Idiopathic intracranial hypertension-clinical characteristics, neuroimaging and outcome of patients from Pretoria, South Africa

Abstract

BACKGROUND : Idiopathic intracranial hypertension is a syndrome characterized by symptoms and signs of raised intracranial pressure without a secondary cause. It primarily affects young obese women who present with headache and papilledema. We report the clinical presentation, brain imaging findings and outcomes of patients with IIH from two large tertiary hospitals in Pretoria, South Africa. METHODS : All patients with confirmed IIH attending Steve Biko Academic Hospital and Kalafong Provincial Tertiary Hospital between July 2019 and June 2024 were included. Demographic data, presenting symptoms and signs, visual assessment, neuroimaging, management and outcomes were analyzed. RESULTS : Forty-seven patients were included (45 females; 96%). Mean age was 34 years and mean BMI was 38.2 kg/m2. The most common presenting symptoms were headache (97.9%), visual abnormalities (blurred vision 55%, transient visual obscurations 42%) and pulsatile tinnitus (40.5%). Papilledema occurred in 46 patients (97.9%); the mean opening pressure was 32 cm H2O. MRI had a higher sensitivity in detecting IIH-related features compared to CT (79% versus 63%). Tortuosity of the optic nerves was most common in 79% of the MRIs, followed by enlarged optic nerve sheaths in 68.4%. Four eyes were blind at presentation and remained blind. While most patients reported improvement on acetazolamide and/or topiramate, at discharge, 21.3% remained symptomatic. CONCLUSION : Demographics and clinical presentation were comparable to international studies, showing that IIH is a disorder prevalent in young obese females. It is disconcerting that patients still lose vision due to a treatable condition and awareness of IIH should be raised.