Neuro-ophthalmology Unit, Emory Eye Center, 1365-B Clifton Road, NE, Atlanta, GA 30322, USA.
Neurology. 2010 Jun 1;74(22):1827-32. doi: 10.1212/WNL.0b013e3181e0f838.
Idiopathic intracranial hypertension (IIH) typically affects young, obese women. We examined 2 groups of atypical patients with IIH: those with a normal body mass index (BMI) and those at least 50 years of age.
A retrospective cohort study of 407 consecutive adult patients with IIH with known BMI from 3 centers was undertaken. Demographics, associated factors, visual acuity, and visual fields were collected at presentation and follow-up.
We identified 18 IIH patients (4%) with normal BMI and 19 (5%) aged 50 years or older at the time of diagnosis who were compared with the remainder of the cohort. Medication-induced IIH was more frequent in patients with IIH with normal BMI (28 vs 7%, p = 0.008). No patient with IIH with a normal BMI had severe visual loss in either eye (0 vs 17%, p = 0.09). Older patients with IIH had a lower BMI, but were still generally obese (33 vs 38, p = 0.04). Older patients were less likely to report headache as initial symptom (37 vs 76%, p < 0.001) and more likely to complain of visual changes (42 vs 21%, p = 0.03). Treatment of any type was less likely in older patients (significant for medications: 74 vs 91%, p = 0.004), and they were more likely to have persistent disc edema at last follow-up (median Frisén grade: 1 vs 0, p = 0.002), but had similar, if not better, visual outcomes compared with younger patients. A case-control study did not identify any new medication or risk factor associations.
Patients with normal body mass index and those 50 years or older make up a small proportion of patients with idiopathic intracranial hypertension (IIH), but appear to have better visual outcomes than more typical patients with IIH.
特发性颅内高压（IIH）通常影响年轻肥胖的女性。我们研究了两组不典型 IIH 患者：体重指数（BMI）正常和年龄至少 50 岁的患者。
对来自 3 个中心的 407 例连续成人 IIH 患者的回顾性队列研究，记录了患者的人口统计学、相关因素、视力和视野。
我们发现 18 例（4%）IIH 患者 BMI 正常，19 例（5%）诊断时年龄 50 岁或以上，与其余队列进行比较。药物引起的 IIH 在 BMI 正常的 IIH 患者中更为常见（28% vs 7%，p = 0.008）。没有 BMI 正常的 IIH 患者双眼出现严重视力丧失（0% vs 17%，p = 0.09）。年龄较大的 IIH 患者 BMI 较低，但仍普遍肥胖（33 岁 vs 38 岁，p = 0.04）。年长的 IIH 患者首发症状更不可能是头痛（37% vs 76%，p < 0.001），更可能出现视力改变（42% vs 21%，p = 0.03）。年长的 IIH 患者更不可能接受任何类型的治疗（药物治疗的差异有统计学意义：74% vs 91%，p = 0.004），且在最后一次随访时更可能持续存在视盘水肿（Frisén 分级中位数：1 级 vs 0 级，p = 0.002），但与年轻患者相比，他们的视力结局相似，甚至更好。病例对照研究未发现任何新的药物或危险因素关联。
BMI 正常和 50 岁及以上的 IIH 患者占 IIH 患者的比例较小，但与更典型的 IIH 患者相比，他们的视力结局似乎更好。
