Evaluation of cerebrospinal fluid opening pressure and protein levels in relation to clinical profile and recovery in idiopathic intracranial hypertension

Aims: Idiopathic intracranial hypertension (IIH) is an increase in CSF pressure without any other primary cause such as hydrocephalus, mass lesion, or meningeal abnormality. Evaluation of the severity of the disease and management of the treatment in patients are important for clinicians, and different parameters such as blood biomarkers and cerebrospinal fluid (CSF) opening pressure or protein levels are investigated. This study aimed to review the cases with IIH and evaluate the relationship between CSF opening pressure and protein levels obtained at the first presentation and the patient's clinical findings. Methods: The data of patients diagnosed with IIH between 2012 and 2024 were retrospectively reviewed in the hospital electronic database, and demographic, clinical findings, neuroimaging results, and CSF analysis results were documented. The association between CSF opening pressure and protein levels obtained at the first presentation and the patient's clinical profile was analyzed. SPSS version 25 program was used in the statistical analysis of the data. p<0.05 was found to be statistically significant. Results: Among 56 cases, 47 patients (83.9%) were female. The median age was 35 years. Visual impairment was the most common symptom (n=42, 75.0%). The mean of the CSF opening pressure was 332.68 mmH20, and patients had protein levels with a median of 27.05 mg/dl. Median CSF protein levels were found to be statistically significantly higher in patients presenting with decreased vision compared to those without (p=0.031). The number of patients with severe papilledema and decreased visual acuity was found to be significantly higher in the high CSF pressure group (p=0.041, p=0.042). Also, the number of patients with recurrent symptoms during the follow-up period was found to be significantly higher in high-pressure group (p=0.045). Conclusion: In this retrospective study, clinical, laboratory, and radiological profiles of IIH patients were examined. Elevated CSF opening pressure in patients was found to be associated with visual impairment, increased symptom recurrence during follow-up, and severe papilledema; however, no association was observed with overall clinical recovery. CSF protein level was found to be associated only with improvement in visual acuity during follow-up. These findings underscore the need for multicenter studies to be conducted on this subject with a larger patient population to define the parameters and associations with the clinical course and prognosis.