Clinical profile, evaluation, management and visual outcome of idiopathic intracranial hypertension in a neuro-ophthalmology clinic of a tertiary referral ophthalmic center in India

AIM: To discuss the clinical features and management of patients who presented with optic disc edema and had features of presumed idiopathic intracranial hypertension (IIH). MATERIALS AND METHODS: Case series of all patients diagnosed to have IIH from January 2000 to December 2003 in the neuro-ophthalmology clinic of a tertiary referral ophthalmic institution, were retrospectively analyzed. Analysis was done for 50/106 patients who fulfilled modified Dandy's criteria and had optic disc edema and a minimal follow-up period of two years. RESULTS: Most (40/50, 80%) of the patients were females and the mean age of presentation for all the 50 patients was 32.89 years. Chief complaints were headache in 38 (76%) patients, 24(48%) patients had transient visual obscuration, 24 (48%) patients had reduced vision, 15 (30%) patients had nausea, vomiting, 4(8%) patients had diplopia. Bilateral disc edema was seen in 46 (92%) patients and unilateral disc edema in 4 (8%) patients. 60 eyes had enlarged blind spot as the common visual field defect. Neuroimaging revealed prominent perioptic CSF spaces in 14 patients and empty sella in three patients. CSF opening pressure was 250–350 mm H2O (water) in 39 patients and was >350 mm H2O in 11 patients. Medical treatment was started for all patients; whereas 35 [70%] patients responded, 15 [30%] patients had to undergo LP shunt.