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Asymmetric papilledema in idiopathic intracranial hypertension.
J Neuroophthalmol. 2015 Mar; 35(1):31-6.JN

Abstract

BACKGROUND

Very asymmetric papilledema in idiopathic intracranial hypertension (IIH) is rare, and few studies have dealt with this atypical presentation of IIH. Our aim was to describe the clinical and radiologic features of patients with IIH and very asymmetric papilledema.

METHODS

We identified all adult patients from our IIH database with very asymmetric papilledema defined as a ≥2 modified Frisén grade difference between the 2 eyes. Demographic data and initial symptoms were collected, and all brain imaging studies performed at our institution were reviewed.

RESULTS

Of the 559 adult patients with definite IIH, 20 (3.6%; 95% confidence interval [CI], 2.3-5.6) had very asymmetric papilledema at initial evaluation. They were older (39 vs 30 years; P < 0.001), had lower cerebrospinal opening pressure (35.5 vs 36 cm of water; P = 0.03), and were more likely to be asymptomatic compared with patients with symmetric papilledema (27% vs 3%; P < 0.001). Visual fields were worse on the side of the highest-grade papilledema (P = 0.02). The bony optic canal was smaller on the side of the lowest-grade edema in all 8 patients (100%) in whom the imaging was sufficient for reliable measurements (P = 0.008).

CONCLUSIONS

IIH with very asymmetric papilledema is uncommon. Very asymmetric papilledema may result from differences in size of the bony optic canals, supporting the concept of compartmentation of the perioptic subarachnoid spaces.

Authors+Show Affiliations

Departments of Ophthalmology (SB, BBB, NJN, VB) and Neurology (BBB, NJN, VB), Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology (BBB), Rollins School of Public Health and Laney Graduate School, Atlanta, Georgia; and Departments of Radiology and Imaging Science (AMS) and Neurological Surgery (NJN), Emory University School of Medicine, Atlanta, Georgia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25494197

Citation

Bidot, Samuel, et al. "Asymmetric Papilledema in Idiopathic Intracranial Hypertension." Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, vol. 35, no. 1, 2015, pp. 31-6.
Bidot S, Bruce BB, Saindane AM, et al. Asymmetric papilledema in idiopathic intracranial hypertension. J Neuroophthalmol. 2015;35(1):31-6.
Bidot, S., Bruce, B. B., Saindane, A. M., Newman, N. J., & Biousse, V. (2015). Asymmetric papilledema in idiopathic intracranial hypertension. Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, 35(1), 31-6. https://doi.org/10.1097/WNO.0000000000000205
Bidot S, et al. Asymmetric Papilledema in Idiopathic Intracranial Hypertension. J Neuroophthalmol. 2015;35(1):31-6. PubMed PMID: 25494197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asymmetric papilledema in idiopathic intracranial hypertension. AU - Bidot,Samuel, AU - Bruce,Beau B, AU - Saindane,Amit M, AU - Newman,Nancy J, AU - Biousse,Valérie, PY - 2014/12/11/entrez PY - 2014/12/11/pubmed PY - 2015/10/30/medline SP - 31 EP - 6 JF - Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society JO - J Neuroophthalmol VL - 35 IS - 1 N2 - BACKGROUND: Very asymmetric papilledema in idiopathic intracranial hypertension (IIH) is rare, and few studies have dealt with this atypical presentation of IIH. Our aim was to describe the clinical and radiologic features of patients with IIH and very asymmetric papilledema. METHODS: We identified all adult patients from our IIH database with very asymmetric papilledema defined as a ≥2 modified Frisén grade difference between the 2 eyes. Demographic data and initial symptoms were collected, and all brain imaging studies performed at our institution were reviewed. RESULTS: Of the 559 adult patients with definite IIH, 20 (3.6%; 95% confidence interval [CI], 2.3-5.6) had very asymmetric papilledema at initial evaluation. They were older (39 vs 30 years; P < 0.001), had lower cerebrospinal opening pressure (35.5 vs 36 cm of water; P = 0.03), and were more likely to be asymptomatic compared with patients with symmetric papilledema (27% vs 3%; P < 0.001). Visual fields were worse on the side of the highest-grade papilledema (P = 0.02). The bony optic canal was smaller on the side of the lowest-grade edema in all 8 patients (100%) in whom the imaging was sufficient for reliable measurements (P = 0.008). CONCLUSIONS: IIH with very asymmetric papilledema is uncommon. Very asymmetric papilledema may result from differences in size of the bony optic canals, supporting the concept of compartmentation of the perioptic subarachnoid spaces. SN - 1536-5166 UR - https://www.unboundmedicine.com/medline/citation/25494197/Asymmetric_papilledema_in_idiopathic_intracranial_hypertension_ L2 - https://doi.org/10.1097/WNO.0000000000000205 DB - PRIME DP - Unbound Medicine ER -