to grading of the worse eye at the last visit. Statistical analysis included t test to compare group means and chi-square test to compare proportions.

RESULTS: Of the 43 women included, visual impairment was observed in 80 eyes (93%) at presentation and it was moderate to severe in 14%. The mean CSF opening pressure at presentation did not differ significantly in those with visual impairment compared to those with normal vision. Those having early severe visual impairment had significantly higher (P = 0.015) likelihood of severe visual impairment on last follow-up. Of the total, 34 patients (79%) improved, 4 (9.3%) relapsed on follow-up after period of stability, and 5 (11.6%) worsened over 56 months follow-up (range, 26-132 months). The groups were comparable, except those who improved were younger (P<0.05). At last examination, 9% had significant vision loss.

CONCLUSION: IIH patients can have delayed worsening or relapses and about tenth of patients can have permanent visual loss early or late in the course of the disease. All patients with IIH need to be kept under long-term follow-up, with regular monitoring of visual functions.

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