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N. Villate, T. J. Whittaker; Cerebral Venous Thrombosis and Coagulopathies in Patients With Idiopathic Intracranial Hypertension. Invest. Ophthalmol. Vis. Sci. 2007;48(13):925.
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Idiopathic intracranial hypertension (IIH) in association with coagulopathies and cerebral venous thrombosis (CVT) has been increasingly reported in the medical literature. We studied patients diagnosed with IIH referred to a large university-based Neuro-ophthalmology practice.
Retrospective chart review. After IRB approval, a computerized search of medical records of patients seen between January 2004 and June 2006 with a diagnosis of IIH was conducted. Clinical, radiology and laboratory data was collected on a spreadsheet. Demographic, clinical and laboratory characteristics of IIH patients with MRI/MRV findings consistent with CVT were compared to IIH patients without similar MRI/MRV findings. The statistical significance of differences in continuous variables was determined with one-way analysis of variance, and in categorical variables with the Chi square statistic.
143 charts were retrieved. 33 were excluded because of incomplete information. Data was collected on 110 patients. For the analysis, patients were divided in 3 groups: Group 1 (28) patients with MRI/MRV findings consistent with CVT; Group 2 (53) patients with no MRI/MRV findings suggesting CVT; and, Group 3 (29) patients with no available imaging findings. Female to Male ratio was 7.5:1. Mean age at presentation (N=110) was 31.8 years. Mean duration of symptoms at diagnosis (N=103) was 13.8 weeks (SD 37.7). Association between groups (ANOVA) was not statistically significant for age (P= .261), duration (P=.877) or opening pressure (P=.755). Chi square test to evaluate association between groups and several categorical variables (gender, chief complain, past medical history, optic nerve appearance and visual field defect) was not significant. In Group 1,findings suggesting CVT were evident on MRI in10 patients (35.7%) and on MRV in 23 (82.1%) patients. 13 patients with reportedly normal MRI were found to have CVT on MRV. Among patients with CVT, 15 (N=20) were found to have any hypercoagulable state.
IIH is a diagnosis of exclusion. We could not find predictive or risk factors indicative of a CVT in our series. Because a significant percentage of patients with demonstrable CVT also had coagulopathies, an evaluation for coagulopathy is mandatory. Patients with venous outflow abnormalities should not be classified as IIH, because of different prognostic and therapeutic implications. Ophthalmologists should be aware of the caveats of imaging interpretation in these patients.
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