Idiopathic Intracranial Hypertension Patients Research Articles

Evaluation of Magnetic Resonance Imaging Findings and Clinical Features in Idiopathic Intracranial Hypertension Patients

Evaluation of Magnetic Resonance Imaging Findings and Clinical Features in Idiopathic Intracranial Hypertension Patients

Long-term efficacy of venous sinus stenting in the treatment of idiopathic intracranial hypertension.

Previous studies have suggested that cerebral dural sinus stenosis could be a possible underlying cause of idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a potential alternative for treating IIH related to dural sinus stenosis. However, most of the documented studies have been conducted in Western countries. In this study, we present the results of 16 Chinese IIH patients who underwent VSS treatment in our single center. We prospectively collected angiographic and manometric data from IIH patients who underwent angioplasty/stenting. All patients had confirmed dural sinus stenosis and had failed maximal medical therapy (MMT). Demographic, clinical, and radiological presentation, as well as long-term follow-up outcomes were collected retrospectively. A total of 16 patients who underwent VSS were enrolled in the present study. Demographic data revealed a mean age of 40 (range 20-55), with 69% (11/16) being female, and a mean body mass index (BMI) of 27.05 (range 19.18-38.04) kg/m2 . All patients presented with papilledema and visual disturbances. During a median follow-up period of 47.5 months, 93.75% (15/16) of patients reported improvement in symptoms, although only 37.5% (6/16) experienced complete resolution. Headaches, blurred vision, and amaurosis related to increased pressure improved in 100% (8/8), 81.25% (13/16), and 75% (3/4) of patients, respectively. However, one patient suffered cerebral infarction and secondary epilepsy soon after VSS, and another patient had recurrence of symptoms due to stent wall thrombosis 2 years later. The significance of venous sinus stenosis in the development of IIH may be undervalued. Our study, based on a Chinese case series, affirms the long-term safety and effectiveness of VSS in treating IIH patients with relatively lower BMI than those from Western countries.

Dural venous sinus stenting technique for idiopathic intracranial hypertension in patients with tortuous venous anatomy.

Venous sinus stenting (VSS) for medically refractory idiopathic intracranial hypertension (IIH) is emerging as a safe and effective alternative to shunting. However, stent navigation past the jugular bulb with commonly used carotid stenting systems via femoral access in cases with tortuous venous anatomy can present a challenge, leading to procedural failure. We present a technical refinement using a cervical access and peripheral vascular stent with a more stable 0.035-in. delivery platform as an alternative to the traditional approach to simplify the procedure and overcome the technical difficulties in cases with tortuous venous anatomy. Our institutional database for patients who had IIH and undergone VSS using the peripheral vascular stent between 2013 and 2023 was retrospectively reviewed. Data on 36 patients (33 women, 3 men, mean age 32 years) was collected. VSS was technically successful in all patients (100%) without major complications or thrombosis. There was one case of minor neck cellulitis treated with oral antibiotics. Three patients underwent repeat stenting, and 2 patients had ventriculoperitoneal shunt placement after stenting due to persistent or recurrent symptoms. All patients (100%) had improvement or resolution of papilledema; however, six patients had evidence of optic atrophy and persistent vision loss. Headache was resolved or improved in 91% of patients. In the presence of tortuous venous anatomy, VSS using cervical access and a peripheral vascular stent with a more stable 0.035-in. delivery platform can be considered as a safe and effective alternative approach with shorter procedure time. This approach is particularly advantageous in situations where the procedure is prolonged or high dose of contrast has been administered due to the technical challenges associated with the traditional use of carotid systems via femoral access for stent delivery.

Venous sinus stenting for idiopathic intracranial hypertension patients with functioning ventriculoperitoneal shunts: A case series

Idiopathic intracranial hypertension (IIH) is a disease defined by increased intracranial pressure and associated with a variety of symptoms ranging from headaches to tinnitus. Ventricular peritoneal shunting has been the mainstay treatment for patients with IIH. Although VPS’s have shown efficacy in treating IIH, some patients complain of refractory symptoms even with functioning VPS’s. Venus stenting has emerged as a new technique for treating these refractory symptoms. Despite the scarce literature pertaining its efficacy and safety profile, several small studies have shown promising results. In this case series, four patients with IIH complained of refractory symptoms despite functioning VPS’s and were treated with venous stenting.

Optical coherence tomography angiography findings in optic disc drusen and idiopathic intracranial hypertension.

To evaluate the changes in peripapillary microvascularity in idiopathic intracranial hypertension (IIH) and optic disc drusen (ODD) patients, by comparing them with those in healthy individuals, via optical coherence tomography angiography (OCTA). Sixty-two eyes of 33 patients with ODD, 58 eyes of 30 patients with IIH, and 70 eyes of 70 healthy people were imaged for 6 × 6-mm optic disc scans on a spectral-domain OCTA. Vascular densities in superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) of ODD, IIH, and healthy eyes were compared with a one-way analysis of variance. Post-hoc analysis was performed with the Gabriel test. There was a significant decrease in peripapillary vessel density in SCP, DCP, and CC in patients with IIH compared to the control group (p < 0.05). In ODD patients, especially peripapillary vessel density in DCP was significantly reduced compared to the control group (p < 0.05). Peripapillary vessel density in DCP was significantly lower in the IIH group than ODD group (p < 0.05). Peripapillary vascular density may be affected during the course of the disease in both IIH and ODD. Compared to healthy individuals, the decrease in vascular density in these patients and the consequent decrease in perfusion in the peripapillary region may guide the pathogenesis of the complications in the course of these two diseases. Although vascular density in DCP and CC differs significantly between IIH and ODD, case-controlled studies are needed to evaluate the role of OCTA in the differential diagnosis of IHH and ODD.

Diffusion-tensor MR imaging of optic pathway in idiopathic intracranial hypertension.

To investigate the role of diffusion tensor imaging (DTI) of optic pathway in patients with idiopathic intracranial hypertension (IIH). This study included 41 IIH patients and 22 controls. They underwent DTI of the optic nerve (ON) and optic radiation (OR). Their fractional anostrophy (FA) and mean diffusivity (MD) were calculated by two reviewers and correlated with papilledema grade. The optic nerve mean FA and MD of patients for reviewer-1 were 0.21 ± 0.047 and 2.189 ± 0.52 ×10-3mm2/s and for reviewer-2 were 0.216 ± 0.047 and 2.17 ± 0.54 ×10-3mm2/s. The mean ON FA and MD of controls for reviewer-1 were 0.33 ± 0.048 and 1.29 ± 0.26 ×10-3mm2/s and for reviewer-2 were 0.34 ± 0.05 and 1.3 ± 0.26 ×10-3mm2/s. There was significant difference in FA and MD between patients and controls (p < 0.00001). The OR mean FA and MD of patients for reviewer-1 were 0.61 ± 0.03 and 2.26 ± 0.55 ×10-3mm2/s and for reviewer-2 were 0.6 ± 0.03 and 2.24 ± 0.57 ×10-3mm2/s The mean OR FA and MD of controls for reviewer-1 were 0.6 ± 0.03 and 2.19 ± 0.49 ×10-3mm2/s and for reviewer-2 were 0.6 ± 0.03 and 2.18 ± 0.49 ×10-3mm2/s. There was no significant difference in FA and MD obtained in patients and controls. Both the FA and the MD of the ON showed strong correlation with the papilledema grade (r = -0.8 and 0.951, respectively). Our findings suggest that, IIH is associated mainly with pre-chiasmatic or ON involvement rather than post-chiasmatic parenchymal or OR involvement. DTI MD and FA parameters of the ON may be a reliable imaging biomarker for diagnosis of IIH and well correlated with papilledema grades.

Intraoperative ultrasound-guided ventricular cannulation in patients with normal-sized ventricles

IntroductionMany pathologies require normal-sized ventricle cannulation, which may be technically challenging even with neuronavigation guidance. This study presents a series of ventricular cannulation of normal-sized ventricles using intraoperative ultrasound (iUS) guidance and the outcomes of patients treated by this technique, for the first time. MethodsThe study included patients who underwent ultrasound-guided ventricular cannulation of normal-sized ventricles (either ventriculoperitoneal (VP) shunting or Ommaya reservoir) between January 2020 and June 2022. All patients underwent iUS-guided ventricular cannulation from the right Kocher's point. The inclusion criteria for normal-sized ventricles were as follows: (1) Evans index <30%, and (2) widest third ventricle diameter <6mm. Medical records and pre-, intra- and post-operative imaging were retrospectively analyzed. ResultsNine of the 18 included patients underwent VP shunt placement; 6 had idiopathic intracranial hypertension (IIH), 2 had resistant cerebrospinal fluid fistula following posterior fossa surgery, and 1 had iatrogenic intracranial pressure elevation following foramen magnum decompression. Nine patients underwent Ommaya reservoir implantation, 6 of whom had breast carcinoma and leptomeningeal metastases and 3 hematologic disease and leptomeningeal infiltration. All catheter tip positions were achieved in a single attempt, and none were placed suboptimally. Mean follow-up was 10 months. One IIH patient (5.5%) had early shunt infection which necessitated shunt removal. ConclusioniUS is a simple and safe method for accurate cannulation of normal-sized ventricles. It provides an effective real-time guidance option for challenging punctures.

Evaluation of Peripapillary and Macular Optical Coherence Tomography Angiography Characteristics in Different Stages of Papilledema.

Prospective evaluation of optical coherence tomography (OCT) and OCT angiography (OCT-A) characteristics in different stages of papilledema in idiopathic intracranial hypertension (IIH). In this prospective, observational study patients of IIH with papilledema were recruited and divided into 3 groups-early/established (Group 1), chronic (Group 2), and atrophic papilledema (Group 3). Peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell inner plexiform layer (GC-IPL) were recorded on OCT. Peripapillary and macular perfusion was documented at superficial retinal, deep retinal, and choriocapillary level using OCT-A. The investigations were repeated at 3 months. RNFL showed significant thinning in all groups on follow-up with the atrophic group showing maximum thinning ( P = 0.01-Group 3). GC-IPL was significantly reduced in all stages of papilledema at baseline compared with the controls. Thinnest GC-IPL was noted in the atrophic group (52.75 ± 7.44 μm; P = 0.00 in Group 3 vs controls) that showed further deterioration on follow-up. On Image J analysis, significant decrease was noted at various levels in the peripapillary and macular perfusion at baseline especially in the atrophic group which showed further deterioration noted on follow-up. The final visual acuity showed a statistically significant weak negative correlation with baseline RNFL (r = -0.306) and GC-IPL (r = -0.384) and moderately negative correlation with baseline superficial peripapillary retinal perfusion (r = -0.553). A significant negative correlation was seen between increasing grade of papilledema and superficial peripapillary retinal perfusion with both Image J and automated indices (r = -0.46; r = -0.61), respectively. GC-IPL may help identify early damage in papilledema even in the presence of thicker RNFL. Significant vascular changes can be observed on OCT-A that may help predict the final visual outcome in papilledema due to IIH.

Long Term Effects of Metabolic and Bariatric Surgery on Idiopathic Intracranial Hypertension.

Idiopathic Intracranial Hypertension (IIH) is a rare disorder, linked to severe obesity. The study aimed to evaluate long-term effects of metabolic and bariatric surgery (MBS) on IIH outcomes. Retrospective study of patients with IIH and severe obesity who underwent MBS. Data were retrieved from prospectively maintained databases of two bariatric surgeons. Thirteen patients were included, of them 12 women. Median age was 36 (interquartile range;IQR 21,47) years and body mass index (BMI) was 40.4 (IQR 37.8,41.8) kg/m2. All patients had visual disturbances,12/13 had headaches, and 6/13 had tinnitus. The mean opening pressure on lumbar puncture was 45 cmH2O, and 11/13 patients had papilledema. Medications for IIH were consumed by 11/13 patients, and 2/13 patients had prior surgical intervention for IIH. MBS types included sleeve gastrectomy (n=7), adjustable gastric banding (n=2), roux-en-y gastric bypass (n=2), one anastomosis gastric bypass (n=1), duodenal switch (n=1). At a median follow-up of 10 years (IQR 8,13), the median BMI and total weight loss were 29.7 kg/m2 and 27%, respectively. Remission of symptoms was achieved in 9/13 patients. MBS results in significant and sustainable weight loss, with subsequent resolution or improvement of IIH. It may be considered as a preventive measure for IIH in patients with severe obesity.

The Effects of Pressure Gradient on Papilledema Improvement After Venous Sinus Stenting in Idiopathic Intracranial Hypertension.

This study aimed to evaluate the impact of the pressure gradient on papilledema after stenting in patients with idiopathic intracranial hypertension (IIH) patients and venous sinus stenosis (VSS). In this prospective cohort study, we examined 121 patients with IIH and VSS who underwent stenting. The papilledema Frisen grade at the 1-month follow-up was used as a grouping factor (favorable outcome: 0-1; unfavorable outcome: 2-5). We used multivariable logistic regression modeling to determine independent predictors of favorable outcome. The performance of the prediction model was evaluated using a receiver operating characteristic (ROC) analysis. A total of 96 patients had papilledema grades 0 to 1, and 25 patients had papilledema grades 2 to 5. Patients with the first group had significantly lower gradient pressures preoperatively (15.2 mmHg vs. 21.4 mmHg, p=0.001) and postoperatively (2 mmHg vs. 3.3 mmHg, p=0.002) relative to those in the second group. Multivariate analysis indicated that preoperative pressure gradient (odds ratio [OR] = 1.119; 95% confidence interval [CI] = 1.034-1.211]) and postoperative pressure gradient (OR = 1.498; 95% CI = 1.147-1.957) were independent predictors of favorable outcome. In the ROC analysis, the cut-off pressure gradient for the highest sensitivity (0.44) and specificity (0.874) was 22.75 mmHg, with a Youden's index of 0.314. Survival analysis demonstrated that patients with a preoperative pressure gradient <22.75 mmHg had more rapid improvement of papilledema than did those with a pressure gradient >22.75 mmHg (mean+SD: 2.639+0.382 [95% CI: 1.890-3.388] versus mean+SD: 3.882+0.884 [95% CI: 2.149-5.616]; p=0.004). A significant reduction in the pressure gradient appears to be strongly correlated with the success of VSS in patients with IIH. A higher preoperative pressure gradient may reduce stenting efficacy in patients with IIH. Venous sinus stenting has the potential to yield substantial clinical advantages in individuals diagnosed with idiopathic intracranial hypertension with venous sinus stenosis. Nevertheless, a heightened preoperative pressure gradient could lead to less favorable results. Thus, the early adoption of venous sinus stenting is advised to avert additional irreversible clinical deterioration among idiopathic intracranial hypertension patients with venous sinus stenosis.

Longitudinal prospective cohort study evaluating prognosis in idiopathic intracranial hypertension patients with and without comorbid polycystic ovarian syndrome

IntroductionIdiopathic intracranial hypertension (IIH) and polycystic ovary syndrome (PCOS) are hyperandrogenic metabolic disorders that affect women of reproductive age living with obesity. The previously reported prevalence of comorbid PCOS in IIH patients is highly variable and the longitudinal impact on visual and headache outcomes are unknown.MethodsIn this prospective longitudinal cohort study patients were identified from the IIH: Life database over a nine-year period (2012–2021). Data collected included demographics and PCOS questionnaire data. Key visual and detailed headache outcomes were recorded. We analysed the key variables for influential outcomes of vision and headache. Logistical regression methods were used to model long term visual and headache outcomes.ResultsOverall 398 women with IIH and documented PCOS questionnaires were followed up for a median of 10 months (range 0–87). Prevalence of PCOS in IIH was 20% (78/398) diagnosed by the Rotterdam criteria. Patients with IIH and comorbid PCOS reported higher self-reported fertility problems (3.2-fold increased risk) and increased need for medical help in becoming pregnant (4.4-fold increased risk). Comorbid PCOS in IIH patients does not adversely impact long-term vision or headache outcomes. The headache burden was high in both cohorts studied.ConclusionsThe study demonstrated that comorbid PCOS in IIH is common (20%). Diagnosing comorbid PCOS is important as it can impact on fertility and is known to have long-term adverse cardiovascular risks. Our data suggest that a diagnosis of PCOS in those with IIH does not significantly exacerbate long-term vision or headache prognosis.

Enhancement of optic nerve sheath on MRI in idiopathic intracranial hypertension(IIH)

ObjectiveOptic nerve sheath(ONS) enhancement in idiopathic intracranial hypertension (IIH) patients has been reported in recent years. In this retrospective observation, we analyzed the clinical characteristics of IIH patients with enhancement of ONS. MethodsEighty-two patients with clinically diagnosed IIH from January 2017 to December 2019 were under observation. Then, based on the presence of contrast-enhancement (CE) in ONS on orbital magnetic resonance image (MRI), the IIH patients were divided into CE-ONS group and no-CE(NCE)-ONS group. Six months follow-up information was also included in the observation study. By comparing clinical data of the two groups of IIH patients, we tried to evaluate whether there is clinical heterogeneity in CE-ONS patients. Result12 patients were included in CE-ONS group, 10 females and 2 males. 70 patients were included in NCE-ONS group, 56 women and 14 men. We found that patients with CE-ONS had a longer course of disease (median disease duration before diagnosis, 5 months vs. 3months, P<0.01) and more likely had the sign of distension of the perioptic subarachnoid space (DPSS) (58.33 % vs. 24.29 %, P = 0.034). But no significant differences were found in demographic characteristics, clinical symptoms, degree of visual impairment, papilledema, opening pressure(OP) on lumbar puncture and clinical outcomes. ConclusionAs a rare sign on MRI, ONS enhancement can occur in patients with IIH. IIH patients with CE-ONS may have a longer course of disease and more prone to DPSS, but there is no significant difference in clinical manifestations, OP, and clinical outcomes compared with IIH patients without CE-ONS.

Evaluation of retinal vascular and structural alterations in pediatric idiopathic intracranial hypertension patients without papilledema

PurposeThe aim of this study was to evaluate retinal structural and microvascular alterations using optical coherence tomography-angiography (OCTA) in pediatric idiopathic intracranial hypertension (IIH) patients with regressed papilledema. MethodsThis study included 40 eyes of 21 IIH patients and 69 eyes of 36 healthy controls. Radial peripapillary capillary (RPC) vessel density and peripapillary retinal nerve fiber layer (RNFL) thickness were evaluated by XR Avanti AngioVue OCTA (Optovue, Fremont, CA, USA). The data were obtained from measurement zones that are automatically divided into two equal hemispheres (superior and inferior) and eight quadrants (superior-temporal, superior-nasal, inferior-temporal, inferior-nasal, nasal-superior, nasal-inferior, temporal-superior, temporal-inferior). Initial cerebrospinal fluid (CSF) pressure, grade of papilledema, and duration of follow-up were recorded. ResultsThere were significant differences in RPC vessel densities and RNFL thicknesses between the study groups (p ˃ 0.05). Significantly higher RPC vessel density measurements were observed in the patient group for the whole image, peripapillary, inferior-hemi, and whole nasal quadrants (p < 0.05). Except for the temporal-superior, temporal-inferior, inferior-temporal, and superior-temporal quadrants, the RNFL in all regions was significantly thicker in the IIH group than in the control group (p ˂ 0.001). ConclusionsRNFL thickness and RPC vessel density were significantly different between the IIH patient and control groups, suggesting that retinal microvascular and subclinical structural changes that were potentially secondary to CSF pressure can persist after the resolution of papilledema. However, our results should be confirmed by further longitudinal studies investigating the progress of these alterations to determine their effects on peripapillary tissues.

Clinicoradiological profile of idiopathic intracranial hypertension

Objectives: Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of a space-occupying lesion. IIH patients usually present with typical symptoms and signs of increased ICP, such as headache, vomiting, neck pain, double vision, transient visual obscuration (TVO), and papilledema. Typical magnetic resonance imaging (MRI) findings include empty sella turcica, optic nerve tortuosity, globe flattening, and transverse sinus stenosis. Material and Methods: All patients from July 2021 to June 2022 presented to the super-specialty neuroclinic with symptoms suggestive of IIH were included in this study after consent. Clinical patterns and MRI brain findings along with other risk factors and comorbidities were studied. Results: Total 12 patients were studied out of which all were female. The most common age group was 31–40 years (41.6%). The most common clinical presentations were headache and TVOs followed by painless loss of vision, visual field changes and double vision. In this study, 7 out of 12 cases presented with headache (58.3%) out of which only 3 were migrainous. TVOs were presenting complaints of 7 patients (58.3%). Painless visual loss was there in 3 patients (25%), out of which only one case was bilateral (33%). In all cases (100%), MRI was suggestive of IIH. Transverse sinus stenosis in 3 cases (25%) and scleral flattening in 1 case (14.2%) were seen, respectively. Conclusion: Clinical suspicion followed by MRI brain is of utmost importance. Prompt diagnosis and treatment are essential in IIH patients to prevent permanent visual loss.

Neurophysiological visual assessment in patients with idiopathic intracranial hypertension: visual evoked potential and multifocal field electroretinography

BackgroundDetermining the cause of visual deterioration in idiopathic intracranial hypertension (IIH) patients is of clinical necessity. This study aimed to study the effect of chronic increased ICP on the retina and optic nerve through objective electrophysiological measures in chronic IIH patients.MethodsThirty patients with chronic IIH and thirty age and sex-matched healthy controls were included in this study. Papilledema grade and CSF pressure were evaluated in the patients’ group. Both groups were submitted to visual evoked potentials (VEP) and multifocal electroretinogram (mfERG).ResultThe mean value of P100 latencies of the right and left on two check sizes, 1 deg and 15ṁ in chronic IIH patients, was significantly delayed than controls (P-value < 0.001 for each). Chronic IIH patients showed a significantly lower amplitude of the right and left R1, R2, R3, R4 & R5 compared to controls (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, = 0.001) (P-value = 0.002, < 0.001), respectively. Also, patients showed a significantly delayed peak time of the right and left R1 and R2 compared to controls (P-value < 0.001, < 0.001) (P-value = 0.001, = 0.009), respectively. There was a significant positive correlation between each of CSF pressure and papilledema grade with right and left PVEP latencies. In contrast, there was no statistically significant correlation between either CSF pressure or papilledema grade and PVEP amplitudes in both eyes.ConclusionIn chronic IIH patients, both optic nerve dysfunction and central retinal changes were identified, supported by VEP and the mfERG findings.

Archetypal analysis of longitudinal visual fields for idiopathic intracranial hypertension patients presenting in a clinic setting.

We previously applied archetypal analysis (AA) using visual fields (VF) from the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) to derive a model, which quantified patterns (or archetypes [ATs] of VF loss), anticipated recovery, and identified residual VF deficits. We hypothesized that AA could produce similar results using IIH VFs collected in clinical practice. We applied AA to 803 VFs from 235 eyes with IIH from an outpatient neuro-ophthalmology clinic and created a clinic-derived model of ATs, with the relative weight (RW) and average total deviation (TD) for each AT. We also created a combined-derived model from an input dataset containing the clinic VFs and 2862 VFs from the IIHTT. We used both models to decompose clinic VF into ATs of varying percent weight (PW), correlated presentation AT PW with mean deviation (MD), and evaluated final visit VFs considered "normal" by MD ≥ -2.00 dB for residual abnormal ATs. The 14-AT clinic-derived and combined-derived models revealed similar patterns of VF loss previously identified in the IIHTT model. AT1 (a normal pattern) was most prevalent in both models (RW = 51.8% for clinic-derived; 35.4% for combined-derived). Presentation AT1 PW correlated with final visit MD (r = 0.82, p < 0.001 for the clinic-derived model; r = 0.59, p < 0.001 for the combined-derived model). Both models showed ATs with similar patterns of regional VF loss. The most common patterns of VF loss in "normal" final visit VFs using each model were clinic-derived AT2 (mild global depression with enlarged blind spot; 44/125 VFs; 34%) and combined-derived AT2 (near-normal; 93/149 VFs; 62%). AA provides quantitative values for IIH-related patterns of VF loss that can be used to monitor VF changes in a clinic setting. Presentation AT1 PW is associated with the degree of VF recovery. AA identifies residual VF deficits not otherwise indicated by MD.

Role of Obstructive Sleep Apnea in Idiopathic Intracranial Hypertension (P10-4.004)

<h3>Objective:</h3> It remains unclear if the presence or treatment of Obstructive Sleep Apnea (OSA) influences the severity or natural history of Idiopathic Intracranial Hypertension (IIH). Hence, we did retrospective analysis to investigate the correlation of OSA in IIH with regards to opening pressure and papilledema grading. <h3>Background:</h3> Retrospective review of all IIH patients seen between 2018–2020 in Neuro-Ophthalmology clinic at University of Kentucky. <h3>Design/Methods:</h3> 80 IIH patients were categorized into three groups. Group 1 had IIH and OSA (19 patients), group 2 had IIH, but no OSA (21 patients) and Group 3 had IIH with suspected OSA, but sleep study not completed (40 patients). Comparison of these three groups on demographic and clinical outcomes were done. <h3>Results:</h3> Chi-square tests were used to compare the three groups on categorical outcomes. One-way analysis of variance (ANOVA) or Wilcoxon rank-sum tests were used to compare the groups on continuous outcomes that were either normally or non-normally distributed, respectively. Patients in group 1 were significantly older than group 2 (p = .013). Group 1 weighed significantly more than group 2 and 3 (p = .004 and p &lt; .001, respectively). Group 1 had a significantly higher BMI than those on group 3 (p = .024), but their difference compared to group 2 did not reach significance (p = .061). When comparing the three groups on clinical outcomes, overall, there were no significance differences in opening pressure, or papilledema grading for either eye. <h3>Conclusions:</h3> In our study, there was no significant difference between the association of OSA on IIH in terms of opening pressure and the severity of papilledema. Larger, prospective and controlled studies are required to further evaluate the relationship between OSA and IIH, and the effect of OSA treatment on the clinical course of IIH. <b>Disclosure:</b> Dr. Thandampallayam Ajjeya has nothing to disclose. Dr. Sudhakar has nothing to disclose.

Select Patients with High-Risk IIH May Be Managed with Medical Therapy Alone (P2-9.009)

<h3>Objective:</h3> Measure visual outcomes in high-risk idiopathic intracranial hypertension (IIH), with particular attention to medical or surgical treatment course and disease recurrence. <h3>Background:</h3> In IIH, presentations with BMI &gt;40, high-grade papilledema, worse visual field mean deviation (VFMD), and worse visual acuity are associated with worse visual outcomes. In the absence of randomized data on high-risk patients, surgery is often recommended, but risks complications, infections, or surgical revision. <h3>Design/Methods:</h3> We retrospectively reviewed the charts of all IIH patients who presented to 3 providers between April 2019 and April 2022 with grade IV or V papilledema. Patients were treated at the discretion of their neuro-ophthalmologist. Outcomes were stratified by presenting VFMD. <h3>Results:</h3> 11 patients were evaluated. Average age was 25.8 years, 10/11 were female, and average BMI was 38.3 kg/m2. On presentation, VA was 20/30 or worse in 9/11 patients, but improved to 20/20 or better in 9/11 patients. Average presenting VFMD was −13.8 dB, but improved by an average of 7.1 dB in those with initial VFMD worse than −7.0 dB and 2.1 dB in those with initial VFMD better than −7.0 dB. 2 patients met published criteria for “fulminant” IIH, but both improved to 20/20 acuity OU with significant VFMD improvements on medical therapy alone. All patients received acetazolamide with rapid dose escalation. Average maximum dose was 2.75 g per day. 2 also received topiramate. 1 patient received a ventriculoperitoneal shunt 3 days after presentation. 1 patient received an optic nerve sheath fenestration 15 days after presentation. 1 patient on medical therapy had recurrent disease over an average of 352 days of follow up. <h3>Conclusions:</h3> Select patients with high-risk or “fulminant” IIH may be successfully managed without surgery. These patients required close monitoring and aggressive medical therapy. Reduced visual acuity on presentation recovered well in most patients. Larger cohorts with longer follow-up are needed. <b>Disclosure:</b> Dr. Gluckstein has nothing to disclose. An immediate family member of Dr. Rizzo has received personal compensation for serving as an employee of LIfeBiosciences. Dr. Rizzo has received intellectual property interests from a discovery or technology relating to health care. Dr. Rizzo has received intellectual property interests from a discovery or technology relating to health care. Dr. Chen has nothing to disclose.

Interpretation of telemetric intracranial pressure recordings in people with idiopathic intracranial hypertension after shunt implantation.

The M.scio telesensor (Aesculap-Miethke, Germany) is a device integrated within a ventriculoperitoneal (VP) shunt for non-invasive measurement of the intracranial pressure (ICP). The purpose of this study was to analyze the telemetric recordings with the M.scio system in shunted patients with idiopathic intracranial hypertension (IIH), in order to determine reference values and assist the interpretation of telemetric data. This was a cohort study of consecutive patients with fulminant IIH who underwent primary VP shunt insertion between July 2019 and June 2022. The first telemetric measurements after surgery in the sitting and supine positions were analyzed. Telemetric ICP values, wave morphology, and pulse amplitude were determined for functioning and malfunctioning shunts. Fifty-seven out of 64 patients had available telemetric recordings. The mean ICP was - 3.8mmHg (standard deviation (SD) = 5.9) in the sitting and 16.4mmHg (SD = 6.3) in the supine position. The ICP curve demonstrated pulsatility in 49 (86%) patients. A pulsatile curve with mean ICP in the above ranges indicated a functioning shunt, whereas the lack of pulsatility was challenging to interpret. There was a significant positive correlation between ICP versus amplitude, ICP versus body mass index (BMI), and amplitude versus BMI. This clinical study defined ICP values and curves in IIH patients with a shunt. The results will assist the interpretation of telemetric ICP recordings in clinical decision making. More research is required to model longitudinal recordings and explore the link between telemetric measurements with clinical outcomes.

Pituitary Dysfunction in Idiopathic Intracranial Hypertension: An Analysis of 80 Patients.

Empty sella is a commonly described imaging entity in patients with idiopathic intracranial hypertension (IIH). Though menstrual and hormonal disturbances have been associated with IIH, available literature lacks systematic analysis of pituitary hormonal disturbances in IIH. More so, the contribution of empty sella in causing pituitary hormonal abnormalities in patients of IIH has not been described. We carried out this study to systematically assess the pituitary hormonal abnormalities in patients with IIH and its relation to empty sella. Eighty treatment naïve patients of IIH were recruited as per a predefined criterion. Magnetic resonance imaging (MRI) brain with detailed sella imaging and pituitary hormonal profile were done in all patients. Partial empty sella was seen in 55 patients (68.8%). Hormonal abnormalities were detected in 30 patients (37.5%), reduced cortisol levels in 20%, raised prolactin levels in 13.8%, low thyroid-stimulating hormone (TSH) levels in 3.8%, hypogonadism in 1.25%, and elevated levels of gonadotropins were found in 6.25% of participants. Hormonal disturbances were independent and were not associated with the presence of empty sella (p = 0.493). Hormonal abnormalities were observed in 37.5% patients with IIH. These abnormalities did not correlate with the presence or absence of empty sella. Pituitary dysfunction appears to be subclinical in IIH and responds to intracranial pressure reduction, not requiring specific hormonal therapies.