Date of Award

2024

Degree Type

Dissertation

First Advisor

Dilraj Sokhi

Second Advisor

Sheila Marco

Third Advisor

Jasmit Shah

Department

Internal Medicine (East Africa)

Abstract

Introduction; Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by elevated intracranial cerebrospinal fluid (CSF) pressure without demonstratable evident causes. The mechanisms leading to a particular predilection for women of childbearing age who are overweight and obese or who have recent rapid weight changes remain imprecisely described. The Modified Dandy criteria is used for diagnosis and includes-clinical symptoms, papilledema, lumbar puncture (LP) opening pressure, and neuroimaging. If undiagnosed, it can progress to disabling irreversible visual loss. Weight loss is useful in addition to medical therapy in treating the condition. Data in Sub-Saharan Africa is scarce.

Methods; This study described the epidemiology, clinical attributes, investigation findings, and treatment outcomes of patients diagnosed with IIH at AKUHN. This was a retrospective cross- sectional study. Data were extracted from medical files of patients meeting the International Classification of Diseases, Tenth Revision (ICD-10) criteria for IIH aged at least 18 years who were diagnosed or managed at AKUHN from January 2011 to December 2022. The project was approved by the Aga Khan University Institutional Ethics Review Committee (2022 ISERC-56) and NACOSTI (Ref No: 313854).

Results; A total of 152 patient files met the study criteria. The male-to-female ratio was 9 to 1. The mean age was 34.2 years. Mean BMI was 31.2 kgs/m2. 93.4% of patients presented with headache, the commonest symptom. 32.2 % had compromised vision at presentation in at least one eye. There was no comorbid condition that was associated with the onset of IIH. 80.5% had LP opening pressure >25 CmH2O, with the median being 31 CmH2O. 80.2% had brain MRI, with 78.4% having ancillary IIH findings. 44% were treated with acetazolamide only, 15% with topiramate only, and 30% with acetazolamide and topiramate. 49.3% had symptom improvement at one year of follow-up. 9.8 % were referred for neurosurgical evaluation, mainly due to refractory symptoms. 52.6% did not have a formal documented weight loss plan. The mean BMI at one year of clinic follow-up was 30.9 kg/m2.

Conclusion; The study describes the first cohort of IIH patients from the East Africa region. Demographics are concordant with those reported internationally. Modified Dandy criteria was applied to the diagnosis of IIH in African patients. Nutrition and formal weight loss plans should be incorporated in the IIH standard of care.

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