title: Factors affecting visual loss and visual recovery in patients with pseudotumor cerebri syndrome.
abstract: OBJECTIVE
  To investigate the frequency of visual loss (VL), possible predictive factors of VL, and improvement in patients with pseudotumor cerebri (PTC) syndrome.
  
  
  METHODS
  We reviewed 50 PTC patients (43 females, seven males) who underwent neuro-ophthalmic examination at the time of diagnosis and after treatment. Demographic data, body mass index (BMI), time from symptom onset to diagnosis (TD), maximum intracranial pressure (MIP), occurrence of cerebral venous thrombosis (CVT), and treatment modalities were reviewed. VL was graded as mild, moderate, or severe on the basis of visual acuity and fields. Predictive factors for VL and improvement were assessed by regression analysis.
  
  
  RESULTS
  The mean ± SD age, BMI, and MIP were 35.2 ± 12.7 years, 32.0 ± 7.5 kg/cm2, and 41.9 ± 14.5 cmH2O, respectively. Visual symptoms and CVT were present in 46 and eight patients, respectively. TD (in months) was <1 in 21, 1-6 in 15, and >6 in 14 patients. Patients received medical treatment with (n=20) or without (n=30) surgery. At presentation, VL was mild in 16, moderate in 12, and severe in 22 patients. Twenty-eight patients improved and five worsened. MIP, TD, and hypertension showed a significant correlation with severe VL. The best predictive factor for severe VL was TD >6 months (p=0.04; odds ratio, 5.18). TD between 1 and 6 months was the only factor significantly associated with visual improvement (p=0.042).
  
  
  CONCLUSIONS
  VL is common in PTC, and when severe, it is associated with a delay in diagnosis. It is frequently permanent; however, improvement may occur, particularly when diagnosed within 6 months of symptom onset.
authors.affiliation: Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Clara L
authors.initials: CL
authors.lastname: Afonso
authors.affiliation: Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Aley
authors.initials: A
authors.lastname: Talans
authors.affiliation: Department of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Mário Luiz Ribeiro
authors.initials: ML
authors.lastname: Monteiro
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use; D003276:Contraceptives, Oral / Q000009:adverse effects; D057210:Delayed Diagnosis / Q000009:adverse effects; D005260:Female; D006261:Headache / Q000150:complications; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011559:Pseudotumor Cerebri / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D020127:Recovery of Function; D012044:Regression Analysis; D012851:Sinus Thrombosis, Intracranial / Q000150:complications; D013997:Time Factors; D014786:Vision Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D055815:Young Adult
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D003276:Contraceptives, Oral