The Idiopathic Intracranial Hypertension Life Long Asymptomatic study: Evaluation of the impact of an asymptomatic IIH presentation on outcomes

Abstract text (incl. figure legends and references)

Question

Papilloedema can be an incidental finding at a routine optician review or neurological examination, and some of these would be asymptomatic. The long-term prognosis of these patients in comparison to the more common symptomatic population needs to be investigated.

Methods

Evaluate key outcomes such as vision (LogMAR visual acuity; Humphrey visual field perimetric mean deviation (PMD) and optical coherence tomography (OCT)) and headache in a prospectively collected cohort within the IIH Life database (2012-2021). Comparison was made according to whether they were symptomatic at diagnosis or not.

Results

Truly asymptomatic presentations are uncommon (10%, 36/343), with incidental papilloedema more common at 35% (121/343). Asymptomatic IIH patients had similar visual outcomes compared to those with symptomatic disease, with as expected lower headache frequency outcomes.

Conclusions

Asymptomatic IIH can pose a challenge to the neurology and ophthalmology teams managing IIH. We have shown that prognosis is similar to that of the more "typical" IIH and there should be managed as per standard IIH guidelines.