RESUMO
OBJECTIVE: To compare French and American white patients with idiopathic intracranial hypertension (IIH), and to determine prognostic factors associated with visual loss. METHODS: Medical records of all consecutive white patients with definite IIH seen between 2001 and 2006 in three French tertiary care medical centers and one American tertiary medical center were reviewed. Demographics, associated clinical features, and visual function at presentation and follow-up were collected. French white patients were compared to American white patients. RESULTS: One hundred and thirty-four patients (66 French, 68 American) were included. American patients were 8.7 times more likely than French patients to have visual acuity 20/60 or worse or visual field constriction (95% CI: 2.1-36.1, p=0.0001). American patients were treated more aggressively than French patients. French patients were older (31 vs. 28 years, p=0.02) and more likely to have anemia (20 vs. 2%, p<0.001). American patients had a longer duration of symptoms prior to diagnosis (12 vs. 4 weeks, p=0.01) and longer follow-up than French patients (26 vs. 11 months, p=0.001). Multivariable analysis found that nationality was an independent risk factor for visual loss. French and American patients did not differ regarding gender proportion, frequency of obesity, sleep apnea, endocrine diseases, or systemic hypertension. Cerebrospinal fluid (CSF) opening pressures were similar in both groups. CONCLUSION: American patients with IIH had worse visual outcomes than French patients despite more aggressive treatment. These differences are not explained by differences in previously known risk factors.
Assuntos
Hipertensão Intracraniana/epidemiologia , Adolescente , Adulto , Peso Corporal/fisiologia , Pressão do Líquido Cefalorraquidiano/fisiologia , Feminino , França/epidemiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia , Testes Visuais , Acuidade Visual , População Branca , Adulto JovemRESUMO
OBJECTIVE: To compare the characteristics of idiopathic intracranial hypertension (IIH) in men vs women in a multicenter study. METHODS: Medical records of all consecutive patients with definite IIH seen at three university hospitals were reviewed. Demographics, associated factors, and visual function at presentation and follow-up were collected. Patients were divided into two groups based on sex for statistical comparisons. RESULTS: We included 721 consecutive patients, including 66 men (9%) and 655 women (91%). Men were more likely to have sleep apnea (24% vs 4%, p < 0.001) and were older (37 vs 28 years, p = 0.02). As their first symptom of IIH, men were less likely to report headache (55% vs 75%, p < 0.001) but more likely to report visual disturbances (35% vs 20%, p = 0.005). Men continued to have less headache (79% vs 89%, p = 0.01) at initial neuro-ophthalmologic assessment. Visual acuity and visual fields at presentation and last follow-up were significantly worse among men. The relative risk of severe visual loss for men compared with women was 2.1 (95% CI 1.4-3.3, p = 0.002) for at least one eye and 2.1 (95% CI 1.1-3.7, p = 0.03) for both eyes. Logistic regression supported sex as an independent risk factor for severe visual loss. CONCLUSION: Men with idiopathic intracranial hypertension (IIH) are twice as likely as women to develop severe visual loss. Men and women have different symptom profiles, which could represent differences in symptom expression or symptom thresholds between the sexes. Men with IIH likely need to be followed more closely regarding visual function because they may not reliably experience or report other symptoms of increased intracranial pressure.
Assuntos
Pseudotumor Cerebral/diagnóstico , Caracteres Sexuais , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Cefaleia/complicações , Cefaleia/diagnóstico , Cefaleia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/epidemiologiaRESUMO
OBJECTIVE: To evaluate racial differences in idiopathic intracranial hypertension (IIH). METHODS: Medical records of all consecutive patients with definite IIH seen between 1989 and 2006 were reviewed. Demographics, associated factors, and visual function at presentation and follow-up were collected. Black patients were compared to non-black patients. RESULTS: We included 450 patients (197 black, 253 non-black). Obesity, systemic hypertension, anemia, and sleep apnea were more common in black patients than in non-black patients (p = 0.01). CSF opening pressure was higher in black patients (40 vs 34 cm CSF, p < 0.001). Visual acuity, visual field loss, and degree of papilledema at presentation and follow-up were worse in black patients (p = 0.01). Diagnostic and therapeutic measures were similar between black patients and non-black patients, except for optic nerve sheath fenestration (p = 0.01) and lumbar puncture (p = 0.03), both more commonly performed on black patients. The relative risk of severe visual loss for black patients compared with non-black patients was 3.5 (95% CI 2.0 to 5.8, p < 0.001) in at least one eye and 4.8 (95% CI 2.1 to 10.9, p < 0.001) in both eyes. Logistic regression analysis supported race, anemia, body mass index, and male gender as independent risk factors for severe visual loss and suggested that racial differences may be partially accounted for by differences in CSF opening pressure, body mass index, and frequency of anemia. CONCLUSION: Black patients with idiopathic intracranial hypertension (IIH) were more likely than non-black patients with IIH to have severe visual loss in at least one eye. This difference did not appear to result from diagnosis, treatment, or access to care, but may partially relate to differences in other risk factors. Black patients have a more aggressive disease and may need closer follow-up and lower thresholds for early intervention.