Intracranial idiopathic hypertension: 1-year follow-up study

Evaluating the optic nerve stiffness and optic nerve sheath diameter in idiopathic intracranial hypertension patients after the resolution of papilledema

PURPOSE

The objective of this study was to investigate the optic nerve's elastic properties and optic nerve sheath diameter (ONSD) using shear-wave elastography (SWE) in patients with idiopathic intracranial hypertension (IIH) compared to healthy individuals.

METHODS

The study included 22 IIH patients and 15 healthy subjects. SWEs were performed on the optic nerve and ONSD, and optic nerve stiffness were measured.

RESULTS

The patients with IIH demonstrated higher stiffness of the optic nerve compared with that of healthy volunteers (P < 0.001). The optic nerve sheath diameter of the optic nerve in the IIH group was significantly larger than that in the control group (P < 0.001). There was no correlation between the disease duration and SWE values in the Spearman correlation test.

CONCLUSION

These findings suggest that ONSD can be used as a follow-up method in the treatment of IIH. However, there was not any correlation between the disease duration and SWE-based stiffness measurement of the optic nerve.

The importance of specific rehabilitation for an obese patient with idiopathic intracranial hypertension: a case report

Idiopathic intracranial hypertension (IIH) is associated with obesity, and weight loss is important to reduce intracranial pressure and improve visual function. A 38-year-old woman with IIH followed an extreme diet, which resulted in 30% weight loss (BMI moved from 34.9 to 24.6). Weight loss resulted in a significant reduction of papilloedema, normalization of intracranial pressure and improvement in headache pattern, but also induced a state of initial malnutrition, relevant depression and disability. She was discharged with the indication to start a controlled diet and improve physical activity: clinical situation get back to stability, with the patient loosing further weight (BMI=21.8) through a balanced diet and moderate physical exercise. Obese patients with IIH should be offered a comprehensive treatment approach consisting of diet and nutritional support, psychological counselling, indication to increase physical activity and, when appropriate, a specific rehabilitation programme.

[Analysis of the joint and a posteriori probability between primary empty sella, its comorbidities and audiovestibular pathology]

BACKGROUND

Primary empty sella is a herniation of the sellar diaphragm into the pituitary space. It is an incidental finding and patients may manifest neurological, ophthalmological and/or endocrine disorders. Episodes of vertigo, dizziness, and hearing loss, have been reported.

OBJECTIVE

To determine the conditional probability, as well as the statistical dependency, through the Bayesian analysis in patients with primary empty sella and audiovestibular disorders.

PATIENTS

Individuals who attended the National Rehabilitation Institute from January 2010 to December 2011, diagnosed with primary empty sella and audiovestibular disorders.

MATERIAL AND METHODS

An analysis was performed on a sample of 18 patients with a diagnosis of primary empty sella confirmed with magnetic resonance studies and who had signs of vertigo, hearing loss and dizziness.

RESULTS

Of the 18 patients studied, 3 (16.66%) had primary empty sella as the only clinical evidence. In 9 patients (50%) empty sella was associated with vertigo, and 16 patients (88.88%) were diagnosed with hearing loss, with sensorineural hearing loss being the most frequent (77.77%). The intersection between the proportions of primary empty sella with the presence and type of hearing loss was calculated. Thus for sensorineural hearing loss, the calculated ratio was P(AB)=0.6912, and for conductive and mixed hearing loss the value of P(AB)=0.0493 in both cases.

CONCLUSIONS

Bayesian analysis and conditional probability enables the dependence between two or more variables to be calculated. In this study both mathematical models were used to analyse comorbidities and audiovestibular disorders in patients diagnosed with primary empty sella.