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S.M. Pepin, E.M. Salcone; Idiopathic intracranial hypertension and asthma: Evidence for an association . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1607.
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Purpose:Complex relationships exist between idiopathic intracranial hypertension (IIH or pseudotumor cerebri) and a host of comorbidities. Diseases associated with IIH include depression, endocrine disorders (hypo– and hyperthyroidism, Addison's disease), sleep apnea, SLE, and orthostatic edema. No case series have yet described an association between IIH and asthma. The purpose of this study is to determine whether asthma and reactive airway diseases are commonly comorbid with IIH. Methods:We performed a retrospective review of medical charts of all patients with the diagnosis of IIH seen in our Department of Ophthalmology in the past four years. Patient information was collected, including gender, age, height, weight, MRI/MRV results, lumbar puncture opening pressures, medication use, and comorbid conditions. Patients must have met modified Dandy criteria for inclusion in the study. Of 31 cases of intracranial hypertension patients, 16 were determined to meet these criteria. Body mass indexes were calculated if possible, and greater than 27.5kg/m2 was considered overweight or obese (NHANES II definition). Asthma or reactive airway disease (RAD) was considered positive if a patient reported the current or past diagnosis of asthma/RAD by their primary care physician and was treated with asthma medication. Controls were based on national published literature of asthma prevalence in the U.S. Results:Nine of sixteen patients with IIH had been diagnosed with asthma or RAD (56%). A 16.4% prevalence of asthma or wheezing has recently been reported among U.S. adults that yields OR=6.5 indicating a statistically significiant association between IIH and asthma/RAD. 81% of the IIH subjects were determined to be overweight or obese (13 of 16). Among the overweight and obese patients, 61.5% had asthma (8 of 13). Conclusions:We found that asthma or reactive airway disease occurs frequently among patients with IIH, presenting preliminary evidence for an association between these diseases. The cause for this relationship is speculative, but we suspect that there may be more to the association than the common comorbidity of obesity. Further investigation is warranted to determine the nature of the relationship between obesity, IIH and RAD. Perhaps intrinsic characteristics of reactive airway disease contribute to the development of IIH, such as chronic inhaled steroid use or episodic hypercapnea and hypoxia. Other causes for the relationship may include common exposures or lifestyles, similar immunologic/inflammatory pathways, or a parallel mechanism of decreased tissue compliance.
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