Visual Outcomes and Clinical Predictors of Recovery After Medical Management of Idiopathic Intracranial Hypertension: A Prospective Cohort Study

Abstract

Background: Idiopathic intracranial hypertension is a disorder of raised intracranial pressure that predominantly affects young women and poses a substantial risk of irreversible visual impairment if not promptly and effectively managed. Although medical therapy is effective in many cases, visual outcomes vary, and reliable clinical predictors of recovery remain incompletely defined, particularly in low- and middle-resource settings. Objective: To evaluate visual outcomes following medical treatment in patients with idiopathic intracranial hypertension and to identify baseline factors associated with good visual recovery. Methods: This prospective cohort study enrolled 68 adults diagnosed with idiopathic intracranial hypertension at a tertiary care hospital in DHQ Hospital, Mandi Baha ud Din, Pakistan between February 2021 and June 2024. Baseline demographic, clinical, anthropometric, and cerebrospinal fluid parameters were recorded at diagnosis. All patients received standardized medical therapy and underwent neuro-ophthalmic assessment at baseline and at three months. Visual outcomes were classified using the Wall and George grading system. Multivariable logistic regression analysis was performed to identify independent predictors of good visual outcome. Results: At three months, 54 patients (79.4%) achieved a good visual outcome. Cranial nerve palsy at baseline was significantly more frequent among patients with poor outcomes and was independently associated with reduced odds of good visual recovery. Higher body mass index was also an independent predictor of poorer visual outcome. Age, sex, cerebrospinal fluid opening pressure, and presenting symptoms were not significantly associated with visual recovery after adjustment. Conclusion: Most patients with idiopathic intracranial hypertension experienced significant visual improvement with medical therapy; however, cranial nerve palsy and higher body mass index were associated with poorer visual outcomes. Early recognition of high-risk features and close neuro-ophthalmic monitoring may improve visual prognosis.