Elsevier

Revue Neurologique

Volume 165, Issues 6–7, June–July 2009, Pages 542-548
Revue Neurologique

Original article
Idiopathic intracranial hypertension: A comparison between French and North-American white patientsHypertension intracrânienne idiopathique : comparaison de deux populations française et nord-américaine

https://doi.org/10.1016/j.neurol.2008.11.021Get rights and content

Abstract

Objective

To compare French and American white patients with idiopathic intracranial hypertension (IIH), and to determine prognostic factors associated with visual loss.

Methods

Medical records of all consecutive white patients with definite IIH seen between 2001 and 2006 in three French tertiary care medical centers and one American tertiary medical center were reviewed. Demographics, associated clinical features, and visual function at presentation and follow-up were collected. French white patients were compared to American white patients.

Results

One hundred and thirty-four patients (66 French, 68 American) were included. American patients were 8.7 times more likely than French patients to have visual acuity 20/60 or worse or visual field constriction (95% CI: 2.1–36.1, p = 0.0001). American patients were treated more aggressively than French patients. French patients were older (31 vs. 28 years, p = 0.02) and more likely to have anemia (20 vs. 2%, p < 0.001). American patients had a longer duration of symptoms prior to diagnosis (12 vs. 4 weeks, p = 0.01) and longer follow-up than French patients (26 vs. 11 months, p = 0.001). Multivariable analysis found that nationality was an independent risk factor for visual loss. French and American patients did not differ regarding gender proportion, frequency of obesity, sleep apnea, endocrine diseases, or systemic hypertension. Cerebrospinal fluid (CSF) opening pressures were similar in both groups.

Conclusion

American patients with IIH had worse visual outcomes than French patients despite more aggressive treatment. These differences are not explained by differences in previously known risk factors.

Résumé

Objectifs

Comparer deux populations de patients caucasiens atteints d’hypertension intracrânienne idiopathique (HII), l’une française et l’autre nord-américaine et déterminer les facteurs prédictifs de l’altération visuelle finale.

Méthodes

Revue des dossiers de tous les patients caucasiens atteints d’HII vus entre 2001 et 2006 dans quatre centres de soin tertiaires (trois en France et un aux États-Unis). Les données démographiques, cliniques et les paramètres de la fonction visuelle au diagnostic et au terme du suivi ont été collectés.

Résultats

Cent trente-quatre patients (66 français et 68 nord-américains) ont été inclus. Les patients américains avaient 8,7 fois plus de risque d’avoir une acuité visuelle inférieure ou égale à 20/60 et/ou un rétrécissement concentrique du champ visuel (IC à 95 % : 2,1–36,1 ; p = 0,0001). Les patients américains avaient reçu des traitements plus agressifs que les patients français. Les patients français étaient plus âgés (31 ans vs 28 ans, p = 0,02) et avaient plus souvent une anémie (20 % vs 2 %, p < 0,001). Le délai diagnostique et le suivi étaient plus longs chez les patients américains (respectivement 12 semaines vs quatre semaines, p = 0,01 et 26 mois vs 11 mois, p = 0,001). En analyse multivariée, la nationalité était retrouvée comme facteur de risque indépendant d’une altération visuelle. Les deux groupes étaient similaires en termes de sex-ratio, de fréquence de l’obésité, du syndrome d’apnée du sommeil, d’endocrinopathies et de l’hypertension artérielle systémique. La pression d’ouverture du liquide céphalorachidien (liquide cérébro spinal [LCS]) était identique entre les deux groupes.

Conclusion

Dans cette étude, les patients américains atteints d’HII avaient un moins bon pronostic visuel que les patients français en dépit de traitements plus agressifs. Cette différence de pronostic ne pouvait être expliquée par des différences de facteurs de risque connus.

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):

  • signs and symptoms of increased intracranial pressure;

  • no localizing signs except abducens nerve palsy;

  • 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.

References (22)

  • J.J. Corbett et al.

    Visual loss in pseudotumor cerebri. Follow-up of 57 patients from 5 to 41 years and a profile of 14 patients with permanent severe visual loss

    Arch Neurol

    (1982)
  • Cited by (0)

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