Idiopathic intracranial hypertension after 40 years of age: clinical features in 23 patients

Idiopathic intracranial hypertension (IIH) is a well-recognized disorder of unknown etiology associated with elevated intracranial pressure (ICP), normal neuroimaging, and normal cerebrospinal fluid (CSF) composition, found mostly among obese females of childbearing age. The aim of this study is to investigate the clinical features of IIH in patients older than 40 years. This is a retrospective chart review (1998-2007) of all consecutive patients older than 40 years who were diagnosed with IIH based on the Modified Dandy Criteria. Twenty three of the 200 IIH patients in the institutional database fulfilled study entry criteria. They included 22 females and one male whose mean age was 51.4 years (range 41-79). Coexisting systemic arterial hypertension was found in 13 (56.5%) patients. Seventeen patients (73.9%) had symptoms attributable to elevated ICP. The most common presenting symptoms were visual; mainly blurred vision and transient visual obscuration (15/17 patients, 88.23%). Eleven patients (64.7%) complained of headache, and another 4 (23.5%) of pulsatile intracranial noise. The average follow up period was 21.8 months. The findings indicate that IIH among individuals older than 40 years of age may be underreported. These patients are more likely to present with systemic hypertension and with more visual disturbances, but with fewer complaints of headache than the younger IIH population.