Re-evaluating the Incidence of Idiopathic Intracranial Hypertension in an Era of Increasing Obesity

doi:10.1016/j.ophtha.2017.01.006

Ophthalmology

Volume 124, Issue 5, May 2017, Pages 697-700

Presented at: American Academy of Ophthalmology annual meeting, October 2016, Chicago, Illinois.

https://doi.org/10.1016/j.ophtha.2017.01.006 Get rights and content

Purpose

To re-evaluate the population-based incidence of idiopathic intracranial hypertension (IIH) and to determine if it mirrors the rise in obesity.

Design

Retrospective, population-based cohort.

Participants

All residents of Olmsted County, Minnesota, diagnosed with IIH between January 1, 1990, and December 31, 2014.

Methods

All cases of IIH were identified using the Rochester Epidemiology Project, which is a record-linkage system of medical records for all patient–physician encounters among Olmsted County, Minnesota, residents. All medical records were reviewed to confirm a diagnosis of IIH. The incidence rates of IIH were compared against the incidence of obesity in Minnesota over the same period.

Main Outcome Measures

Incidence of IIH, lumbar puncture opening pressures, and body mass index.

Results

There were 63 new cases of IIH, yielding an overall age- and gender-adjusted annual incidence of 1.8 per 100 000 (95% confidence interval, 1.3–2.2) between 1990 and 2014. It increased from 1.0 per 100 000 (1990–2001) to 2.4 per 100 000 (2002–2014; P = 0.007). The incidence of IIH was 3.3 per 100 000 in women and 0.3 per 100 000 in men (P ≤ 0.001). In obese women 15 to 44 years of age, the incidence was 22.0 per 100 000 compared with 6.8 per 100 000 among all women in the same age group. A strong correlation was observed between IIH incidence rates and obesity rates in Minnesota (R² = 0.70, P = 0.008).

Conclusions

The incidence of IIH has increased since 1990, which is highly correlated with the rise in obesity during the same period.

Section snippets

Methods

The medical records of all patients diagnosed in Olmsted County, Minnesota, with IIH, intracranial hypertension, pseudotumor cerebri, or papilledema from January 1, 1990, through December 31, 2014, were reviewed. Potential participants were identified using the Rochester Epidemiology Project, a multicenter medical records database designed to capture data on all patient–physician encounters in Olmsted County, Minnesota.6, 7 This study was approved by the Institutional Review Board of the Mayo

Results

From 1990 through 2014, 63 patients were diagnosed in Olmsted County with IIH, 92.1% of whom were women (Table 1). Among patients with available BMI data, 36 of 48 (82.6%) were obese, more than half of whom were morbidly obese (52.6%). Body mass index was unknown for 17 patients.

The incidence rates of IIH in the Olmsted County population are summarized in Table 2. The overall age- and gender-adjusted incidence rate was 1.8 per 100 000 persons. The IIH incidence increased significantly over the

Discussion

A prior study using the Rochester Epidemiology Project data to evaluate the epidemiologic features of IIH before 1990 found a crude annual incidence of 1.0 per 100 000 persons and 3.3 per 100 000 persons in women 15 to 44 years of age in Olmsted County, Minnesota.⁵ This study has been used to quote the incidence of IIH since it was published in 1993.⁹ Looking at the same patient population, the current study found that the crude annual incidence rate has doubled in Olmsted County, Minnesota, to

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National trends in the endovascular and surgical treatment of idiopathic intracranial hypertension
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The pattern of surgical treatments for Idiopathic Intracranial Hypertension (IIH) in the United States is not well-studied, specifically the trend of utilizing endovascular venous stenting (EVS) as an emerging technique.
In this cross-sectional study, we aimed to explore the national trend of utilizing different procedures for the treatment of IIH including EVS, Optic Nerve Sheath Fenestration (ONSF), and CSF Shunting, with a focus on novel endovascular procedures. Moreover, we explored rates of 90-day readmission and length of hospital stay following different procedures, besides the effects of sociodemographic and clinical parameters on procedure choice.
36,437 IIH patients were identified from records between 2010 and 2018. Those in the EVS group were 29 years old on average, and 93.4 % were female. Large academic hospital setting was independently associated with higher EVS utilization, while other factors were not predictive of procedure choice. The proportion of EVS use in IIH hospitalizations increased significantly from 2010 to 2018 (P < 0.001), while there was a relative decline in the frequency of shunting procedures (P = 0.001), with ONSF utilization remaining stable (P = 0.39). The rate of 90-day readmission and length of hospital stay were considerably lower following EVS compared to other procedures (Ps < 0.001).
This study presents novel population-level data on national trends in the frequency and outcome of EVS for IIH therapy. EVS was associated with shorter length of hospital stays and fewer readmission rates. In addition, a continuous increase in venous stenting compared to other procedures suggests an increasing role for endovascular therapies in IIH.
Pseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis
2024, Neurologia
El síndrome de pseudotumor cerebri (SPTC) en pacientes prepuberales presenta características que lo diferencian respecto a su presentación en la etapa pospuberal. Nuestro objetivo es describir las características de los pacientes diagnosticados de SPTC pediátrico en nuestro centro y compararlas en función de su estado puberal.
Se incluyeron a los pacientes diagnosticados de SPTC en un hospital de tercer nivel entre los años 2006 y 2019 con edades comprendidas entre uno y 18 años que cumplieran los criterios diagnósticos actualizados del SPTC. Se clasificaron en función de su estado puberal y peso corporal. Posteriormente, se analizaron los datos de las punciones lumbares, estudios de neuroimagen, valoraciones oftalmológicas, así como el régimen terapéutico recibido a lo largo de su seguimiento.
Se recogieron 28 pacientes, 22 prepuberales y seis pospuberales, con edad media de 9,04 ± 2,86 años. El 83,3% de los pacientes pospuberales eran varones presentando sobrepeso/obesidad en el 66,7%. Eran varones el 27% de los pacientes prepuberales, de ellos asociaban sobrepeso el 31,8%. La sintomatología más frecuente fue cefalea (89,9%) y visión borrosa (42,9%). Todos los pacientes presentaron papiledema; un 21,4% de los casos presentaron parálisis del VI par. Se identificó un posible desencadenante en un 28,6%. El 19% presentaron recurrencia clínica, siendo todos ellos prepuberales. La resolución clínica completa se produjo en el 55,6% de los pacientes.
Pacientes con SPTC presentan menor prevalencia de obesidad en la etapa prepuberal, junto con un mayor porcentaje de etiologías secundarias y tasa de recurrencia que los pacientes pospuberales.
Pseudotumor cerebri (PC) in prepubertal patients displays certain characteristics that differentiate it from its presentation at the postpubertal stage. The aim of this study is to describe the characteristics of paediatric patients diagnosed with PC at our centre and to compare them according to their pubertal status.
We included patients aged between 1 and 18 years who were diagnosed with PC in a tertiary-level hospital between 2006 and 2019 and who met the updated diagnostic criteria for PC. They were classified according to body weight and pubertal status. Subsequently, we analysed results from lumbar punctures, neuroimaging studies, ophthalmological assessments, and treatments received during follow-up.
We included 28 patients, of whom 22 were of prepubertal age and 6 were of postpubertal age. The mean age (standard deviation) was 9.04 (2.86) years. Among the postpubertal patients, 83.3% were boys, 66.7% of whom presented overweight/obesity. In the group of prepubertal patients, 27% were boys, 31.8% of whom were overweight. The most frequent symptoms were headache (89.9%) and blurred vision (42.9%). All patients presented papilloedema, and 21.4% manifested sixth nerve palsy. Possible triggers were identified in 28.6% of cases. Nineteen percent of patients presented clinical recurrence, all of whom were prepubertal patients. Complete clinical resolution was achieved in 55.6% of patients.
Prepubertal patients with PC show lower prevalence of obesity, higher prevalence of secondary aetiologies, and higher recurrence rates than postpubertal patients.
A Systematic Review of Neuropsychiatric Symptoms in Idiopathic Intracranial Hypertension
2024, Journal of the Academy of Consultation-Liaison Psychiatry
There is limited characterization of neuropsychiatric symptoms (NPS) in patients with idiopathic intracranial hypertension (IIH). Along with commonly presenting symptoms of IIH, including headache and papilledema, NPS may have a significant impact on IIH outcomes.
We completed a systematic review of the literature to characterize the most common noncognitive NPS in IIH patients and examine associations between noncognitive NPS and IIH outcomes.
A Preferred Reporting Items for Systemic Reviews and Meta-Analysis compliant literature search was conducted in Ovid Medline, PubMed, PsycInfo, Embase, Web of Science, Cochrane, CINAHL, and Scopus databases. The initial query yielded 1688 unique articles. These articles were narrowed to those including empirical analyses of noncognitive NPS in adult patients with IIH.
A final cohort of eight articles comprised 724 individuals with IIH and 257 healthy controls. Noncognitive NPS, specifically anxiety and depression, were more common in IIH patients compared to controls. Patients with IIH also reported increased headache, visual disturbances, and overall poorer quality of life. Limitations included heterogeneous sample characteristics along with variability in measurement of noncognitive NPS between studies.
A greater understanding of the most prevalent noncognitive NPS such as depression and anxiety in IIH patients, particularly among females who are obese and facing social and economic marginalization, may help to reduce IIH-associated morbidity. In particular, improved screening and timely management of psychiatric conditions using a multidisciplinary approach may improve IIH outcomes.
Secondary intracranial hypertension due to thoracic syrinx
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Non-invasive Measurement of the Viscoelasticity of the Optic Nerve and Sclera for Assessing Papilledema: A Pilot Clinical Study
2023, Ultrasound in Medicine and Biology
The purpose of this study was to evaluate our novel ultrasound vibro-elastography (UVE) technique for assessing patients with papilledema by non-invasively measuring shear wave speed (SWS), elasticity and viscosity properties of the optic nerve and sclera.
Shear wave speeds were measured at three frequencies—100, 150 and 200 Hz—on the optic nerve and sclera tissues for assessing patients with papilledema resulting from idiopathic intracranial hypertension (IIH). The method was evaluated in six papilledema patients and six controls on two separate locations for each participant (i.e., optic nerve and posterior sclera). SWSs of the optic nerve and sclera were analyzed by using a 2-D speed map technique within a circular region of interest (ROI) (i.e., the diameter of the ROI was 1.5 mm × 3.0 mm at the optic nerve and sclera, respectively). Elasticity and viscosity were then analyzed using the wave speed dispersion over the three frequencies.
We measured values of SWS at both locations, optic nerve and sclera, of the right eye and left eye at three different frequencies in IIH patients and controls. The SWS (mean ± standard deviation [m/s]) of the right eye was significantly higher at the sclera in IIH patients compared with controls (i.e., patients vs. controls: 5.91 ± 0.54 vs. 3.86 ± 0.56, p < 0.0001 at 100 Hz), but there was no significant difference at the optic nerve (i.e., patients vs. controls: 3.62 ± 0.39 vs. 3.36 ± 0.35, p = 0.1100 at 100Hz). We observed increased elasticity (kPa) in IIH patients, indicating there are significant differences in elasticity between patients and controls at the optic nerve and sclera (i.e., right eye [patients vs. controls]: 14.42 ± 6.59 vs. 6.5 ± 5.71, p = 0.0065 [optic nerve]; 33.04 ± 10.62 vs. 9.16 ± 7.15, p < 0.0001 [sclera]). Viscosity was also (Pa·s) higher in the sclera and optic nerve of the left eye (i.e., left eye [patient vs. control]: 8.89 ± 4.37 vs. 7.27 ± 5.01, p = 0.3790 (optic nerve); 16.05 ± 10.79 vs. 8.49 ± 6.09, p < 0.0194 [sclera]).
This research illustrates the feasibility of using our UVE system to evaluate stiffness of different tissues in the eye non-invasively. It suggests that the viscoelasticity of the posterior sclera is higher than that of the optic nerve. We found that the posterior sclera is stiffer than the optic nerve in patients with papilledema resulting from IIH, making UVE a potential non-invasive technique for assessing papilledema.
Optic disc vessel density changes after shunt surgery in idiopathic intracranial hypertension
2023, Photodiagnosis and Photodynamic Therapy
To detect the change in optic disc vessel density in patients with idiopathic intracranial hypertension (IIH) after shunt surgery.
Twenty-one patients with IIH underwent shunt surgery. Patients were subjected to full ophthalmic and neurological examinations. Optic disc vessel density was measured using optical coherence tomography angiography (OCT-A) before and two months after surgery.
The age of patients ranged from 27 to 48 years old, with a mean of (34.85 ± 6.87). Visual acuity ranged between 0.2 and 0.9 by log Mar, with a mean of (0.64±o.20). The mean deviation (MD) of the perimeter ranged from -22.9 to 0 dB, with a mean of (-9.77 ± 7.23 dB). With respect to the grade of papilledema, 15 eyes (35.7%) were of grade II, 21 eyes (50.0%) were of grade III, and 6 eyes (14.3%) were grade IV.
Intracranial pressure measured by lumbar puncture (LP) prior to surgery ranged from 30 to 40 cm, with a mean of 35.43 cm. Except for right transverse sinus hypoplasia in 6 patients (28.6%), MRV was normal. In 15 patients (71.4%), lumboperitoneal shunt was performed, while ventriculoperitoneal shunt was performed in 6 patients (28.6%).
After surgery, the optical disc vessel density was decreased in all patients. This decrease was highly significant for the whole image, the inner disc, the peripapillary, superior, and inferior hemispheres. Moreover, this reduction affected both optic disc microvasculature (referred to as capillary vessel density) and macro vasculature (also known as all vessel density).
There were positive correlations between the CSF opening pressures and the preoperative optic disc vessel density of the whole image and inside disc with a P-value (0.002, 0.009), respectively. In addition, there was a positive correlation between the opening CSF pressures and the reduction in whole image vessel density after surgery with a P-value of 0.000.
Optic disc vessel density decreased after shunt surgery in patients with IIH. Consequently, optic disc vessel density can be used as a biomarker for the reduction of CSF opening pressure.

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: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Supported in part by Research to Prevent Blindness, Inc, New York, New York (an unrestricted grant to the Department of Ophthalmology). This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging, National Institutes of Health, Bethesda, Maryland (grant no.: R01AG034676). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

: Author Contributions:

: Conception and design: Kilgore, Lee, Leavitt, Chen

: Analysis and interpretation: Kilgore, Lee, Leavitt, Mokri, Hodge, Frank, Chen

: Data collection: Kilgore, Chen

: Obtained funding: none

: Overall responsibility: Kilgore, Lee, Leavitt, Mokri, Hodge, Frank, Chen

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Original articleRe-evaluating the Incidence of Idiopathic Intracranial Hypertension in an Era of Increasing Obesity

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Neurol Clin

Mayo Clin Proc

J Neurol Sci

Epidemiology and risk factors for idiopathic intracranial hypertension

Int Ophthalmol Clin

Idiopathic intracranial hypertension

Curr Pain Headache Rep

Prevalence of childhood and adult obesity in the United States, 2011–2012

JAMA

Idiopathic intracranial hypertension (pseudotumor cerebri). Descriptive epidemiology in Rochester, Minn, 1976 to 1990

Arch Neurol

The patient record in epidemiology

Sci Am

Intracranial pressure without brain tumor: diagnosis and treatment

Ann Surg

Original article
Re-evaluating the Incidence of Idiopathic Intracranial Hypertension in an Era of Increasing Obesity