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A multi-centre case series of patients with coexistent intracranial hypertension and malignant arterial hypertension

Eye volume 38, pages 274–278 (2024)Cite this article

Subjects

Abstract

Objective

To describe the clinical characteristics, outcomes, and management of a large cohort of patients with concomitant malignant arterial hypertension and intracranial hypertension.

Methods

Design: Retrospective case series. Subjects: Patients aged ≥ 18 years with bilateral optic disc oedema (ODE), malignant arterial hypertension and intracranial hypertension at five academic institutions. Patient demographics, clinical characteristics, diagnostic studies, and management were collected.

Results

Nineteen patients (58% female, 63% Black) were included. Median age was 35 years; body mass index (BMI) was 30 kg/m2. Fourteen (74%) patients had pre-existing hypertension. The most common presenting symptom was blurred vision (89%). Median blood pressure (BP) was 220 mmHg systolic (IQR 199–231.5 mmHg) and 130 mmHg diastolic (IQR 116–136 mmHg) mmHg), and median lumbar puncture opening pressure was 36.5 cmH2O. All patients received treatment for arterial hypertension. Seventeen (89%) patients received medical treatment for raised intracranial pressure, while six (30%) patients underwent a surgical intervention. There was significant improvement in ODE, peripapillary retinal nerve fibre layer thickness, and visual field in the worst eye (p < 0.05). Considering the worst eye, 9 (47%) presented with acuity ≥ 20/25, while 5 (26%) presented with ≤ 20/200. Overall, 7 patients maintained ≥ 20/25 acuity or better, 6 demonstrated improvement, and 5 demonstrated worsening.

Conclusions

Papilloedema and malignant arterial hypertension can occur simultaneously with potentially greater risk for severe visual loss. Clinicians should consider a workup for papilloedema among patients with significantly elevated blood pressure and bilateral optic disc oedema.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology and Visual Neuroscience University of Minnesota, Minnesota, USA

    Victoria Sattarova, Collin M. McClelland & Michael S. Lee

  2. Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, USA

    Alexis Flowers

  3. Department of Ophthalmology Duke University, Durham, USA

    Sidney M. Gospe III

  4. Departments of Ophthalmology and Neurology Mayo Clinic College of Medicine, Rochester, USA

    John J. Chen

  5. Department of Ophthalmology and Visual Sciences Washington University in St. Louis, St. Louis, USA

    Leanne Stunkel

  6. Department of Ophthalmology The Permanente Medical Group Northern California, California, USA

    M. Tariq Bhatti

  7. Department of Ophthalmology Emory University, Atlanta, Georgia

    Michael Dattilo, Sachin Kedar & Valerie Biousse

  8. Department of Neurology Emory University, Atlanta, Georgia

    Sachin Kedar & Valerie Biousse

Authors
  1. Victoria Sattarova
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  10. Collin M. McClelland
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Contributions

MSL was responsible for designing the protocol, analysing data, interpreting results, and writing the draft of the manuscript. VS was responsible for designing the protocol, analysing data, interpreting results, and writing the draft of the manuscript. JJC, SG, MTB, AF, CMC, SK, VB, LS, and MD were responsible for collecting data, analysing data, interpreting results, and editing the manuscript.

Corresponding author

Correspondence to Michael S. Lee.

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Competing interests

None of the authors have any disclosures relevant to this submission. Michael S Lee, MD receives royalties from Uptodate and Springer, receives research support from Invex, owns stock in Horizon, and serves as a consultant for Panbela. John Chen, MD, PhD serves as a consultant to Roche, UCB, and Horizon. Sidney Gospe MD has received support from the NIH. M. Tariq Bhatti, MD has served as a consultant for Bristol Meyers Squbb and Sanofi Genzyme. Valerie Biousse has served as a consultant for Gensight and Neurophoenix. Leanne Stunkel MD has no disclosures. Michael Dattilo, MD, PhD has no disclosures. Alexis Flowers, MD has no disclosures. Collin McClelland, MD has no disclosures. Victoria Sattarova, MD has no disclosures. Sachin Kedar, MD has not disclosures.

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Sattarova, V., Flowers, A., Gospe, S.M. et al. A multi-centre case series of patients with coexistent intracranial hypertension and malignant arterial hypertension. Eye 38, 274–278 (2024). https://doi.org/10.1038/s41433-023-02672-z

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  • DOI: https://doi.org/10.1038/s41433-023-02672-z

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