Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age: A multicenter clinical cohort study

Peter A. Downie; John J. Chen; M. Tariq Bhatti; Andrew T. Melson; Gregory P. Van Stavern; Collin M. McClelland; Bruce R. Lindgren; Jibran A. Sharieff; Michael S. Lee

doi:10.1016/j.ajo.2020.11.007

Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age: A multicenter clinical cohort study

Peter A. Downie, John J. Chen, M. Tariq Bhatti, Andrew T. Melson, Gregory P. Van Stavern, Collin M. McClelland, Bruce R. Lindgren, Jibran A. Sharieff, Michael S. Lee

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4 Scopus citations

Abstract

PURPOSE: To characterize the clinical features of idiopathic intracranial hypertension (IIH) in patients >50 years of age compared to the typical IIH population and existing data for this older cohort.

DESIGN: Retrospective, clinical cohort study.

METHODS: Medical records of 65 patients >50 years of age at first diagnosis of IIH were reviewed based on the Modified Dandy Criteria from 4 academic centers. Each center provided randomly selected controls from IIH patients <50 years of age for each study patient at their location. Data recorded included patient demographics, presenting symptoms, medications, coexisting medical conditions, cerebrospinal fluid (CSF) opening pressure, treatments, and neuro-ophthalmic data from initial and final visits.

RESULTS: Compared to controls, the older cohort showed the following characteristics: fewer females (n = 51 [78.5%] vs. controls: n = 60 [92.3%]; P = .045), fewer headaches (n = 33 [50.8%] vs. controls: 52 [80.0%]; P = .001), more frequent incidental discoveries of papilledema (n = 19 [29.2%] vs. controls: 7 [10.8%]; P = .015), and lower CSF opening pressure [median: 33 cm H 2O [range: 21-58 cm H 2O] vs. the median for controls: 34 cm H 2O [range: 24-67 cm H 2O; P = .029).

CONCLUSIONS: Patients with IIH diagnosed at >50 years of age were less often female and had lower CSF opening pressure, fewer headaches, a higher chance of incidentally identified papilledema, and body mass index similar to that of younger IIH patients. Older IIH onset was not associated with worse visual outcome.

Original language	English (US)
Pages (from-to)	96-101
Number of pages	6
Journal	American journal of ophthalmology
Volume	224
DOIs	https://doi.org/10.1016/j.ajo.2020.11.007
State	Published - Apr 2021

Bibliographical note

Funding Information:
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This research was supported by the US National Institutes of Health , United States/ National Center for Advancing Translational Sciences , United States grant UL1TR002494 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health/National Center for Advancing Translational Sciences. C.M.M. is a consultant for Horizon Therapeutics. M.S.L. is a consultant and holds stock in Horizon Therapeutics, Osmotica Pharmaceuticals, Royalties, and Springer Publishing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Funding Information:
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This research was supported by the US National Institutes of Health, United States/National Center for Advancing Translational Sciences, United States grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health/National Center for Advancing Translational Sciences. C.M.M. is a consultant for Horizon Therapeutics. M.S.L. is a consultant and holds stock in Horizon Therapeutics, Osmotica Pharmaceuticals, Royalties, and Springer Publishing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

Adult
Body Mass Index
Cerebrospinal Fluid Pressure
Female
Headache/diagnosis
Humans
Male
Middle Aged
Papilledema/diagnosis
Pseudotumor Cerebri/diagnosis
Retrospective Studies
Sex Factors
Visual Acuity/physiology
Visual Fields/physiology
Young Adult

PubMed: MeSH publication types

Multicenter Study
Journal Article
Research Support, N.I.H., Extramural
Comparative Study

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10.1016/j.ajo.2020.11.007

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Downie, P. A., Chen, J. J., Bhatti, M. T., Melson, A. T., Van Stavern, G. P., McClelland, C. M., Lindgren, B. R., Sharieff, J. A., & Lee, M. S. (2021). Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age: A multicenter clinical cohort study. American journal of ophthalmology, 224, 96-101. https://doi.org/10.1016/j.ajo.2020.11.007

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title = "Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age: A multicenter clinical cohort study",

abstract = "PURPOSE: To characterize the clinical features of idiopathic intracranial hypertension (IIH) in patients >50 years of age compared to the typical IIH population and existing data for this older cohort.DESIGN: Retrospective, clinical cohort study.METHODS: Medical records of 65 patients >50 years of age at first diagnosis of IIH were reviewed based on the Modified Dandy Criteria from 4 academic centers. Each center provided randomly selected controls from IIH patients <50 years of age for each study patient at their location. Data recorded included patient demographics, presenting symptoms, medications, coexisting medical conditions, cerebrospinal fluid (CSF) opening pressure, treatments, and neuro-ophthalmic data from initial and final visits.RESULTS: Compared to controls, the older cohort showed the following characteristics: fewer females (n = 51 [78.5%] vs. controls: n = 60 [92.3%]; P = .045), fewer headaches (n = 33 [50.8%] vs. controls: 52 [80.0%]; P = .001), more frequent incidental discoveries of papilledema (n = 19 [29.2%] vs. controls: 7 [10.8%]; P = .015), and lower CSF opening pressure [median: 33 cm H 2O [range: 21-58 cm H 2O] vs. the median for controls: 34 cm H 2O [range: 24-67 cm H 2O; P = .029). CONCLUSIONS: Patients with IIH diagnosed at >50 years of age were less often female and had lower CSF opening pressure, fewer headaches, a higher chance of incidentally identified papilledema, and body mass index similar to that of younger IIH patients. Older IIH onset was not associated with worse visual outcome.",

keywords = "Adult, Body Mass Index, Cerebrospinal Fluid Pressure, Female, Headache/diagnosis, Humans, Male, Middle Aged, Papilledema/diagnosis, Pseudotumor Cerebri/diagnosis, Retrospective Studies, Sex Factors, Visual Acuity/physiology, Visual Fields/physiology, Young Adult",

author = "Downie, {Peter A.} and Chen, {John J.} and Bhatti, {M. Tariq} and Melson, {Andrew T.} and {Van Stavern}, {Gregory P.} and McClelland, {Collin M.} and Lindgren, {Bruce R.} and Sharieff, {Jibran A.} and Lee, {Michael S.}",

note = "Funding Information: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This research was supported by the US National Institutes of Health , United States/ National Center for Advancing Translational Sciences , United States grant UL1TR002494 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health/National Center for Advancing Translational Sciences. C.M.M. is a consultant for Horizon Therapeutics. M.S.L. is a consultant and holds stock in Horizon Therapeutics, Osmotica Pharmaceuticals, Royalties, and Springer Publishing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This research was supported by the US National Institutes of Health, United States/National Center for Advancing Translational Sciences, United States grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health/National Center for Advancing Translational Sciences. C.M.M. is a consultant for Horizon Therapeutics. M.S.L. is a consultant and holds stock in Horizon Therapeutics, Osmotica Pharmaceuticals, Royalties, and Springer Publishing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",

year = "2021",

month = apr,

doi = "10.1016/j.ajo.2020.11.007",

language = "English (US)",

volume = "224",

pages = "96--101",

journal = "American journal of ophthalmology",

issn = "0002-9394",

publisher = "Elsevier USA",

}

TY - JOUR

T1 - Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age

T2 - A multicenter clinical cohort study

AU - Downie, Peter A.

AU - Chen, John J.

AU - Bhatti, M. Tariq

AU - Melson, Andrew T.

AU - Van Stavern, Gregory P.

AU - McClelland, Collin M.

AU - Lindgren, Bruce R.

AU - Sharieff, Jibran A.

AU - Lee, Michael S.

N1 - Funding Information: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This research was supported by the US National Institutes of Health , United States/ National Center for Advancing Translational Sciences , United States grant UL1TR002494 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health/National Center for Advancing Translational Sciences. C.M.M. is a consultant for Horizon Therapeutics. M.S.L. is a consultant and holds stock in Horizon Therapeutics, Osmotica Pharmaceuticals, Royalties, and Springer Publishing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This research was supported by the US National Institutes of Health, United States/National Center for Advancing Translational Sciences, United States grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health/National Center for Advancing Translational Sciences. C.M.M. is a consultant for Horizon Therapeutics. M.S.L. is a consultant and holds stock in Horizon Therapeutics, Osmotica Pharmaceuticals, Royalties, and Springer Publishing. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2020 Elsevier Inc.

PY - 2021/4

Y1 - 2021/4

N2 - PURPOSE: To characterize the clinical features of idiopathic intracranial hypertension (IIH) in patients >50 years of age compared to the typical IIH population and existing data for this older cohort.DESIGN: Retrospective, clinical cohort study.METHODS: Medical records of 65 patients >50 years of age at first diagnosis of IIH were reviewed based on the Modified Dandy Criteria from 4 academic centers. Each center provided randomly selected controls from IIH patients <50 years of age for each study patient at their location. Data recorded included patient demographics, presenting symptoms, medications, coexisting medical conditions, cerebrospinal fluid (CSF) opening pressure, treatments, and neuro-ophthalmic data from initial and final visits.RESULTS: Compared to controls, the older cohort showed the following characteristics: fewer females (n = 51 [78.5%] vs. controls: n = 60 [92.3%]; P = .045), fewer headaches (n = 33 [50.8%] vs. controls: 52 [80.0%]; P = .001), more frequent incidental discoveries of papilledema (n = 19 [29.2%] vs. controls: 7 [10.8%]; P = .015), and lower CSF opening pressure [median: 33 cm H 2O [range: 21-58 cm H 2O] vs. the median for controls: 34 cm H 2O [range: 24-67 cm H 2O; P = .029). CONCLUSIONS: Patients with IIH diagnosed at >50 years of age were less often female and had lower CSF opening pressure, fewer headaches, a higher chance of incidentally identified papilledema, and body mass index similar to that of younger IIH patients. Older IIH onset was not associated with worse visual outcome.

AB - PURPOSE: To characterize the clinical features of idiopathic intracranial hypertension (IIH) in patients >50 years of age compared to the typical IIH population and existing data for this older cohort.DESIGN: Retrospective, clinical cohort study.METHODS: Medical records of 65 patients >50 years of age at first diagnosis of IIH were reviewed based on the Modified Dandy Criteria from 4 academic centers. Each center provided randomly selected controls from IIH patients <50 years of age for each study patient at their location. Data recorded included patient demographics, presenting symptoms, medications, coexisting medical conditions, cerebrospinal fluid (CSF) opening pressure, treatments, and neuro-ophthalmic data from initial and final visits.RESULTS: Compared to controls, the older cohort showed the following characteristics: fewer females (n = 51 [78.5%] vs. controls: n = 60 [92.3%]; P = .045), fewer headaches (n = 33 [50.8%] vs. controls: 52 [80.0%]; P = .001), more frequent incidental discoveries of papilledema (n = 19 [29.2%] vs. controls: 7 [10.8%]; P = .015), and lower CSF opening pressure [median: 33 cm H 2O [range: 21-58 cm H 2O] vs. the median for controls: 34 cm H 2O [range: 24-67 cm H 2O; P = .029). CONCLUSIONS: Patients with IIH diagnosed at >50 years of age were less often female and had lower CSF opening pressure, fewer headaches, a higher chance of incidentally identified papilledema, and body mass index similar to that of younger IIH patients. Older IIH onset was not associated with worse visual outcome.

KW - Adult

KW - Body Mass Index

KW - Cerebrospinal Fluid Pressure

KW - Female

KW - Headache/diagnosis

KW - Humans

KW - Male

KW - Middle Aged

KW - Papilledema/diagnosis

KW - Pseudotumor Cerebri/diagnosis

KW - Retrospective Studies

KW - Sex Factors

KW - Visual Acuity/physiology

KW - Visual Fields/physiology

KW - Young Adult

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DO - 10.1016/j.ajo.2020.11.007

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AN - SCOPUS:85100027153

SN - 0002-9394

VL - 224

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JO - American journal of ophthalmology

JF - American journal of ophthalmology

ER -

Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age: A multicenter clinical cohort study

Abstract

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Keywords

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