Background

Idiopathic intracranial hypertension (IIH) is an unexplained increase in intracranial pressure often associated with obesity. The aim of this study was to conduct a retrospective observational study of the long term clinical, visual, and treatment outcomes in IIH patients.

Methods

A retrospective observational study of patients diagnosed with IIH over a 12-year period at a single centre was completed via database review. Demographic data, symptoms at baseline and last visit, treatments undertaken, and duration of follow-up were included. Visual outcomes, including visual acuity, colour vision, 30-2 Humphrey automated perimetry data, and retinal nerve fibre layer thickness (RNFL), were collected at baseline and last visit.

Results

IIH was diagnosed in 132 patients (90.9 % female) with a median of 2.8 years (range: 0–9.1) follow-up. Mean BMI was 35.9 ± 7.9 kg/m². Symptoms at presentation were headache (87.6 %), pulsatile tinnitus (27.2 %) and transient visual obscurations (27.2 %). First-line management was acetazolamide in 86.4 %, with 34.2 % of these patients ceasing treatment because of adverse events. Visual field measures and RNFL at last follow-up improved when compared to baseline (median MD: − 1.99 dB (IQR −3.6 to −0.9) to −0.85 (−2.1 to 0.0) (p < 0.001), median RNFL: 132 μm (IQR 116 – 183) to 103 (92 – 113) (p < 0.001)). Some patients (6.1 %) required surgery for more severe IIH.

Conclusions

Long-term symptomatic and visual prognosis in IIH patients is excellent. However, a subset of patients with more severe disease require surgical intervention. Adverse events of treatment lead to high medication discontinuation rates.

中文翻译：

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特发性颅内高压的长期预后：观察性研究和文献复习

背景

特发性颅内高压（IIH）是无法解释的颅内压增高，通常与肥胖有关。这项研究的目的是对IIH患者的长期临床，视觉和治疗结果进行回顾性观察研究。

方法

通过数据库审查，完成了对在单个中心诊断为IIH超过12年的患者的回顾性观察研究。包括人口统计学数据，基线和最后访视时的症状，所采取的治疗方法以及随访时间。在基线和最后访视时收集视觉结果，包括视敏度，色觉，30-2汉弗莱自动视野检查数据和视网膜神经纤维层厚度（RNFL）。

结果

在132例患者中诊断出IIH（90.9％为女性），中位随访时间为2.8年（范围：0–9.1）。平均BMI为35.9±7.9 kg / m ²。出现的症状是头痛（87.6％），搏动性耳鸣（27.2％）和短暂的视觉模糊（27.2％）。一线治疗为乙酰唑胺，占86.4％，其中34.2％的患者因不良事件而停止治疗。与基线相比，最后一次随访的视野测量和RNFL改善（中位数MD：-1.99 dB（IQR -3.6至-0.9）至-0.85（-2.1至0.0）（p <0.001），中位RNFL：132μm （IQR 116 – 183）至103（92 – 113）（p <0.001））。一些患者（6.1％）需要进行手术以治疗更严重的IIH。

结论

IIH患者的长期症状和视觉预后极好。但是，一部分患有更严重疾病的患者需要手术干预。治疗的不良事件导致较高的药物停药率。