Does the Presence of Transverse Sinus Stenosis (TSS) Influence the Clinical Presentation and Outcome of Idiopathic Intracranial Hypertension (IIH) (P07.266)

Abstract

Objective: To evaluate differences in characteristics and visual outcomes between IIH patients with and without TSS. Background TSS is common in IIH, but its effect on the course and outcome of IIH is unknown. Design/Methods: All IIH patients seen in our institution between 9/2009 and 9/2011 who underwent brain MRV or CTV were included. Patients were separated into two groups based on the presence or absence of TSS. Patient characteristics, presenting symptoms/signs, and visual outcomes were recorded. All visual fields (VF; HVF/GVF) were graded as [1]=normal; [2]=blind spot enlargement; [3]=nasal/temporal defect; or [4]=diffuse constriction. Univariate statistics and linear regression were applied. Results: 134 patients were included: 49 with TSS (48 bilateral), 85 without TSS. There were no differences between the two groups with respect to mean age (29vs.27years, p=0.26), black race (53%vs.42%, p=0.23), female sex (92%vs.84%, p=0.17), mean BMI (36vs.37, p=0.38), or mean CSF-OP (38cm vs. 38 cm, p=0.99). Headache frequency in the two groups was similar at baseline (82%vs.81%, p=0.95) and at last follow up (41%vs.50%, p=0.36). Grade of papilledema, visual acuity, and VF were similar at baseline, but initial HVF mean deviation (HVF-MD) was better in the TSS group than in the no-TSS group (-4.8vs.-6.8, p=0.08). There was no medical or surgical therapy difference by TSS status. At last follow-up, grade of papilledema, visual acuity, and VF were similar. However, the no-TSS group had significantly more improvement in VF-grade (-0.60vs-0.28, p=0.049) and HVF-MD (3.0vs.1, p=0.026) than the TSS group. Linear regression suggested that the worse HVF-MD among no-TSS patients at baseline better predicted their degree of improvement than the patient9s TSS status. Conclusions: While TSS was found in 37% of IIH patients, the presence of TSS did not have a substantial impact on outcomes. Our findings do not support routine TSS stenting in IIH. Disclosure: Dr. Riggeal has nothing to disclose. Dr. Bruce has nothing to disclose. Dr. Saindane has nothing to disclose. Dr. Kelly has nothing to disclose. Dr. Ridha has nothing to disclose. Dr. Newman has received personal compensation for activities with Biogen Idec. Dr. Biousse has nothing to disclose.