Idiopathic intracranial hypertension initially diagnosed in ophthalmology: A case series

Idiopathic intracranial hypertension (IIH), presenting with blurred vision and papilledema in ophthalmology clinics due to elevated intracranial pressure, faces misdiagnoses like optic neuritis. This study explored clinical and radiological characteristics of IIH patients initially diagnosed in ophthalmology. This study included patients diagnosed with IIH between December 2016 and January 2021 at Henan Eye Hospital's ophthalmology department. Data on best corrected visual acuity, cranial magnetic resonance imaging, magnetic resonance venography, computed tomography venography, and digital subtraction angiography were collected. The study included 41 patients (82 eyes, 34 females, median age: 38 years, and range 19-62 years). Among them, 13 had intracranial pressure above 400 mmH2O, 20 between 300 and 400 mmH2O, and 8 between 250 and 300 mmH2O. Blurred vision, temporary vision loss, and dizziness or headache occurred in 97.6%, 70.7%, and 65.9% patients. All patients showed bilateral optic disc edema, with 13 cases showing positive relative afferent pupillary defect and 28 negative. Visual acuity was ≥ 1.0 in 31 eyes (37.8%) and 0.6 to 1.0 in 26 eyes (31.7%), while only 5 eyes had normal visual fields. Magnetic resonance imaging showed that 17 patients had empty sella signs; 30 cases (73.2%) showed intracranial venous sinus stenosis on magnetic resonance venography or computed tomography venography. Twelve patients underwent digital subtraction angiography, all showing intracranial venous sinus stenosis. IIH patients initially diagnosed in ophthalmology show varied clinical manifestations lacking specificity. Diagnosis may require multiple disciplines to avoid misdiagnosis.