Idiopathic intracranial hypertension: demographic profile, clinical features, associations and clinical and visual outcomes in black African patients presenting to St John Eye Hospital

Alli, Hassan Dawood
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Aim To determine and document the demographic profile, clinical features, associations and clinical and visual outcomes in black African patients with idiopathic intracranial hypertension (IIH) attending St John Eye Hospital during 2006 and 2007. Method A retrospective descriptive study was conducted on black African IIH patients. Patient files and data of 21 of 32 IIH patients, seen in the Neuro-ophthalmology clinic at St John Eye Hospital over a two year period (2006 and 2007), were available and this study is based on these 21 patients. All 21 patients fulfilled the modified Dandy criteria for the diagnosis of IIH. Information obtained from files of the 21 patients were recorded on a data capture sheet. The demographics, initial (presenting) and final visual acuities and visual fields, initial and final clinical symptoms and signs, associations and treatment modalities were recorded on the data capture sheet. Visual and clinical outcomes were determined by comparing the final with the initial (presenting) symptoms and signs. The minimum follow-up period between the initial and the final visit was two months. Patients were regarded as legally blind if they had severe to profound visual acuity and/or visual field loss. Results All 21 patients were female and black African. Mean age was 31.2 ± 8.9 years (range 16 – 50 years). Mean period of follow up was 19.9 ± 20.1 months (range 2 – 77 months). 71.4% were obese. All patients presented with symptoms. The commonest presenting symptom was headache (90%) followed by visual loss (67%), transient visual obscurations (38%) and diplopia (29%). The results of the presenting signs were as follows: Seven eyes (17%) had visual acuity loss (most of which were mild [9.5%]), seven patients (33%) had abduction deficits, four patients (9.5%) had unilateral abnormal pupil reactions and all patients had papilloedema. Of the recorded associations seven patients (33%) were hypertensive, six (29%) were on contraception (two [9.5%] were on oral contraception) and two (9.5%) were taking prednisone prior to presentation. After the initial visit, all 21 vi IIH patients were treated with acetazolamide (Diamox) and weight loss was recorded in three patients (14%). Two patients (9.5%) had optic nerve sheath fenestrations (ONSF), two (9.5%) had lumbar-peritoneal shunts (LPS) and six (28.6%) had multiple lumbar punctures (LP’s). The outcome analysis was as follows: Symptoms in 19 patients (90%) improved but 16 patients (76%) still had papilloedema. Two patients (9.5%) had abduction deficits at the final visit. Visual acuity loss occurred in five eyes (12%) at the final visit compared to seven eyes (17%) at the initial visit (presentation). From the initial visit (presentation) to the final visit, visual acuity in seven eyes (16%) improved, 31 eyes (74%) remained stable and four eyes (10%) worsened. Although visual fields in 33 eyes (79%) improved from the initial to the final visit, 36 eyes (86%) still had visual field loss at the final visit. 26% of eyes had severe to profound visual impairment i.e. were legally blind, at the final visit. Conclusion The results of 21 black African IIH patients reported in this study were similar to some other studies with regards to demographics, clinical features and clinical and visual outcomes. An association between IIH and oral contraceptives, steroids and hypertension could not be established. Although symptoms resolved in most patients, a significant number of patients still had papilloedema and visual field loss following treatment. Despite treatment, a quarter of the patients were legally blind at the final visit, indicating that this condition is not benign.
MMed, Ophthalmology, Faculty of Health Sciences, University of the Witwatersrand
intracranial hypertension , visual effects