A systematic review on idiopathic intracranial hypertension comorbid with polycystic ovarian syndrome and its consequences

Relationship Between Radiological Features of Primary Empty or Primary Partial Empty Sella and Pituitary Hormone Levels

Purpose: The purpose of this study was to assess the relationship between the radiological criteria determining an primary empty or primary partial empty sella and the pituitary hormone levels. Methods: Out of 594 patients who underwent pituitary magnetic resonance imaging (MRI), we selected 43 patients with primarily empty and partial empty sella and conducted a prospective evaluation of pituitary MRI in 2022. Pituitary craniocaudal (CC) diameter, pituitary volume, sellar volume, pituitary volume expressed as a percentage of sellar volume (bony sella), and pituitary height expressed as a percentage of sellar height (craniocaudal) were assessed. Serum pituitary hormone concentrations were measured, and a logistic regression analysis was performed to assess a relationship between the radiological and hormonal parameters. Results: Only six patients (14%) exhibited abnormal hormone levels. None of the assessed radiological parameters were correlated with the presence of the hormonal disorders either in the univariate or multivariate logistic regression analysis. The univariate logistic regression analysis revealed a significant relationship between age and the hormonal disorders (OR 0.916 [0.844-0.993]; p = 0.034), but this was not confirmed in the multivariate analysis. Conclusions: These findings suggest that radiological parameters alone are insufficient to predict hormonal dysfunction in patients with empty or partial empty sella. However, younger patients may be at a higher risk, warranting closer hormonal monitoring.

Longitudinal visual outcomes in idiopathic intracranial hypertension: the role of early prognostic indicators and risk stratification in disease management

BACKGROUND

Idiopathic intracranial hypertension (IIH) is increasingly prevalent, yet longitudinal outcome data are scarce. This study aimed to characterise demographic and longitudinal clinical changes in a cohort of patients with IIH.

METHODS

Retrospective cohort analysis on adult patients diagnosed with IIH (Friedman criteria) enrolled in the neuro-ophthalmology database (NODE) across two tertiary centres. Baseline demographic data was obtained at first assessment, with clinical and paraclinical outcomes collected longitudinally. Multivariable statistical analysis identified factors associated with poorer visual outcomes.

RESULTS

A total of 221 patients were included. 91.8% were female (ratio 11:1). Mean age at presentation was 29.2 ± 8.1 years with mean body mass index (kg/m2) at diagnosis of 38.7 ± 9.4. Headache was the most common symptom. Papilloedema was found in 95.5% of patients at baseline. Mean CSF opening pressure was 32.67 ± 6.85cmCSF (range 25-76). Visual outcomes remained stable over time. Trajectory plots showed no deviations in visual acuity, while regression models found no associations with sex, site or age. A higher retinal nerve fibre layer thickness and greater baseline Frisen grade were associated with worse outcomes. Baseline papilloedema grade and CSF opening pressure emerged as early prognostic indicators, aiding risk stratification for those with a greater probability of persistent optic nerve abnormalities including higher retinal nerve fibre layer elevation and sustained atrophic changes over time.

CONCLUSIONS

This study offers insights into visual outcomes in IIH, emphasising the importance of early recognition, risk stratification, and intervention in those with a more severe clinical phenotype at presentation.

Approach to the Patient With Headache

OBJECTIVE

The evaluation of patients with headache relies heavily on the history. This article reviews key questions for diagnosing primary and secondary headache disorders with a rationale for each and phrasing to optimize the information obtained and the patient's experience.

LATEST DEVELOPMENTS

The availability of online resources for clinicians and patients continues to increase, including sites that use artificial intelligence to generate a diagnosis and report based on patient responses online. Patient-friendly headache apps include calendars that help track treatment response, identify triggers, and provide educational information.

ESSENTIAL POINTS

A structured approach to taking the history, incorporating online resources and other technologies when needed, facilitates making an accurate diagnosis and often eliminates the need for unnecessary testing. A detailed yet empathetic approach incorporating interpersonal skills enhances relationship building and trust, both of which are integral to successful treatment.