Signs of Intracranial Hypertension in Chronic Inflammatory Polyradiculoneuropathies-A Cross Sectional Cohort Study

Inflammatory polyradiculoneuropathy (IPN) has been associated with intracranial hypertension (IH) in various case reports, suggesting a potential link between the two conditions. However, the prevalence of IH in patients with IPN has not been addressed by prospective studies.

In this cross-sectional prospective study, we prospectively screened consecutive patients with chronic IPN for the presence of clinical and paraclinical signs of IH (fundoscopy, perimetry, optical coherence tomography, ultrasonography) between August 31, 2021, and December 31, 2023.

Of 27 patients included (median age: 61.0 years [IQR 22.0]; 30.8% female; median time since diagnosis: 49.5 months [IQR 42.0]), ten patients (37.0%) with IPN had sonographic evidence of IH (IPN + IH), with 40% reporting symptoms of IH. Compared to patients without signs of IH, IPN + IH were younger (40.5 years [24.0] vs. 63.0 years [10.0]) and had higher CSF total protein (67.7 mg/dL [57.6] vs. 56.1 mg/dL [26.7]). However, IPN + IH did not have higher BMI (24.1 [5.2] vs. 26.0 [3.8]) or female predominance (33.3% vs. 29.4%).

Signs of IH seem to be a common feature in IPN, indicating a likely association. The demographic and clinical profile of IPN + IH patients differs from that of idiopathic IH, suggesting that IH in IPN is likely secondary and may be linked to elevated CSF protein. Given that the majority of patients were asymptomatic and that the specificity of IH symptoms remains low, routine screening for subclinical IH signs may be warranted in this population.