Conflict of Interest: None
A Comparison of Idiopathic Intracranial Hypertension With and Without Papilledema
Article first published online: 3 FEB 2009
© 2009 the Authors. Journal compilation © 2009 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 49, Issue 2, pages 185–193, February 2009
How to Cite
Digre, K. B., Nakamoto, B. K., Warner, J. E.A., Langeberg, W. J., Baggaley, S. K. and Katz, B. J. (2009), A Comparison of Idiopathic Intracranial Hypertension With and Without Papilledema. Headache: The Journal of Head and Face Pain, 49: 185–193. doi: 10.1111/j.1526-4610.2008.01324.x
- Issue published online: 3 FEB 2009
- Article first published online: 3 FEB 2009
- Accepted for publication October 26, 2008.
- idiopathic intracranial hypertension;
- visual loss;
- visual fields;
- pseudotumor cerebri;
- functional visual loss
Objective.— To compare clinical features, visual characteristics, and treatment of idiopathic intracranial hypertension patients with and without papilledema.
Background.— Idiopathic intracranial hypertension does not often occur without papilledema. This study estimates the prevalence and compares the clinical characteristics of idiopathic intracranial hypertension patients with and without papilledema.
Methods.— We performed a cross-sectional analysis of all idiopathic intracranial hypertension patients diagnosed at the University of Utah Neuro-Ophthalmology Unit between 1990 and 2003. Patient records were reviewed for presence of papilledema and other signs, symptoms, and treatment characteristics. Each patient without papilledema was matched to the patient with papilledema who was closest to his/her age and sex. McNemar's and Wilcoxon-signed rank sum tests were used to compare characteristics between matched pairs.
Results.— Among all patients (n = 353), the prevalence of those without papilledema was 5.7% (n = 20). Patients without papilledema reported photopsias (20%), and were found to have spontaneous venous pulsations (75%) and non-physiologic visual field constriction (20%) more often than did those with papilledema. Mean opening pressure, although above normal, was lower in patients without papilledema (mean = 309 mm cerebrospinal fluid) compared with those with papilledema (mean = 373 mm cerebrospinal fluid, P = .031). Idiopathic intracranial hypertension patients without papilledema had more frequent diagnostic lumbar punctures than did patients with papilledema. Visual acuities and treatment were similar between groups.
Conclusions.— The clinical presentation of idiopathic intracranial hypertension without papilledema is only somewhat different from that of idiopathic intracranial hypertension with papilledema. The lower opening pressure in patients without papilledema may explain variations in symptoms and signs between the 2 groups. When there are visual field changes in idiopathic intracranial hypertension without papilledema, non-physiologic visual loss should be considered.