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Etiology of Papilledema in Patients in the Eye Clinic Setting.
JAMA Netw Open. 2020 06 01; 3(6):e206625.JN

Abstract

Importance

The study of health conditions associated with papilledema will augment the clinical judgment of eye care professionals treating patients with optic disc edema in determining the urgency of additional evaluation and counseling patients accordingly.

Objectives

To determine the incidence, demographic characteristics, and etiologies of papilledema based on a unique records-linkage research platform; and to describe the demographic and clinical differences between patients with idiopathic intracranial hypertension (IIH) and other causes of papilledema.

Design, Setting, and Participants

Retrospective population-based cross-sectional study of patients treated for papilledema at outpatient eye clinics in Olmsted County, Minnesota, using the Rochester Epidemiology Project. Data were collected from January 1990 to December 2014 and analyzed from September 2018 to April 2019.

Main Outcomes and Measures

Etiologies of papilledema, body mass index, incidence of headache, or localizing neurologic signs.

Results

Eighty-six patients were diagnosed with papilledema during the 24-year period, providing an age- and sex-adjusted incidence of 2.5 individuals per 100 000 per year; 68 patients (79%) were women, 73 (85%) were white patients, and the median (range) age was 27.7 (6.2-64.2) years. Nineteen patients (22%) presented with a previously diagnosed attributable cause (eg, trauma or intracranial tumor). Among patients presenting with papilledema without a previously diagnosed attributable cause, 58 patients (87%) had IIH, and 9 patients (13%) were found to have a secondary cause of raised intracranial pressure, such as intracranial tumor, cerebral venous sinus thrombosis, or granulomatous meningitis. Patients with IIH had a higher median (range) body mass index (37.5 [20.4-55.7] vs 27.4 [16.6-40.1]; P = .003) and headache prevalence (54 of 58 patients [93%] vs 6 of 9 patients [67%]; P = .004) than patients with other causes of papilledema. Of 9 patients with papilledema but no IIH, 2 (22%) had localizing neurologic signs, such as gait abnormalities, hearing loss, focal weakness or numbness, visual field defects, or aphasia. Among 42 patients with demographic characteristics typically associated with IIH (female sex, with obesity, aged 15 to 45 years, and absent localizing neurologic signs or symptoms), 40 (95%) had papilledema that was associated with IIH. Conversely, among the 19 patients without these demographic characteristics, 7 (37%) had an alternative cause.

Conclusions and Relevance

In this study, most patients who presented to the eye clinic with papilledema without a previously known cause were found to have IIH. These patients were more likely to present with headaches and had statistically higher body mass index. Clinicians should take these findings into account when determining the pretest probability of a patient having IIH or an alternative cause of papilledema.

Authors+Show Affiliations

Alix School of Medicine, Mayo Clinic, Rochester, Minnesota.Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota.University of Minnesota College of Biological Sciences, Minneapolis.Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis.Department of Health Sciences Research, Mayo Clinic, Jacksonville, Floriada.Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis.Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32484553

Citation

Crum, Olivia M., et al. "Etiology of Papilledema in Patients in the Eye Clinic Setting." JAMA Network Open, vol. 3, no. 6, 2020, pp. e206625.
Crum OM, Kilgore KP, Sharma R, et al. Etiology of Papilledema in Patients in the Eye Clinic Setting. JAMA Netw Open. 2020;3(6):e206625.
Crum, O. M., Kilgore, K. P., Sharma, R., Lee, M. S., Spiegel, M. R., McClelland, C. M., Bhatti, M. T., & Chen, J. J. (2020). Etiology of Papilledema in Patients in the Eye Clinic Setting. JAMA Network Open, 3(6), e206625. https://doi.org/10.1001/jamanetworkopen.2020.6625
Crum OM, et al. Etiology of Papilledema in Patients in the Eye Clinic Setting. JAMA Netw Open. 2020 06 1;3(6):e206625. PubMed PMID: 32484553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Etiology of Papilledema in Patients in the Eye Clinic Setting. AU - Crum,Olivia M, AU - Kilgore,Khin P, AU - Sharma,Rishi, AU - Lee,Michael S, AU - Spiegel,Matthew R, AU - McClelland,Collin M, AU - Bhatti,M Tariq, AU - Chen,John J, Y1 - 2020/06/01/ PY - 2020/6/3/entrez PY - 2020/6/3/pubmed PY - 2020/11/24/medline SP - e206625 EP - e206625 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 6 N2 - Importance: The study of health conditions associated with papilledema will augment the clinical judgment of eye care professionals treating patients with optic disc edema in determining the urgency of additional evaluation and counseling patients accordingly. Objectives: To determine the incidence, demographic characteristics, and etiologies of papilledema based on a unique records-linkage research platform; and to describe the demographic and clinical differences between patients with idiopathic intracranial hypertension (IIH) and other causes of papilledema. Design, Setting, and Participants: Retrospective population-based cross-sectional study of patients treated for papilledema at outpatient eye clinics in Olmsted County, Minnesota, using the Rochester Epidemiology Project. Data were collected from January 1990 to December 2014 and analyzed from September 2018 to April 2019. Main Outcomes and Measures: Etiologies of papilledema, body mass index, incidence of headache, or localizing neurologic signs. Results: Eighty-six patients were diagnosed with papilledema during the 24-year period, providing an age- and sex-adjusted incidence of 2.5 individuals per 100 000 per year; 68 patients (79%) were women, 73 (85%) were white patients, and the median (range) age was 27.7 (6.2-64.2) years. Nineteen patients (22%) presented with a previously diagnosed attributable cause (eg, trauma or intracranial tumor). Among patients presenting with papilledema without a previously diagnosed attributable cause, 58 patients (87%) had IIH, and 9 patients (13%) were found to have a secondary cause of raised intracranial pressure, such as intracranial tumor, cerebral venous sinus thrombosis, or granulomatous meningitis. Patients with IIH had a higher median (range) body mass index (37.5 [20.4-55.7] vs 27.4 [16.6-40.1]; P = .003) and headache prevalence (54 of 58 patients [93%] vs 6 of 9 patients [67%]; P = .004) than patients with other causes of papilledema. Of 9 patients with papilledema but no IIH, 2 (22%) had localizing neurologic signs, such as gait abnormalities, hearing loss, focal weakness or numbness, visual field defects, or aphasia. Among 42 patients with demographic characteristics typically associated with IIH (female sex, with obesity, aged 15 to 45 years, and absent localizing neurologic signs or symptoms), 40 (95%) had papilledema that was associated with IIH. Conversely, among the 19 patients without these demographic characteristics, 7 (37%) had an alternative cause. Conclusions and Relevance: In this study, most patients who presented to the eye clinic with papilledema without a previously known cause were found to have IIH. These patients were more likely to present with headaches and had statistically higher body mass index. Clinicians should take these findings into account when determining the pretest probability of a patient having IIH or an alternative cause of papilledema. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32484553/Etiology_of_Papilledema_in_Patients_in_the_Eye_Clinic_Setting_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.6625 DB - PRIME DP - Unbound Medicine ER -