Visual Outcomes and Clinical Predictors of Recovery After Medical Management of Idiopathic Intracranial Hypertension: A Prospective Cohort Study
Keywords:
Idiopathic intracranial hypertension; Visual outcome; Cranial nerve palsy; Body mass index; Neuro-ophthalmologyAbstract
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.
References
1. Toscano S, Lo Fermo S, Reggio E, Chisari CG, Patti F, Zappia M. An update on idiopathic intracranial hypertension in adults: a look at pathophysiology, diagnostic approach and management. J Neurol. 2021;268(9):3249–3268.
2. Kwee RM, Kwee TC. Systematic review and meta-analysis of MRI signs for diagnosis of idiopathic intracranial hypertension. Eur J Radiol. 2019;116:106–115.
3. Radojičič A. Estimation of the predictive role of presenting symptoms in establishing the diagnosis of idiopathic intracranial hypertension, course and outcome of the disease [dissertation]. Belgrade: University of Belgrade; 2019.
4. Mahapatra U, Ganguly D, Sen S, Ghosh S. Idiopathic intracranial hypertension presenting with multiple cranial nerve palsy. J Indian Med Assoc. 2023;121(5):59–61.
5. Wang MT, Bhatti MT, Danesh-Meyer HV. Idiopathic intracranial hypertension: pathophysiology, diagnosis and management. J Clin Neurosci. 2022;95:172–179.
6. Fargen KM, Coffman S, Torosian T, Brinjikji W, Nye BL, Hui F. “Idiopathic” intracranial hypertension: an update from neurointerventional research for clinicians. Cephalalgia. 2023;43(4):03331024231161323.
7. Bouffard MA. Fulminant idiopathic intracranial hypertension. Curr Neurol Neurosci Rep. 2020;20(6):1–9.
8. Hawryluk GW, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2019;45(12):1783–1794.
9. Gurney SP, Ramalingam S, Thomas A, Sinclair AJ, Mollan SP. Exploring the current management of idiopathic intracranial hypertension and understanding the role of dural venous sinus stenting. Eye Brain. 2020;12:1–13.
10. Takkar A, Lal V. Idiopathic intracranial hypertension: the monster within. Ann Indian Acad Neurol. 2020;23(2):159–166.
11. Rana V, Gupta V, Spaide RF, Sukhija J, Singh SR, Agrawal R, et al. Venous overload choroidopathy associated with idiopathic intracranial hypertension. Retin Cases Brief Rep. 2022;16(6):606–611.
12. Martin M, Lobo D, Bitot V, Couffin S, Escalard S, Mounier R, et al. Prediction of early intracranial hypertension after severe traumatic brain injury: a prospective study. World Neurosurg. 2019;127:e1242–e1248.
13. Schizodimos T, Soulountsi V, Iasonidou C, Kapravelos N. An overview of management of intracranial hypertension in the intensive care unit. J Anesth. 2020;34(5):741–757.
14. Rahman MM. Sample size determination for survey research and non-probability sampling techniques: a review and set of recommendations. J Entrep Bus Econ. 2023;11(1):42–62.
15. Sharma SK, Mudgal SK, Thakur K, Gaur R. How to calculate sample size for observational and experimental nursing research studies. Natl J Physiol Pharm Pharmacol. 2020;10(1):1–8.
16. Al-Hashel JY, Ismail II, Ibrahim M, John JK, Husain F, Kamel WA, et al. Demographics, clinical characteristics, and management of idiopathic intracranial hypertension in Kuwait: a single-center experience. Front Neurol. 2020;11:672.
17. Raoof N, Hoffmann J. Diagnosis and treatment of idiopathic intracranial hypertension. Cephalalgia. 2021;41(4):472–478.
18. Mollan SP, Sinclair AJ. Outcome measures in idiopathic intracranial hypertension. Expert Rev Neurother. 2021;21(6):687–700.
19. Wang Z, Zhang Y, Hu F, Ding J, Wang X. Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus. CNS Neurosci Ther. 2020;26(12):1230–1240.
20. Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral venous thrombosis: a comprehensive review. Eur Neurol. 2020;83(4):369–379.
21. Mazumdar D, Meethal NSK, Panday M, Asokan R, Thepass G, George RJ, et al. Effect of age, sex, stimulus intensity, and eccentricity on saccadic reaction time in eye movement perimetry. Transl Vis Sci Technol. 2019;8(4):13.
22. Baheti N, Nair M, Thomas S. Long-term visual outcome in idiopathic intracranial hypertension. Ann Indian Acad Neurol. 2011;14(1):19–24.
23. Walker C, Choi SC, Ray SD. Anti-epileptic medications. In: Side Effects of Drugs Annual. Vol 41. Amsterdam: Elsevier; 2019. p. 65–96.
24. Mandura R, Khawjah D, Alharbi A, Arishi N. Visual outcomes of idiopathic intracranial hypertension in a neuro-ophthalmology clinic in Jeddah, Saudi Arabia. Saudi J Ophthalmol. 2023;37(1):25–31.
25. Xu W, Prime Z, Papchenko T, Danesh-Meyer HV. Long-term outcomes of idiopathic intracranial hypertension: observational study and literature review. Clin Neurol Neurosurg. 2021;205:106463.
26. Chiu HH, Reginald YA, Moharir M, Wan MJ. Visual outcomes in idiopathic intracranial hypertension in children. Can J Ophthalmol. 2022;57(6):376–380.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Naeem Afzal, Muhammad Kashif Ali (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright is retained by the Author(s). Published in JPMHR under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Unrestricted reuse is permitted with proper attribution to the author(s) and source.
