Clinical Consequences of the Revised Diagnostic Criteria for the Diagnosis of Idiopathic Intracranial Hypertension

2014 ◽  
Vol 45 (S 01) ◽  
Author(s):  
B. Bubl ◽  
P. Weber
Keyword(s):  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Idiopathic Intracranial Hypertension ◽  
Clinical Consequences

scholarly journals Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension

2019 ◽  
Vol 39 (06) ◽  
pp. 682-691
Author(s):  
Sarah R. Ahmad ◽  
Heather E. Moss
Keyword(s):  
Clinical Trials ◽  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Surgical Management ◽  
Idiopathic Intracranial Hypertension ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Diagnosis And Management

AbstractAdvances in ophthalmic diagnostics and results of interventional clinical trials are shifting diagnosis and management of idiopathic intracranial hypertension (IIH) to be more technology- and evidence-based. In this article, the evidence supporting current diagnostic criteria, evaluation, and medical and surgical management of IIH are reviewed.

WED 094 Diagnostic error rates in diagnosing idiopathic intracranial hypertension

2018 ◽  
Vol 89 (10) ◽  
pp. A10.1-A10
Author(s):  
Scotton Sangeeta ◽  
Liczkowski Anthony ◽  
Mollan Susan P ◽  
Sinclair Alexandra J
Keyword(s):  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Lumbar Puncture ◽  
Error Rate ◽  
Idiopathic Intracranial Hypertension ◽  
Final Diagnosis ◽  
Diagnostic Error ◽  
Error Rates ◽  
Tertiary Centre ◽  
Error Taxonomy

ObjectiveTo quantify the rate of diagnostic error amongst patients with IIH. Additionally to identify factors contributing to diagnostic error.MethodsSequential patients referred with a diagnosis of IIH to the Birmingham tertiary neuro-ophthalmology IIH clinic were prospectively included (October 2013- February 2017) A diagnostic error taxonomy tool was applied to cases referred as ‘definite’ or ‘possible’ IIH. Discrepancy between referred and final diagnosis were recorded. Results212 patients were referred, (96.2% female), 138/212 (65%) with definite IIH and 74/212 (35%) with possible IIH. Of those diagnosed with definite IIH 25% were not IIH and out of those diagnosed with possible IIH 57% were not IIH. Reasons for diagnostic error included incorrectly identifying papilloedema where in fact pseudopapilloedema existed and diagnosing IIH following an isolated lumbar puncture (LP) pressure >25 cmCSF (but in the absence of other diagnostic criteria for IIH). Misdiagnosis lead to 43% receiving unnecessary acetazolamide (or other diuretics) and 14% having multiple LPs.ConclusionsWe noted a high diagnostic error rate amongst IIH patients referred to a tertiary centre for ongoing management. Where there is doubt about the presence of true papilloedema early specialist review may reduce unnecessary treatment and LP’s.

Idiopathic intracranial hypertension: Clinical nosography and field-testing of the ICHD diagnostic criteria. A case-control study

Cephalalgia ◽  
2014 ◽  
Vol 35 (7) ◽  
pp. 553-562 ◽  
Author(s):  
Hanne M Yri ◽  
Rigmor H Jensen
Keyword(s):  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Idiopathic Intracranial Hypertension ◽  
Field Testing ◽  
Standardized Interview ◽  
Before And After ◽  
Diagnostic Lumbar Puncture ◽  
Increased Sensitivity ◽  
Control Study ◽  
New Onset

Aims The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. Materials and methods We included 44 patients with new-onset IIH. Thirty-four patients with suspected but unconfirmed IIH served as controls. Headache and other IIH-related symptoms were assessed by a detailed standardized interview. In participants referred before diagnostic lumbar puncture ( n = 67), we recorded headache intensity before and after cerebrospinal fluid (CSF) withdrawal. Results Headache in patients with IIH was daily occurring in 86%, focal in 84% and pulsating in 52%. Aggravation of headache by coughing or straining and relief after CSF withdrawal were significantly more frequent in patients than in controls ( p ≤ 0.002). From the ICHD-2 to the ICHD-3 beta classification the sensitivity increased from 60% to 86% whereas the specificity decreased from 86% to 53%. Based on our data the headache criteria can be revised to increase sensitivity to 95% and specificity to 65%. Conclusion Aggravation of headache by coughing or straining, relief after CSF withdrawal, retrobulbar pain and pulsatile tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity.

scholarly journals Migraine headache in patients with idiopathic intracranial hypertension

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
Farzad Sina ◽  
Saeed Razmeh ◽  
Neda Habibzadeh ◽  
Arefeh Zavari ◽  
Mona Nabovvati
Keyword(s):  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Idiopathic Intracranial Hypertension ◽  
Migraine Headache ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
High Prevalence

Migraine is a neurological disorder that afflicts many people in the world and can cause severe disability during the attacks. The pathophysiology of migraine is complex and not fully understood. It seems that migraine is common in idiopathic intracranial hypertension (IIH). However, the association between migraine headache and IIH is still unclear. The present study was conducted to assess the prevalence of migraine headache and associated factors in IIH patients. In this cross-sectional study, a total of 68 patients diagnosed with IIH underwent a medical history interview and a neurological examination. The diagnosis of migraine was based on the four diagnostic criteria of the International Classification of Headache Disorders 3rd edition. Forty-five patients (63.2%) met the diagnostic criteria of migraine headache. There was no significant difference between patients with and without migraine headache in respect of their age, gender, body mass. This study revealed high prevalence of migraine headache in IIH patients; appropriate treatment can reduce their headache and prevent unnecessary treatments for IIH.

scholarly journals Abnormal Optic Nerves Signals in Orbital MRI: a Rare Sign in Idiopathic Intracranial Hypertension

2019 ◽  
Author(s):  
Zhonghua Ma ◽  
Hanqiu Jiang ◽  
Jiawei Wang
Keyword(s):  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Medical Records ◽  
Idiopathic Intracranial Hypertension ◽  
Radiological Examination ◽  
Inclusion Criteria ◽  
Optic Nerves ◽  
Nerve Signal ◽  
Optic Nerve Involvement

Abstract Background It is recognized that radiological examination is essential for the diagnosis of Idiopathic intracranial hypertension (IIH). The present study demonstrated a rare sign of IIH in optic nerves on MRI images. Methods Review the medical records and MRI images of 82 the patients with IIH referred to our neurology department from January 2017 to December 2018. Inclusion criteria were: 1) accorded with the IIH diagnostic criteria adapted from Friedman et al. [1], 2) abnormal optic nerve signal with enhancement on orbital MRI, 3) no better explanation for the optic nerve involvement. Results 12 patients are enrolled. The age of patients ranged from 16 to 55 years, median age 32.91±14.36 years, two patients were male and ten were female. The CSF opening pressures (OP) of all patients were all above 30 cmH2O. Enhancement of optic nerves sheaths (ONS) in retrobulbar segments were observed in all affected eyes showed on coronal orbital MRI gadolinium (Gd)-enhanced T1WI sequence. Conclusions Enhancement of ONS on MRI is a rare sign of IIH that clinicians should recognize in order to avoid misdiagnosis and mistreatment. Keywords: Idiopathic intracranial hypertension, Optic nerves sheaths, Orbital MRI

scholarly journals Idiopathic intracranial hypertension in pediatric and adolescent patients

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Safwat Abouhashem ◽  
Ahmed A. M. Gad ◽  
Mohamed El-Malkey ◽  
Esam A. Daoud
Keyword(s):  
Risk Factors ◽  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
Pediatric Patients ◽  
Opening Pressure ◽  
Group I ◽  
Group Ii ◽  
Associated Risk Factors

Abstract Objectives Pediatric idiopathic intracranial hypertension is a rare condition, but inappropriate diagnosis and management may lead to devastating outcome with loss of vision and lifelong handicap. Dandy criteria are used for diagnosis of idiopathic intracranial hypertension (IIH) in adult, but these criteria cannot be applied in all pediatric patients. The aim of this study is to evaluate the diagnostic criteria and outcome of management of IIH in pediatric patients. Methods Nineteen patients with IIH and age less than 16 years old have been evaluated for the diagnostic criteria and outcome of management. The patients were classified according to the secondary sexual criteria into adolescent IIH and pediatric IIH. Full neurological and ophthalmological evaluation was completed in all patients. The patients were managed and followed up for a mean period of 12 ± 8.6 months at Zagazig University hospitals or Kingdom Hospital in the time period from 2009 to 2018. Results Nineteen patients (16 females and 3 males) had been diagnosed and treated with idiopathic intracranial hypertension, their age is between 4 and 15 years, and the patients have been divided into two groups. Group I (pediatric IIH) involved 9 patients (6 females and 3 males), and their age is ranging between 4 and 9 years with mean age 5.56 ± 1.9 years while group II (adolescent IIH) involved 10 patients, all of them are females and their age ranges between 12 and 15 years with mean age 13.5 ± 1.3. Diagnostic criteria of the patients are papilledema, symptoms and signs of intracranial hypertension, and elevated CSF opening pressure with normal MRI. Headache, delayed school performance, and sixth nerve palsy are the most common clinical finding in the patients of group I while headache is the most common presenting symptom in group II. Anemia and otitis media are the most common associated risk factors in group I while obesity and female gender were the most common associated risk factors in group II. The minimum value for opening pressure in group I is 180 mmH2O while the minimum value in group II is 250 mm. 16 patients improved after the first lumbar puncture and drainage of CSF; two patients improved after repeated lumbar puncture while lumbo-peritoneal shunt was inserted for two patients, both of them were in group II. Recurrence was diagnosed in four patients (21%), one of them (11.1%) was in group I while three of them (30%) were in group II. Conclusion Pediatric idiopathic intracranial hypertension can be classified into two subtypes: pediatric type and adolescent type according to the secondary sexual criteria. Modified Dandy criteria can be applied for the diagnosis of adolescent type, but pediatric type is not associated with obesity, has no female predominance, and usually responds to the initial lumbar puncture with a low rate of recurrence.

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