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  • Written By: Howard Pomeranz, MD, PhD
    Neuro-Ophthalmology/Orbit

    This retrospective review of a large cohort of idiopathic intracranial hypertension (IIH) patients confirmed the strong association between being overweight and IIH presentation and recurrence.

    The authors reviewed medical records of 82 patients with IIH seen from 1995 to 2008 at one medical center in Israel. The predominant presenting symptoms were headache, transient visual obscurations, tinnitus and diplopia. Eighty-two percent of patients were overweight at the time of diagnosis, and 35 percent of these patients reported significant weight gain during the preceding year.

    Overweight patients had higher cerebrospinal fluid (CSF) opening pressure than patients with normal weight (37.8 ± 10 mm water vs. 32.4 ± 9.8 mm water). The grade of papilledema correlated with CSF opening pressure, while there was an inverse correlation between depression of visual field sensitivity and grade of papilledema.

    At a mean follow-up of 61.3 months, 84 percent of patients improved, while 22 percent required CSF diversion procedures or optic nerve sheath fenestration.

    Sixty-seven percent of patients suffered recurrence of IIH, with the number of recurrences inversely correlated with weight loss. Patients with recurrence presented with more visual field defects than patients without recurrences. Women with recurrence had a history of more pregnancies.