Functional visual loss in idiopathic intracranial hypertension.
OBJECTIVE
To identify and describe patients with idiopathic intracranial hypertension (IIH) with concurrent functional visual loss (FVL).


METHODS
Observational, retrospective case series.


METHODS
Seventeen patients with IIH and FVL.


METHODS
Clinical features were collected retrospectively. Data from 281 cases of IIH were analyzed for concurrence of FVL.


METHODS
Occurrence of FVL diagnosed at presentation or on subsequent follow-up.


RESULTS
Seventeen patients had FVL and IIH. Of the 17 patients with FVL and IIH, 11 (65%) had FVL on presentation, with the remaining 6 patients developing FVL after initial presentation. Two patients in this cohort had documented recurrence of their IIH. There were several common patterns of FVL. All 17 patients had functional visual fields, with 82% having tubular fields and 71% exhibiting nonphysiologic constriction on perimetry testing. Seventy-six percent of patients had nerve/field mismatch showing no atrophic disc changes. Eighty-eight percent of patients had significant psychiatric, psychosocial, or other medical comorbidities. The majority of patients were managed surgically at some point in their clinical history, with 53% having nerve decompression, shunt, or both. Three patients had optic nerve sheath fenestrations after the diagnosis of FVL.


CONCLUSIONS
Results suggest a high prevalence of FVL in IIH with a potential association with psychiatric illness and psychosocial stressors requiring careful consideration before surgical intervention.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Ney
Joshua J
JJ
Departments of Neurology and Ophthalmology, Scheie Eye Institute, University of Pennsylvania School of Medicine, 51 North 39th Street, Philadelphia, PA 19104, USA.
Volpe
Nicholas J
NJ
Liu
Grant T
GT
Balcer
Laura J
LJ
Moster
Mark L
ML
Galetta
Steven L
SL
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D010211:Papilledema / Q000175:diagnosis; D011559:Pseudotumor Cerebri / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000175:diagnosis / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology