Functional Visual Loss in Idiopathic Intracranial Hypertension

Abstract

To identify and describe patients with idiopathic intracranial hypertension (IIH) with concurrent functional visual loss (FVL). Observational, retrospective case series. Seventeen patients with IIH and FVL. Clinical features were collected retrospectively. Data from 281 cases of IIH were analyzed for concurrence of FVL. Occurrence of FVL diagnosed at presentation or on subsequent follow-up. Seventeen patients had FVL and IIH. Of the 17 patients with FVL and IIH, 11 (65%) had FVL on presentation, with the remaining 6 patients developing FVL after initial presentation. Two patients in this cohort had documented recurrence of their IIH. There were several common patterns of FVL. All 17 patients had functional visual fields, with 82% having tubular fields and 71% exhibiting nonphysiologic constriction on perimetry testing. Seventy-six percent of patients had nerve/field mismatch showing no atrophic disc changes. Eighty-eight percent of patients had significant psychiatric, psychosocial, or other medical comorbidities. The majority of patients were managed surgically at some point in their clinical history, with 53% having nerve decompression, shunt, or both. Three patients had optic nerve sheath fenestrations after the diagnosis of FVL. Results suggest a high prevalence of FVL in IIH with a potential association with psychiatric illness and psychosocial stressors requiring careful consideration before surgical intervention. The author(s) have no proprietary or commercial interest in any materials discussed in this article.