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Purpose: Our aim was to describe the clinical profile of patients with idiopathic intracranial hypertension (IIH), assess ophthalmological manifestations, and correlate grade of papilledema with optic nerve sheath diameter (ONSD) and cerebrospinal fluid (CSF) opening pressure. Methods: This was a prospective cross?sectional study. Patients between 18 and 60 years, diagnosed with IIH using modified Dandy criteria were included. Demographic details, ocular symptoms and signs were noted and papilledema graded. Ocular investigations such as B?scan ONSD and perimetry findings were noted for analysis. Results: The study included 32 patients of mean age 35.25(±9.57) years with a predominantly female population (96.9%). Mean BMI was 28.12(±5.32) kg/m2. Common presenting complaint was headache (87.5%). The most common gynecological disorder was dysmenorrhea (15.6%). Vitamin D deficiency (46.9%) was a biochemical abnormality seen. Most patients had BCVA 6/6 (62.5%). Lateral rectus palsy was present in 12.5%. Papilledema was present in 81.3% eyes with 31.3% Grade I. There was visual field loss in 53.1%, with 20.3% Grade I. Mean CSF opening pressure was 376.3(±191.51) mmH2O. MRI showed empty sella (34.4%) and tortuous optic nerve (18.8%). MRV showed transverse sinus stenosis (52.4%) as common abnormality. There was significant correlation between grade of papilledema and B?scan ONSD. No correlation was seen between CSF opening pressure and ONSD, grade of papilledema and grade of visual field defect and CSF opening pressure with BMI. Conclusion: Clinical profile of patients with IIH was an overweight female of child?bearing age with headache. Visual field examinations are essential in management and follow?up. B?scan ONSD is useful to quantify raised ICP.
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Purpose: To determine the correlation between functional parameters and optical coherence tomography (OCT) features in patients of idiopathic intracranial hypertension (IIH). Methods: A prospective observational study in early and established cases of papilledema in IIH presenting from December 2017 to February 2019. Functional parameters (visual acuity, contrast sensitivity, mean deviation, VER, and MfERG) and structural parameters (RNFL, GCL?IPL, and optic disc height) were measured at baseline and every 6 weeks for 6 months. Results: At baseline, average RNFL had a moderate negative correlation with mean deviation (r = ?0.45; P = 0.0007) and a positive correlation with logMAR visual acuity (r = 0.18; P = 0.17). On the contrary, baseline GCL and logMAR visual acuity had a negative correlation (r = ?0.4, P = 0.02). Optic disc height (ODH) had a negative correlation with visual field mean deviation (r = ?0.046; P = 0.0005). At 6 months, ODH and GCL?IPL complex had a statistically significant correlation with functional parameters. However, RNFL values did not show any significant correlation with any of the functional parameters. Baseline GCL?IPL and optic disc height values had a moderate and significant correlation with final functional parameters. However, RNFL did not show any correlation with final functional parameters. Correlation between GCL?IPL thickness at 6 weeks and final functional parameters were stronger than that with baseline GCL values. Conclusion: In the setting of severe papilledema, RNFL can misguide the prognosis. GCL?IPL can be a valuable tool for an objective evaluation of the integrity of the optic nerve in IIH and ODH may be used as an alternative or in combination with GCL?IPL in these cases.
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Objective:To study the role of Magnetic Resonance Imaging in diagnostic evaluation of benign intracranial hypertension (BIH).Materials and methods:The present study was carried out in the Department of Radiodiagnosis, ESIC Medical College & Hospital, Faridabad. The study included twenty seven patients who were diagnosed with benign intracranial hypertension(BIH) based on modified Dandy's criteria.Results:Middle aged females were more commonly affected. Most common radiological findings were slit like frontal horns of lateral ventricles and empty sella, present in all of our patients. Findings involving optic nerve were present in 13 out of 27 (48%) of our patients, while 2 of 27 (7%) patients had spontaneous csf leak in presence of BIH. On manometry, CSF opening pressure[OP] was more than 25cm of H2O in all the patients.Conclusion:Slit like ventricles, empty sella, vertical kinking of optic nerve and distension of the perioptic subarachnoid space are important radiological markers of BIH that contribute to its diagnosis
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Pseudo tumor cerebri is a clinical entity of uncertain etiology characterized by intracranial hypertension. The syndrome classically manifests with headaches and visual changes in women with obesity. This case is being presented for the following points: raised ICT, bilateral CN VI palsy, bilateral papilledema (left > right), neck rigidity present without Kernig's and Brudginski signs. Keeping the history, Neurological findings, investigative results, point to the possibility of raised intracranial pressure with CN VI involvement. The final clinical diagnosis, to the above syndrome, points out to ‘Pseudo-tumor cerebri’.