Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A US-Based Study From 1990 to 2024

Ahmed Y Azzam; Mahmoud Nassar; Mahmoud M Morsy; Adham A Mohamed; Jin Wu; Muhammed Amir Essibayi; David J Altschul

doi:10.1101/2024.12.08.24318685

Epidemiological Patterns, Treatment Response, and Metabolic Correlations of Idiopathic Intracranial Hypertension: A US-Based Study From 1990 to 2024

medRxiv [Preprint]. 2024 Dec 13:2024.12.08.24318685. doi: 10.1101/2024.12.08.24318685.

Authors

Ahmed Y Azzam^{1

2

3}, Mahmoud Nassar^{4

5}, Mahmoud M Morsy^{6

7}, Adham A Mohamed⁸, Jin Wu⁹, Muhammed Amir Essibayi^{1

10}, David J Altschul^{1

10}

Affiliations

¹ Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, USA.
² Director of Clinical Research and Clinical Artificial Intelligence, American Society for Inclusion, Diversity, and Health Equity (ASIDE), Delaware, USA.
³ Visiting Assistant Professor, SNU Medical Big Data Research Center, Seoul National University, Gwanak-gu, Seoul, South Korea.
⁴ Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA.
⁵ Founder, American Society for Inclusion, Diversity, and Health Equity (ASIDE), Delaware, USA.
⁶ Faculty of Medicine, October 6 University, Giza, Egypt.
⁷ Clinical Research Fellow, American Society for Inclusion, Diversity, and Health Equity (ASIDE), Delaware, USA.
⁸ Cairo University Hospitals, Cairo University, Cairo, Egypt.
⁹ National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
¹⁰ Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Abstract

Introduction: Idiopathic Intracranial Hypertension (IIH) presents an increasing health burden with changing demographic patterns. We studied nationwide trends in IIH epidemiology, treatment patterns, and associated outcomes using a large-scale database analysis within the United States (US).

Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network database (1990-2024). We investigated demographic characteristics, time-based trends, geographic distribution, treatment pathways patterns, comorbidity profiles and associated risks with IIH. We used multivariate regression, Cox proportional hazards modeling, and standardized morbidity ratios to assess various outcomes and associations.

Results: Among 51,526 patients, we found a significant increase in adult IIH incidence from 16.0 to 127.0 per 100,000 (adjusted RR: 6.94, 95% CI: 6.71-7.17). Female predominance increased over time (female-to-male ratio: 3.29, 95% CI: 3.18-3.40). Southern regions showed the highest prevalence (43.0%, n=21,417). Initial medical management success rates varied between acetazolamide (42.3%) and topiramate (28.7%). Advanced interventional procedures showed 82.5% success rates in refractory cases. Cox modeling revealed significant associations between IIH and metabolic syndrome (HR: 2.14, 95% CI: 1.89-2.39) and cardiovascular complications (HR: 1.76, 95% CI: 1.58-1.94), independent of BMI.

Conclusions: Our findings highlight IIH as a systemic disorder with significant metabolic implications beyond its neurological manifestations. The marked regional disparities and rising incidence rates, especially among adults, suggest the need for targeted healthcare strategies. Early intervention success strongly predicts favorable outcomes, supporting prompt diagnosis and treatment initiation. These results advocate for an integrated approach combining traditional IIH management with broad metabolic screening care.

Keywords: Epidemiology; Headache; Idiopathic Intracranial Hypertension; Intracranial Pressure; Pesudotumor Cerebri.

Publication types

Preprint

Grants and funding

The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through CTSA award number: UM1TR004400. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.