The authors present a retrospective cohort study with the aim of exploring how idiopathic intracranial hypertension (IIH) can present differently in older age groups, a group that has been relatively underrepresented in previous research. Cases were identified from a single tertiary neuro-ophthalmology centre, from a 7-year period. Inclusion criteria: being over 18 years old at the time of diagnosis. Only reliable visual fields and optical coherence tomography (OCT) images were evaluated. Individuals who were pregnant, taking any medication known to correlate with papilledema, infections or inflammation or any other cause of optic nerve swelling were excluded. Cases were divided into 2 groups depending on age: 18–44 years were the younger group and >45 years were the older group. A total of 167 individuals with IIH were identified, with 135 in the younger group and 32 in the older group. The study reported that older patients generally had statistically significantly milder clinical features: fewer headaches, lower lumbar puncture opening pressures, lower body mass indices, and less severe papilledema than younger patients. The older group were significantly more likely to have an empty sella on neuroimaging. Visual field loss and overall rates of papilledema were similar between the two groups. The authors suggest that IIH in older adults may represent a milder, longstanding condition that remained undiagnosed for many years rather than a truly late-onset disease. The authors acknowledge several limitations, including the retrospective methodology, single-centre setting, and a relatively small sample of in the older group. This study provides evidence that clinicians should maintain a high index of suspicion for IIH in older adults, even when symptoms appear less typical or less severe.
Are the clinical characteristics of idiopathic intracranial hypertension different in older adults
Reviewed by Lauren Hepworth
Clinical characteristics of idiopathic intracranial hypertension in older adults.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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