Original articleIdiopathic intracranial hypertension: A comparison between French and North-American white patientsHypertension intracrânienne idiopathique : comparaison de deux populations française et nord-américaine
Introduction
Idiopathic intracranial hypertension (IIH) is relatively common in young obese women regardless of ethnic background (Carta et al., 2004, Celebisoy et al., 2002, Craig et al., 2001, Deschamps et al., 2008, Durcan et al., 1988, Mezaal and Saadah, 2005, Radhakrishnan et al., 1993a; Radhakrishnan et al., 1986). Prognosis is variable, but severe visual loss occurs in 10 to 25% of patients (Corbett et al., 1982, Wall and George, 1991). Few studies of IIH have been performed in Europe (Carta et al., 2004, Craig et al., 2001), and no series has attempted to directly compare international differences in IIH. The purpose of the study was to compare the characteristics of white French and American IIH patients.
Section snippets
Patients and methods
This study included consecutive IIH patients from three academic French neuro-ophthalmology services seen between 2001 and 2006. Consecutive patients seen from a similar medical center in the United States during the same time period were also included. Only patients with definite IIH diagnosed according to the modified Dandy criteria were included (Friedman and Jacobson, 2002):
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signs and symptoms of increased intracranial pressure;
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no localizing signs except abducens nerve palsy;
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cerebrospinal
Results
One hundred and thirty-four consecutive white patients with definite IIH were included, 68 from the US at Emory University, and 66 from France (38 from Paris [16 from the Lariboisière Hospital and 22 from the Rothschild Ophthalmologic Foundation], and 28 from Lyon).
Table 1 compares the characteristics of French white patients versus American white patients. French white patients were older than American patients (median: 31 years vs 28 years, p = 0.02). Anemia was more common in the French
Discussion
Our study describes a large, international cohort, including 66 French and 68 American patients with IIH. This is the largest European series of IIH patients, and this study also provides evidence of important international differences in the presentation and prognosis of IIH.
Our most important finding was that American patients tended to have worse visual outcomes than French patients despite more aggressive treatment. American patients had more severe visual field defects at presentation.
Conflicts of interest
S. Mrejen, C. Vignal, B.B. Bruce, R. Gineys, F. Audren, P. Preechawat, A. Gaudric, O. Gout, N.J. Newman, A. Vighetto, M.G. Bousser, and V. Biousse have no conflict of interest to declare.
Acknowledgements
This study was supported in part by a department grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, and by core grant P30-EY06360 (Department of Ophthalmology) from the National Institute of Health, Bethesda, Maryland. Dr. Newman is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award.
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