Clinical Characteristics of Idiopathic Intracranial Hypertension in Patients Over 50 Years of Age: A multicenter clinical cohort study

Purpose: To characterize the clinical features of idiopathic intracranial hypertension (IIH) in patients >50 years of age compared to the typical IIH population and existing data for this older cohort. Design: Retrospective, clinical cohort study. Methods: Medical records of 65 patients >50 years of age at first diagnosis of IIH were reviewed based on the Modified Dandy Criteria from 4 academic centers. Each center provided randomly selected controls from IIH patients <50 years of age for each study patient at their location. Data recorded included patient demographics, presenting symptoms, medications, coexisting medical conditions, cerebrospinal fluid (CSF) opening pressure, treatments, and neuro-ophthalmic data from initial and final visits. Results: Compared to controls, the older cohort showed the following characteristics: fewer females (n = 51 [78.5%] vs. controls: n = 60 [92.3%]; P =.045), fewer headaches (n = 33 [50.8%] vs. controls: 52 [80.0%]; P =.001), more frequent incidental discoveries of papilledema (n = 19 [29.2%] vs. controls: 7 [10.8%]; P =.015), and lower CSF opening pressure [median: 33 cm H₂O [range: 21-58 cm H₂O] vs. the median for controls: 34 cm H₂O [range: 24-67 cm H₂O; P =.029). Conclusions: Patients with IIH diagnosed at >50 years of age were less often female and had lower CSF opening pressure, fewer headaches, a higher chance of incidentally identified papilledema, and body mass index similar to that of younger IIH patients. Older IIH onset was not associated with worse visual outcome.