Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Diversity, Equity, & Inclusion (DEI)
    • Neurology: Clinical Practice Accelerator
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
    • UDDA Revision Series
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Diversity, Equity, & Inclusion (DEI)
    • Neurology: Clinical Practice Accelerator
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Neurology Future Forecasting Series
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
    • UDDA Revision Series
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Neurology Video Journal Club
  • Residents & Fellows

Share

January 26, 2016; 86 (4) Article

Overdiagnosis of idiopathic intracranial hypertension

Adeniyi Fisayo, Beau B. Bruce, Nancy J. Newman, Valerie Biousse
First published December 30, 2015, DOI: https://doi.org/10.1212/WNL.0000000000002318
Adeniyi Fisayo
From the Departments of Ophthalmology (A.F., B.B.B., N.J.N., V.B.), Neurology (B.B.B., N.J.N., V.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine; and the Department of Epidemiology (B.B.B.), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Beau B. Bruce
From the Departments of Ophthalmology (A.F., B.B.B., N.J.N., V.B.), Neurology (B.B.B., N.J.N., V.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine; and the Department of Epidemiology (B.B.B.), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA.
MD, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nancy J. Newman
From the Departments of Ophthalmology (A.F., B.B.B., N.J.N., V.B.), Neurology (B.B.B., N.J.N., V.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine; and the Department of Epidemiology (B.B.B.), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Valerie Biousse
From the Departments of Ophthalmology (A.F., B.B.B., N.J.N., V.B.), Neurology (B.B.B., N.J.N., V.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine; and the Department of Epidemiology (B.B.B.), Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Citation
Overdiagnosis of idiopathic intracranial hypertension
Adeniyi Fisayo, Beau B. Bruce, Nancy J. Newman, Valerie Biousse
Neurology Jan 2016, 86 (4) 341-350; DOI: 10.1212/WNL.0000000000002318

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
2667

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Objective: To delineate the factors contributing to overdiagnosis of idiopathic intracranial hypertension (IIH) among patients seen in one neuro-ophthalmology service at a tertiary center.

Methods: We retrospectively reviewed new patients referred with a working diagnosis of IIH over 8 months. The Diagnosis Error Evaluation and Research taxonomy tool was applied to cases referred with a diagnosis of IIH and a discrepant final diagnosis.

Results: Of 1,249 patients, 165 (13.2%) were referred either with a preexisting diagnosis of IIH or to rule out IIH. Of the 86/165 patients (52.1%) with a preexisting diagnosis of IIH, 34/86 (39.5%) did not have IIH. The most common diagnostic error was inaccurate ophthalmoscopic examination in headache patients. Of 34 patients misdiagnosed as having IIH, 27 (27/34 [79.4%]; 27/86 [31.4%]) had at least one lumbar puncture, 29 (29/34 [85.3%]; 29/86 [33.7%]) had a brain MRI, and 8 (8/34 [23.5%]; 8/86 [9.3%]) had a magnetic resonance/CT venogram. Twenty-six had received medical treatment, 1 had a lumbar drain, and 4 were referred for surgery. In 8 patients (8/34 [23.5%]; 8/86 [9.3%]), an alternative diagnosis requiring further evaluation was identified.

Conclusions: Diagnostic errors resulted in overdiagnosis of IIH in 39.5% of patients referred for presumed IIH, and prompted unnecessary tests, invasive procedures, and missed diagnoses. The most common errors were inaccurate ophthalmoscopic examination in headache patients and thinking biases, reinforcing the need for rapid access to specialists with experience in diagnosing optic nerve disorders. Indeed, the high prevalence of primary benign headaches and obesity in young women often leads to costly and invasive evaluations for presumed IIH.

GLOSSARY

BMI=
body mass index;
DEER=
Diagnosis Error Evaluation and Research;
ED=
emergency department;
ICP=
intracranial pressure;
IIH=
idiopathic intracranial hypertension;
IQR=
interquartile range

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 318

  • Received July 1, 2015.
  • Accepted in final form September 16, 2015.
  • © 2015 American Academy of Neurology
View Full Text

AAN Members

We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.

Google Safari Microsoft Edge Firefox

Click here to login

AAN Non-Member Subscribers

Click here to login

Purchase access

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

Letters: Rapid online correspondence

  • Overdiagnosis of IIH: Author response to Mathew et al.
    • Valerie Biousse, Emory University[email protected]
    Submitted August 26, 2016
  • A Headache Medicine Subspecialty Commentary on "Overdiagnosis of Idiopathic Intracranial Hypertension"
    • Paul G. Mathew, Assistant Professor of Neurology, Brigham & Women's Hospital, Department of Neurology, John R. Graham Headache Center, Harvard Medical[email protected]
    • Umer Najib, MD, Regina Krel, MD, Paul B. Rizzoli, MD, FAAN, FAHS, Boston, MA
    Submitted July 13, 2016
  • Caution with the high misdiagnosis rate in IIH
    • Michael O. Kinney, Neurology Resident, Belfast Health and Social Care Trust[email protected]
    • G. McDonnell, J. Best.
    Submitted May 03, 2016
  • Overdiagnosis of IIH: Author response to Dr. Avasarala
    • Valerie Biousse, Emory University[email protected]
    • Nancy J. Newman
    Submitted January 29, 2016
  • The bane of diagnosis of IIH
    • Jagannadha Avasarala, Associate Prof of Neurology, U of South Carolina School of Medicine, Greenville Health System[email protected]
    Submitted January 26, 2016
Comment

REQUIREMENTS

You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. [email protected]
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • GLOSSARY
    • METHODS
    • RESULTS
    • DISCUSSION
    • AUTHOR CONTRIBUTIONS
    • STUDY FUNDING
    • DISCLOSURE
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Disclosures
Advertisement

Hastening the Diagnosis of Amyotrophic Lateral Sclerosis

Dr. Brian Callaghan and Dr. Kellen Quigg

► Watch

Related Articles

  • Misdiagnosing idiopathic intracranial hypertensionYou've got some nerve

Topics Discussed

  • Clinical neurology history
  • Clinical neurology examination
  • Optic nerve
  • Idiopathic intracranial hypertension

Alert Me

  • Alert me when eletters are published

Recommended articles

  • Articles
    Long-term follow-up of idiopathic intracranial hypertension
    The Iowa experience
    V. A. Shah, R. H. Kardon, A. G. Lee et al.
    Neurology, February 19, 2008
  • Articles
    Manometry combined with cervical puncture in idiopathic intracranial hypertension
    J. O. King, P. J. Mitchell, K. R. Thomson et al.
    Neurology, January 08, 2002
  • Resident and Fellow Section
    Clinical Reasoning:
    A 22-year-old woman with headache and diplopia
    Ji Soo Kim et al.
    Neurology, June 29, 2009
  • Editorial
    Misdiagnosing idiopathic intracranial hypertension
    You've got some nerve
    Steven L. Galetta, Kathleen B. Digre et al.
    Neurology, December 30, 2015
Neurology: 101 (22)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise