Etiology of Papilledema in Patients in the Eye Clinic Setting.

This cross-sectional study examines the relative frequency of etiologies of papilledema and describes the clinical and demographic differences between patients with idiopathic intracranial hypertension and other causes of papilledema. Question What is the likely etiology of papilledema among patients presenting to an eye clinic without a previously known cause? Findings In this population-based cross-sectional study including 86 patients diagnosed with papilledema, most patients (87%) were found to have idiopathic intracranial hypertension, while 13% presented with potentially life-threatening conditions, including intracranial tumor, cerebral venous sinus thrombosis, and granulomatous meningitis. Meaning All patients presenting with papilledema require neuroimaging; however, based on the results of this study, those with the typical demographic characteristics of idiopathic intracranial hypertension and lack of other neurologic symptoms may not need urgent neuroimaging, as long as the papilledema is not severe enough to threaten vision. Importance The study of health conditions associated with papilledema will augment the clinical judgment of eye care professionals treating patients with optic disc edema in determining the urgency of additional evaluation and counseling patients accordingly. Objectives To determine the incidence, demographic characteristics, and etiologies of papilledema based on a unique records-linkage research platform; and to describe the demographic and clinical differences between patients with idiopathic intracranial hypertension (IIH) and other causes of papilledema. Design, Setting, and Participants Retrospective population-based cross-sectional study of patients treated for papilledema at outpatient eye clinics in Olmsted County, Minnesota, using the Rochester Epidemiology Project. Data were collected from January 1990 to December 2014 and analyzed from September 2018 to April 2019. Main Outcomes and Measures Etiologies of papilledema, body mass index, incidence of headache, or localizing neurologic signs. Results Eighty-six patients were diagnosed with papilledema during the 24-year period, providing an age- and sex-adjusted incidence of 2.5 individuals per 100000 per year; 68 patients (79%) were women, 73 (85%) were white patients, and the median (range) age was 27.7 (6.2-64.2) years. Nineteen patients (22%) presented with a previously diagnosed attributable cause (eg, trauma or intracranial tumor). Among patients presenting with papilledema without a previously diagnosed attributable cause, 58 patients (87%) had IIH, and 9 patients (13%) were found to have a secondary cause of raised intracranial pressure, such as intracranial tumor, cerebral venous sinus thrombosis, or granulomatous meningitis. Patients with IIH had a higher median (range) body mass index (37.5 [20.4-55.7] vs 27.4 [16.6-40.1]; P = .003) and headache prevalence (54 of 58 patients [93%] vs 6 of 9 patients [67%]; P = .004) than patients with other causes of papilledema. Of 9 patients with papilledema but no IIH, 2 (22%) had localizing neurologic signs, such as gait abnormalities, hearing loss, focal weakness or numbness, visual field defects, or aphasia. Among 42 patients with demographic characteristics typically associated with IIH (female sex, with obesity, aged 15 to 45 years, and absent localizing neurologic signs or symptoms), 40 (95%) had papilledema that was associated with IIH. Conversely, among the 19 patients without these demographic characteristics, 7 (37%) had an alternative cause. Conclusions and Relevance In this study, most patients who presented to the eye clinic with papilledema without a previously known cause were found to have IIH. These patients were more likely to present with headaches and had statistically higher body mass index. Clinicians should take these findings into account when determining the pretest probability of a patient having IIH or an alternative cause of papilledema.