Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

TL;DR

This study explores the clinical and radiological features of non-obese women with idiopathic intracranial hypertension, revealing more severe symptoms compared to obese patients.

Contribution

The study identifies unique clinical and radiological features in non-obese IIH patients, contributing to better recognition and understanding of this subpopulation.

Findings

Non-obese IIH patients were younger and had higher rates of severe papilledema, scleral flattening, and optic nerve dural ectasia.

Non-obese patients showed a tendency for higher lumbar puncture opening pressure and were three times more likely to present with specific radiological combinations.

The findings suggest a more severe and distinct clinical presentation in non-obese IIH patients.

Abstract

While the typical patient with idiopathic intracranial hypertension (IIH) is an obese female of childbearing age, there are unique patient populations, such as non-obese females, that have not been well studied. Characterizing this subpopulation may increase awareness our of it, which may prevent underdiagnosis and improve our understanding of IIH’s underlying pathophysiology. We retrospectively reviewed electronic medical records and compared the clinical and radiological characteristics of non-obese (BMI < 30) and obese (BMI > 30) female patients with IIH. Two hundred and forty-six patients (age 32.3 ± 10) met our inclusion criteria. The non-obese patients (n = 59, 24%) were significantly younger than the obese patients (29.4 ± 9.9 vs. 33.2 ± 10.2, p = 0.004) and had higher rates of severe papilledema (Friesen 4–5; 25.4% vs. 11.8%, p = 0.019), scleral flattening (62.7% vs. 36.9%, p = 0.008), and optic nerve dural ectasia (78.0% vs. 55.6%, p = 0.044). Non-obese patients also had a tendency to have a higher lumbar puncture opening pressure (368 ± 92.7 vs. 344 ± 76.4, p = 0.062). Non-obese patients were three times more likely to present with a combination of scleral flattening and optic nerve dural ectasia (OR = 3.00, CI: 1.57–5.72, χ2 = 11.63, α < 0.001). Overall, non-obese females with IIH were found to have a more fulminant presentation, typified by higher rates of severe papilledema and radiological findings typical for IIH.