A comparison of idiopathic intracranial hypertension with and without papilledema.
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.
Digre
Kathleen B
KB
Department of Ophthalmology, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
Nakamoto
Beau K
BK
Warner
Judith E A
JE
Langeberg
Wendy J
WJ
Baggaley
Susan K
SK
Katz
Bradley J
BJ
D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010211:Papilledema / Q000150:complications* / Q000453:epidemiology; D011559:Pseudotumor Cerebri / Q000150:complications* / Q000503:physiopathology*; D014786:Vision Disorders / Q000150:complications*