Idiopathic Intracranial Hypertension with and Without Papilledema: A Comparative Cohort Study.

Background

Idiopathic intracranial hypertension without papilledema (IIHWOP) is increasingly recognized, but its clinical characteristics and treatment-related outcomes remain insufficiently defined. This study aimed to compare patients with idiopathic intracranial hypertension (IIH) with and without papilledema.

Methods

This retrospective observational cohort study included adult patients diagnosed with IIH at a tertiary neurology and referral center. Demographic, clinical, neuro-ophthalmologic, radiological, lumbar puncture, and treatment-related characteristics were compared according to papilledema status.

Results

Among 123 patients with IIH, 83 (67.5%) had papilledema, and 40 (32.5%) had IIHWOP. Age, sex distribution, body mass index, lumbar puncture opening pressure, and most neuroimaging findings were similar between groups. In exploratory between-group analyses, photophobia [35/40 (87.5%) vs. 55/83 (66.3%), p = 0.023], phonophobia [35/40 (87.5%) vs. 56/83 (67.5%), p = 0.031], and nausea/vomiting [20/40 (50.0%) vs. 17/83 (20.5%), p = 0.002] were more frequent among patients with IIHWOP than among those with papilledema. Diabetes mellitus was also more frequent in the IIHWOP group [8/40 (20.0%) vs. 5/83 (6.0%), p = 0.040]. Treatment persistence did not differ significantly between groups (log-rank p = 0.604). In multivariable analysis, papilledema was associated with higher odds of failure to achieve a complete treatment response, whereas higher lumbar puncture opening pressure was associated with lower odds of treatment nonresponse.

Conclusions

Exploratory analyses suggested that patients with IIHWOP may exhibit a different clinical presentation characterized by more prominent migraine-like symptoms. However, these exploratory observations require confirmation in prospective studies.