Idiopathic Intracranial Hypertension: Incidentally Discovered Disease Compared to Patients Seeking Care Due to Symptoms

Patients with idiopathic intracranial hypertension (IIH) may seek medical care due to symptoms of raised intracranial pressure or papilledema may be incidentally discovered. We aimed to compare the clinical characteristics, disease course and visual outcomes between these two groups of patients.

Poster 97 Idiopathic Intracranial Hypertension: Incidentally Discovered Disease Compared to Patients Seeking Care Due to Symptoms Amir Vosoughi1, Edward Margolin2, Jonathan Micieli2 Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada, 2Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada 1 Introduction: Patients with idiopathic intracranial hypertension (IIH) may seek medical care due to symptoms of raised intracranial pressure or papilledema may be incidentally discovered. We aimed to compare the clinical characteristics, disease course and visual outcomes between these two groups of patients. Methods: Retrospective chart review of consecutive patients (May 2012 to August 2020) conducted at tertiary neuro-ophthalmology clinics. Patients were divided into Group-1 (incidentally discovered disease) and Group-2 (patients seeking medical care due to symptoms of intracranial hypertension such as headache, pulsatile tinnitus, vision loss or diplopia). Results: A total of 186 patients were included in the study (Group-1 n=75; Group-2 n=111). There was no difference in the proportion of females (0.98 vs. 0.94), mean age (32.0+11.6 vs. 30.7+9.5) and BMI (34.0+6.3 vs. 35.0+7.58) between groups. Group-1 patients were significantly less likely to have experienced headache (p=0.001), TVOs (p<0.001) or diplopia (p=0.026). Group-1 patients also had better LogMAR visual acuity (0.028+0.063 vs. 0.090+0.274; p=0.001), better Humphrey mean deviation (-2.78+3.89dB vs. 4.41+5.72dB; p<0.001), and milder papilledema (OCT-RNFL thickness 157.4+69.2mm vs. 192.3+107.1mm; p<0.001). Fewer patients in Group-1 required medical treatment (19 vs. 56; p<0.001) and no patient in Group-1 required surgical treatment (0 vs. 11; p=0.004). At final follow-up, there was no difference in the proportion of patients that lost weight and no difference in reported headache. At final follow-up, there was no significant difference in the OCT-RNFL thickness (123.2+37.2mm vs.120.2 +53.3mm; p0.58), but Group-1 patients continued to have better LogMAR visual acuity (0.029+0.072 vs. 0.081+0.206; p0.002) and Humphrey mean deviation (-2.22+2.87dB vs. -4.30+6.74dB; p<0.001). Conclusions: Patients with incidentally discovered papilledema attributable to IIH have a milder disease course and only a minority require treatment. The route to diagnosis (incidental discovery compared to symptomatic presentation) is an effective way to stratify IIH patients and can help determine prognosis and length of follow-up. References: None. Keywords: high intracranial pressure/headache Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Jonathan Micieli, [e-mail] 2021 Annual Meeting Syllabus | 255