(1266) Social Vulnerability Among Patients with Idiopathic Intracranial Hypertension and Spontaneous Skull Base Cerebrospinal Fluid Leak

Introduction: Patients with spontaneous skull base cerebrospinal fluid (CSF) leaks in the setting of idiopathic intracranial hypertension (IIH) often lack consistent outpatient care and may present later in the disease course than IIH patients without a leak. We therefore hypothesized that patients with IIH who develop CSF leaks would have greater neighborhood-level social vulnerability, quantified as a percentile by the Social Vulnerability Index (SVI), reflecting barriers to healthcare access and modifiable IIH risk factors such as obesity.

Methods: Adult patients with IIH without a CSF leak (IIHwoL; n=96) and patients with IIH and spontaneous CSF leak (IIHwL; n=29) were identified from a single academic center from 2020-2025. Zip codes were mapped to zip-code tabulation areas (ZCTAs) and then to ZCTA-level SVI overall and across four theme‑specific ranks (socioeconomic status, household composition/disability, minority status/language, and housing/transportation). SVI for non-leak, non-IIH, headache patients was also extracted from the medical record.

Results: Both IIHwoL and IIHwL patients were highly exposed to neighborhood disadvantage. Median overall SVI was 0.71 (71st percentile) in the IIHwoL group and 0.72 in the IIHwL group (p=0.88), with small differences for each SVI theme (0.001–0.02; all p>0.05). Overall SVI of the headache population (0.49) was considerably lower than both IIH groups. Mean SVI of 0.72 corresponded to 22.3% of residents below 150% poverty (compared to 18.6% expected at SVI 0.49), 7.0% unemployed (vs 3.9% expected at SVI 0.49), and 29.6% of residents spending more than 30% of their income on housing costs (vs 19.9% expected at SVI 0.49).

Conclusions: IIHwL and IIHwoL patients are exposed to a high level of neighborhood vulnerability. SVI does not appear to distinguish which individuals manifest a leak versus IIH without a leak. These findings support conceptualizing social vulnerability as a common contextual exposure across patients on the IIH spectrum, likely amplifying modifiable risks for both presentations.