Neuro-Ophthalmic Presentations in Patients with IIH: Role of CSF Pressure, Imaging and Visual Function Testing

Background: Idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure without secondary causes, primarily affecting young, obese women. Although headache and visual impairment are hallmark features, the link between cerebrospinal fluid (CSF) pressure, neuro-ophthalmic findings, and visual prognosis remains unclear. This study evaluated neuro-ophthalmic presentations of IIH and analyzed associations between CSF pressure, imaging findings, and visual function testing in patients with IIH. Methods: This cross-sectional study included 100 patients with IIH at the National Institute of Neuro Sciences & Hospital, Dhaka, Bangladesh, from July 2022 to June 2025. Demographic and clinical data, CSF opening pressure, imaging results, and ophthalmological evaluations (fundal photography and perimetry) were collected. Statistical analyses, including chi-square tests and logistic regression, were conducted using SPSS version 25.0, with a significance threshold of p <0.05. Results: The mean age was 26.16 ± 7.49 years, with female predominance. Headache (97%), papilledema (93%), and visual impairment (88%) were the most common symptoms. CSF pressure > 25 cm was noted in 64% of patients and showed a statistically significant association with visual loss (p=0.02), but not with double vision (p=0.96), tinnitus (p=0.51), papilledema (p=0.56), or cranial nerve palsy (p=0.41). Imaging abnormalities were rare (4%). Logistic regression revealed no significant predictive value for CSF pressure >25 (OR 0.13, p=0.06) or perimetry (OR 1.66, p=0.49) for visual impairment. Conclusion: IIH frequently presents with visual impairment and papilledema; however, CSF pressure alone cannot predict IIH. Multimodal evaluation with ophthalmic assessment and imaging is essential for risk stratification and management.