Self-Reported Weight and Height Among Idiopathic Intracranial Hypertension Patients

Depression and generalized anxiety symptoms in idiopathic intracranial hypertension: Prevalence, under-reporting and effect on visual outcome

BACKGROUND

Patients with idiopathic intracranial hypertension (IIH) have been reported to have high prevalence of co-existent mood disorders. We investigated the frequency of symptoms of depression and anxiety in a large cohort of patients with IIH without a known psychiatric diagnosis and compared it with the age- and gender-matched control group. We also studied whether the presence and severity of co-existing mood disorder was related to visual outcome in patients with IIH.

METHODS

The Patient Health Questionnaire-8 (PHQ-8) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for symptoms of generalized anxiety were administered via telephone survey to 100 patients with known diagnosis of IIH and 100 control subjects (matched for age and gender) who did not report a history of anxiety or depression during their prior in-person consultations. All participants were also asked whether they had ever been previously diagnosed with a mood disorder during this telephone assessment. Administered questionnaire results were correlated with final visual outcome in IIH cohort.

RESULTS

34 IIH patients and 36 controls self-reported anxiety and/or depression when specifically asked if they had ever been diagnosed with these conditions although this was not reported on clinic intake questionnaires. Mean PHQ-8 depression scale score was 6.5 ± 0.6 in control group and 7.6 ± 0.6 in IIH group (p = 0.18). Mean GAD-7 score was 6.3 ± 0.5 in control group and 7.7 ± 0.6 in the IIH group (p = 0.06). In multivariable regression, scores on both scales were correlated with higher body mass index (BMI), younger age and presence of headache, but not with IIH diagnosis. In the IIH cohort, visual outcomes were not related to GAD-7 or PHQ-8 scores but were predicted by mean deviation on visual fields at presentation.

CONCLUSIONS

Pre-existing diagnosis of anxiety and depression are highly under-reported. Symptoms of anxiety and depression are very common in young women with elevated BMI and headache, however, there was no statistical difference in frequency of these symptoms between IIH and control groups. Presence and severity of mood disorder symptoms did not correlate with the final visual outcome in patients with IIH.

Magnetic resonance or computed tomography venography in the evaluation of young overweight women with papilledema

BACKGROUND/OBJECTIVES

To compare the yield of magnetic resonance venography (MRV)/computed tomography venography (CTV) in a group of overweight women with incidentally-discovered papilledema and symptomatic intracranial hypertension (IC-HTN) patients without risk factors for dural venous sinus thrombosis (DVST).

DESIGN

Retrospective cohort study.

METHODS

Retrospective cohort study of female patients between ages 16 and 50 with papilledema, body mass index >25 kg/m² and MRV/CTV imaging. Patients were excluded if they had risk factors for DVST. The incidence of DVST and clinical features were retrieved. Patients were divided into those with incidentally-discovered papilledema (Group-1) and those who presented due to symptoms of IC-HTN (Group-2).

RESULTS

One hundred three patients (45 Group-1, 58 Group-2) were included in the study. Group-2 patients were more likely to have pulsatile tinnitus (p = 0.017), transient visual obscurations, and showed a trend towards increased headache (p = 0.058). Group-2 was also more likely to have been treated with acetazolamide (p < 0.01) and undergo lumbar puncture (p = 0.02). DVST was initially reported in four patients (one in Group-1, three in Group-2), but after further review, two cases (one from Group-1, one from Group-2) were found to be false positives. The final two DVST diagnoses were in Group-2 and presented with significant neurological symptoms.

CONCLUSIONS

DVST was not found among a group of 45 young, overweight women with incidentally-discovered papilledema and without DVST risk factors. We therefore believe it is reasonable practice to perform MRI alone, without dedicated MRV/CTV, in the investigation of young, overweight women with incidentally-discovered papilledema without risk factors for DVST.