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Fran Wu, Michael Lee; Smoking associated with cerebrospinal fluid shunt in patients with idiopathic intracranial hypertension. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4365.
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To determine whether smoking is associated with worse disease or more aggressive, surgical treatment of idiopathic intracranial hypertension (IIH).
We conducted a retrospective case-control study of 349 patients with IIH between January 1, 2000, and April 30, 2012. Electronic medical records were reviewed to determine smoking status as obtained through patient history. Subjects who had quit smoking for at least 5 years at the time of presentation were grouped with non-smokers. The following outcomes were recorded: cerebrospinal fluid shunt (ventriculoperitoneal, ventriculoatrial, and lumboperitoneal), optic nerve sheath fenestration, and time to resolution of optic disc edema. Records were also reviewed for demographic data, baseline BMI, opening pressure, edema grade, and mean deviation. Statistical analysis was performed with SAS 9.3.
Of the 349 subjects, 104 were smokers and 245 were non-smokers. Of the smokers, 25 (24%) underwent cerebrospinal fluid shunt during the course of their treatment, whereas 32 (13%) of the non-smokers underwent cerebrospinal fluid shunt. Smoking was associated with placement of a cerebrospinal fluid shunt (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.2-3.8). Smoking was not associated with undergoing optic nerve sheath fenestration (OR 0.98, 95% CI 0.48-2.01) or longer time to resolution of optic disc edema (smokers 1101 days vs. non-smokers 716 days, p=0.42). There was no difference in baseline BMI (36.2 vs. 38.0, p=0.45), opening pressure (35.0 vs. 35.1 cm H2O, p=0.92), odds of edema grade 3 or 4 (OR 0.75, 95% CI 0.41-1.37), or worst mean deviation (-9.3 vs. -8.6, p=0.53).
Among patients with IIH, smokers had a greater odds of undergoing cerebrospinal fluid shunt compared to non-smokers. The reason for this is unclear. A prospective study would be helpful in determining whether patients diagnosed with idiopathic intracranial hypertension and who are smokers should be advised to quit.
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