Author

Zoe Wyse

Date

October 2013

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Intracranial hypertension is a disorder of increased cerebrospinal fluid pressure that may result in symptoms of headache, vision loss and pulse synchronous tinnitus. Idiopathic intracranial hypertension (IIH) differs from secondary intracranial hypertension (SIH) in that there is no known cause of idiopathic intracranial hypertension. Overweight or obese women of child-bearing age are at increased risk of IIH. Patients are diagnosed with IIH using the Modified Dandy Criteria that includes the following requirements: 1) signs and symptoms of increased intracranial pressure, 2) no localizing findings on neurological exam, 3) normal MRI/CT with no evidence of venous obstructive disease, 4) opening CSF pressure>25 cm H20 with normal CSF constituents, 5) awake and alert patient, and 6) no known cause for increased pressure found. Physicians often begin by advising patients to lose weight and also may start them on a carbonic anhydrase inhibitor to lower intracranial pressure. If weight loss and medical management fail to manage symptoms, surgical management may be attempted. Shunting is performed to alleviate intractable headache and potential vision loss. Decompression of the optic nerve may be performed to prevent vision loss and blindness. In some patients cerebral venous sinus stenting may be of benefit if venous sinus stenosis is present. Since obesity is common among many patients with IIH and some studies have suggested weight loss can reduce symptoms of IIH, it is valuable in symptom management to understand whether weight loss is a successful predictor of improvement in symptoms. This study examined whether absolute weight loss, percent weight loss, or BMI change are associated with improvement in patient reported headache, vision and tinnitus. Logistic regression models were used to determine which of these primary predictors were associated with improvement. Weight loss was associated with a greater likelihood of improvement in headache, vision and tinnitus symptoms. Patients who lose weight have an increased likelihood of having improvement in headache, vision and tinnitus symptoms. Weight loss should continue to be a recommendation to patients with IIH.

Identifier

doi:10.6083/M4QN64S4

School

School of Medicine

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