Estimation of the predictive role of presenting symptoms in establishing the diagnosis of idiophatic intracranial hypertension, course and outcome of the disease

Abstract

Idiopathic intracranial hypertension (IIH) is a rare disease characterized by increased intracranial pressure (ICP) in the absence of any other detectable cause. Clinical presentation of IIH is variable, with the most frequent finding of papilledema and headache. Other symptoms include transient visual obscurations (TVO), blurred vision, double vision due to sixth nerve palsy, tinnitus, dizziness, nausea, neck pain, disturbed concentration and memory impairment. The diagnostic value of this variety of presenting symptoms and clinical findings has been scarcely investigated. Current diagnostic criteria for IIH are not based on clinical presentation of the disease, and unlike former criteria do not include specific symptoms of raised ICP. Low prevalence of IIH results in insufficient data regarding the course and long-term outcome of the disease. Objectives: The main aims of the study are to a) characterize the presenting symptoms and signs of IIH defined according to the existing diagnostic criteria, b) analyze the correlation of presenting symptoms and signs with the results of diagnostic procedures: ICP measurement, presence of papilledema, and neuroimaging markers of raised intracranial pressure c) investigate the correlation of presenting symptoms and signs with the course and disease outcome. Methods: This cohort study was conducted in two tertiary centers: Neurology Clinic of the Clinical Center of Serbia and the Danish Headache Center-Rigshospitalet, Glostrup. The study included 286 patients that were consecutively referred by attending neurologist and ophthalmologist for the evaluation of possible IIH from January 2007 to March 2016. The study was conducted in two phases. At first, clinical data were prospectively collected from all study participants in order to evaluate the presenting symptoms and signs of IIH...

Idiopatska intrakranijalna hiprtenzija (IIH) je retko oboljenje koje karakteriše povišen intrakranijalni pritisak (IKP) bez jasno detektabilnog uzroka. Kliničko ispoljavanje IIH je varijabilno a bolest se najčešće manifestuje glavoboljom i edemom papile optičkog živca. Ostale simptome čine tranzitorne vizuelne opskuracije (TVO), zamagljen vid, duple slike usled lezije VI kranijalnog živca, zujanje u ušima, vrtoglavica, mučnina, bol u vratu, teškoće sa pamćenjem i koncentracijom. Dijagnostički značaj različitih prezentujućih simptoma i znakova bolesti nije dovoljno ispitan. Aktuelni dijagnostički kriterijumi za IIH nisu bazirani na kliničkoj prezentaciji bolesti, i za razliku od prethodnih ne zahtevaju postojanje simptomatologije povišenog IKP. Imajući u vidu nisku prevalenciju IIH, u literaturi nema dovoljno podataka o toku i dugoročnom ishodu bolesti. Ciljevi: Ciljevi istraživanja su a) utvrđivanje prezentujućih simptoma i znakova bolesti kod osoba kod kojih je dijagnoza IIH postavljena prema aktuelnim dijagnostičkim kriterijumima, b) uvrđivanje korelacije prezentujućih simptoma i znakova IIH sa rezultatima dijagnostičkih procedura: vrednostima IKP, prisustvom edema papile optičkog živca i neuroradiološkim znacima intrakranijalne hipertenzije, c) utvrđivanje korelacije prezentujućih simptoma i znakova IIH sa kliničkim tokom i ishodom bolesti. Metodologija: Ova kohortna studija je sprovedena u dva tercijarna centra: Klinici za neurologiju Kliničkog centra Srbije u Beogradu i Danskom centru za glavobolje bolnice Rigshospitalet, u Glostrupu. U istraživanje je uključeno 286 bolesnika koji su konsekutivno upućivani od strane neurologa ili oftalmologa pod sumnjom na IIH u periodu od januara 2007. do marta 2016. godine. Istraživanje je sprovedeno u dve faze. U prvoj fazi su klinički podaci prospektivno prikupljani od svih ispitanika sa ciljem da se ustanove prezentujući simptomi i znaci IIH...