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Atasoy B, Yaman Kula A, Balsak S, Polat YB, Donmez Z, Akcay A, Peker AA, Toluk O, Alkan A. Role of diffusion tensor imaging in the evaluation of white matter integrity in idiopathic intracranial hypertension. Headache 2024; 64:1076-1087. [PMID: 39257070 DOI: 10.1111/head.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/26/2024] [Accepted: 07/17/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES To determine whether idiopathic intracranial hypertension (IIH) may affect white matter integrity and optic pathways by using diffusion tensor imaging (DTI) and to correlate the DTI metrics with intracranial pressure (ICP). METHODS This study is a retrospective case-control study. A total of 42 patients who underwent lumbar puncture and those with elevated ICP, meeting the diagnostic criteria for IIH, were included in the study. All patients had supportive magnetic resonance imaging findings for the diagnosis of IIH. The headache control group comprised 36 patients who presented to the Neurology Department with infrequent episodic tension-type headache, had a normal neurologic examination, and had clinical and radiological findings suggestive of normal ICP. For each patient with IIH, clinical findings and ophthalmological measurements were recorded. The apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD) values were calculated using a region of interest-based method in different white matter tracts and optic pathways and compared. RESULTS A total of 42 patients diagnosed with IIH (three males, 39 females), with a mean (standard deviation [SD] age of 38.1 (8.9) years), and 36 headache controls (10 males, 26 females, mean [SD] age; 38.1 [9.4] years) were included in the study. The mean (SD) body mass index (BMI) of the patients with IIH was 25.2 (1.9) kg/m2, and the mean (SD) BMI of the headache controls was 23.3 (1.5) kg/m2 (p < 0.001). Decreased FA values and increased RD values in the cingulum were detected in patients with IIH compared to the headache controls (p = 0.003, Cohen's d = 0.681; p = 0.002 Cohen's d = -0.710). Decreased AD values in the left and right superior cerebellar peduncle and increased ADC values in the middle cerebellar peduncle were detected in patients with IIH compared to the headache controls (p < 0.001, Cohen's d = 0.961; p = 0.009, Cohen's d = 0.607; p = 0.015, Cohen's d = -0.564). Increased ADC and RD values and decreased FA values in optic nerve were detected in patients with IIH (p = 0.010, Cohen's d = -0.603; p = 0.004, Cohen's d = -0.676; p = 0.015 Cohen's d = 0.568). A positive correlation was found between the cerebrospinal fluid pressure and ADC values of the left and right superior and left inferior longitudinal fasciculus, genu of the corpus callosum, and right optic radiation (r = 0.43, p = 0.005; r = 0.31, p = 0.044; r = 0.39, p = 0.010; r = 0.35, p = 0.024; r = 0,41, p = 0.007). There was a positive correlation between the retinal nerve fiber layer thickness and the ADC values of the optic nerve (r = 0.32, p = 0.039). CONCLUSIONS Intracranial hypertension can be associated with deteriorated DTI values, which might be interpreted as a sign of impaired white matter microstructural integrity in many brain regions beyond the periventricular white matter. Pressure-induced edema and axonal degeneration may be the potential underlying mechanisms of this microstructural damage.
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Affiliation(s)
- Bahar Atasoy
- Department of Radiology, Bezmialem Vakıf University Hospital, Istanbul, Turkey
| | - Asli Yaman Kula
- Department of Neurology, Bezmialem Vakıf University Hospital, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Bezmialem Vakıf University Hospital, Istanbul, Turkey
| | - Yagmur Basak Polat
- Department of Radiology, Bezmialem Vakıf University Hospital, Istanbul, Turkey
| | - Zeynep Donmez
- Department of Radiology, Bezmialem Vakıf University Hospital, Istanbul, Turkey
| | - Ahmet Akcay
- Department of Radiology, Bezmialem Vakıf University Hospital, Istanbul, Turkey
| | | | - Ozlem Toluk
- Department of Biostatistics and Medical Informatics, Bezmialem Vakıf University Hospital, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Bezmialem Vakıf University Hospital, Istanbul, Turkey
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Hsu HT, Cheng HC, Hou TW, Tzeng YS, Fuh JL, Chen SP, Chen WT, Lee WJ, Pai YW, Lee YC, Lirng JF, Wang SJ, Wang YF. Idiopathic intracranial hypertension in Asians: a retrospective dual-center study. J Headache Pain 2024; 25:144. [PMID: 39232671 PMCID: PMC11373263 DOI: 10.1186/s10194-024-01852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND There have been limited data on idiopathic intracranial hypertension (IIH) in Asians and there remain uncertainties whether a cerebrospinal fluid (CSF) pressure of 250 mm CSF is an optimum diagnostic cutoff. The aims of the present study included (1) characterization of IIH patients in Taiwan, (2) comparisons among different diagnostic criteria for IIH, and (3) comparisons between patients with CSF pressures of > 250 and 200-250 mm CSF. METHODS This retrospective study involved IIH patients based on the modified Dandy criteria from two tertiary medical centers in Taiwan. Clinical manifestations were retrieved from electronic medical records, and findings on ophthalmologic examination and magnetic resonance images (MRIs) were reviewed. RESULTS A total of 102 patients (71 F/31 M, mean age 33.4 ± 12.2 years, mean CSF pressure 282.5 ± 74.5 mm CSF) were identified, including 46 (45.1%) with obesity (body-mass index ≥ 27.5), and 57 (62.6%) with papilledema. Overall, 80 (78.4%), 55 (53.9%), 51 (50.0%), and 58 (56.9%) patients met the Second and Third Edition of International Classification of Headache Disorders, Friedman, and Korsbæk criteria, respectively. Patients in the 200-250 mm CSF group (n = 40) were less likely to have papilledema (48.5% vs. 70.7%, p = 0.035), transient visual obscuration (12.5% vs. 33.9%, p = 0.005), and horizontal diplopia (10.0% vs. 30.6%, p = 0.006), and had fewer signs on MRIs (2.2 ± 1.3 vs. 2.8 ± 1.0, p = 0.021) when compared with those with CSF pressures > 250 mm CSF (n = 62). However, the percentages of patients with headache (95.0% vs. 87.1%, p = 0.109) at baseline, chronic migraine at six months (31.6% vs. 25.0%, p = 0.578), and visual field defect (86.7% vs. 90.3%, p = 0.709) were similar. CONCLUSIONS It was found that obesity and papilledema were less common in Asian IIH patients when compared with Caucasian patients. Although patients with CSF pressures of 200-250 mm CSF had a less severe phenotype, the risks of having headache or visual loss were comparable to those in the > 250 mm CSF group. It is possible that a diagnostic cutoff of > 200 mm CSF could be more suitable for Asians, although further studies are still needed.
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Grants
- 110-2321-B-010-005, 111-2321-B-A49-004, 111-2314-B-075 -086 -MY3, 111-2321-B-A49-011, and 112-2321-B-075-007 National Science and Technology Council
- 109-2314-B-075 -054 and 110-2314-B-075 -041 -MY3 National Science and Technology Council
- MOHW112-TDU-B-211-144001 Ministry of Health and Welfare
- V108C-092, V109C-096, V110C-111, V111C-161, V112C-078, V113C-123, and V112D67-003-MY3 Taipei Veterans General Hospital
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Affiliation(s)
- Hsiang-Ting Hsu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hui-Chen Cheng
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsung-Wei Hou
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Shiang Tzeng
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Wei-Ju Lee
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yen-Wei Pai
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Chung Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiing-Feng Lirng
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Zhou C, Zhou Y, Liu L, Jiang H, Wei H, Zhou C, Ji X. Progress and recognition of idiopathic intracranial hypertension: A narrative review. CNS Neurosci Ther 2024; 30:e14895. [PMID: 39097911 PMCID: PMC11298205 DOI: 10.1111/cns.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/03/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) mainly affects obese young women, causing elevated intracranial pressure, headaches, and papilledema, risking vision loss and severe headaches. Despite weight loss as the primary treatment, the underlying mechanisms remain unclear. Recent research explores novel therapeutic targets. AIMS This review aimed to provide a comprehensive understanding of IIH's pathophysiology and clinical features to inform pathogenesis and improve treatment strategies. METHODS Recent publications on IIH were searched and summarized using PubMed, Web of Science, and MEDLINE. RESULTS The review highlights potential pathomechanisms and therapeutic advances in IIH. CONCLUSION IIH incidence is rising, with growing evidence linking it to metabolic and hormonal disturbances. Early diagnosis and treatment remain challenging.
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Affiliation(s)
- Chenxia Zhou
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
| | - Lu Liu
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
- Zhongguancun Xirui Institute of Precision Medicine for Heart and Brain TumorsBeijingChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineSchool of Biological Science and Medical Engineering, Beihang UniversityBeijingChina
| | - Chen Zhou
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
| | - Xunming Ji
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
- Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijingChina
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Daou BJ, Ducruet AF. Causes of Pulsatile Tinnitus and Treatment Options. Neurosurg Clin N Am 2024; 35:293-303. [PMID: 38782522 DOI: 10.1016/j.nec.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Pulsatile tinnitus (PT) requires detailed workup to evaluate for an underlying structural cause. With advances in neuroimaging, structural venous abnormalities that can cause PT have becoming increasingly recognized. A number of anomalies, including dural arteriovenous fistulas, idiopathic intracranial hypertension, transverse sinus stenosis, sigmoid sinus wall abnormalities, jugular venous anomalies, and hypertrophied emissary veins, have been implicated in flow disruption and turbulence in the vicinity of auditory structures, resulting in PT. Endovascular treatment options, including stenting, coiling, and embolization with liquid agents, have demonstrated high efficacy and safety. These treatments can lead to symptomatic relief in carefully selected cases.
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Affiliation(s)
- Badih J Daou
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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Prabhat N, Kaur K, Takkar A, Ahuja C, Katoch D, Goyal M, Dutta P, Bhansali A, Lal V. Pituitary Dysfunction in Idiopathic Intracranial Hypertension: An Analysis of 80 Patients. Can J Neurol Sci 2024; 51:265-271. [PMID: 37014102 DOI: 10.1017/cjn.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Empty sella is a commonly described imaging entity in patients with idiopathic intracranial hypertension (IIH). Though menstrual and hormonal disturbances have been associated with IIH, available literature lacks systematic analysis of pituitary hormonal disturbances in IIH. More so, the contribution of empty sella in causing pituitary hormonal abnormalities in patients of IIH has not been described. We carried out this study to systematically assess the pituitary hormonal abnormalities in patients with IIH and its relation to empty sella. METHODS Eighty treatment naïve patients of IIH were recruited as per a predefined criterion. Magnetic resonance imaging (MRI) brain with detailed sella imaging and pituitary hormonal profile were done in all patients. RESULTS Partial empty sella was seen in 55 patients (68.8%). Hormonal abnormalities were detected in 30 patients (37.5%), reduced cortisol levels in 20%, raised prolactin levels in 13.8%, low thyroid-stimulating hormone (TSH) levels in 3.8%, hypogonadism in 1.25%, and elevated levels of gonadotropins were found in 6.25% of participants. Hormonal disturbances were independent and were not associated with the presence of empty sella (p = 0.493). CONCLUSION Hormonal abnormalities were observed in 37.5% patients with IIH. These abnormalities did not correlate with the presence or absence of empty sella. Pituitary dysfunction appears to be subclinical in IIH and responds to intracranial pressure reduction, not requiring specific hormonal therapies.
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Affiliation(s)
- Nandita Prabhat
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
| | - Kirandeep Kaur
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aastha Takkar
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
| | - Chirag Ahuja
- Department of Radio-diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deeksha Katoch
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manoj Goyal
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Hind Institute of Medical Sciences, Safedabad, Lucknow, India
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Momin SMB, Mullins SR, Craven CL, Watkins L, Toma AK. Ventriculo-atrial shunt in idiopathic intracranial hypertension. Acta Neurochir (Wien) 2024; 166:98. [PMID: 38386079 PMCID: PMC10884045 DOI: 10.1007/s00701-024-05985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE CSF diversion is a recognised intervention in idiopathic intracranial hypertension (IIH), particularly in the presence of vision-threatening papilledema. Although ventriculo-atrial (VA) shunt insertion is a routine neurosurgical procedure, ventriculoperitoneal and lumboperitoneal shunts have been mostly used in this particular indication. This study aims to look at a single centre's experience with VA shunts in idiopathic intracranial hypertension (IIH). METHODS Retrospective case series with a review of electronic records over a 10-year period; exclusion criteria were duplication of same shunt insertion, no VA shunt insertion, paediatric patients and indication other than IIH. Notes were reviewed for demographics, shunt survival (defined by time prior to revision) and reasons for revision. RESULTS Eight VA shunt procedures were identified in 6 patients (mean age at insertion 34 ± 10 years) with a mean follow-up of 58 ± 25 months. All shunts were secondary procedures; 2 revisions from lumbo-pleural, 2 from ventriculopleural, 2 from ventriculoatrial and one each from ventriculoperitoneal and combined lumbo-/ventriculoperitoneal. At 50 months, 75% of VA shunts had survived, compared to only 58.3% of VPleural shunts in patients with IIH. Revisions were required due to acute intracranial bleed (1 case)-revised at day 1, and thrombus at distal site (1 case)-revised at day 57. Both shunts were later reinserted. From the latest clinic letters, all patients had their treatment optimised with this procedure, although only two patients had documented resolved papilloedema post-procedure. CONCLUSIONS Ventriculo-atrial shunts are a safe and efficacious alternative option for CSF diversion in IIH. In this series, only 1 shunt was revised for a VA shunt-specific complication.
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Affiliation(s)
- Sheikh M B Momin
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Sophie R Mullins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Claudia L Craven
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Laurence Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Ahmed K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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Cheng H, Jin H, Hu Y, Chen L, Chen Z, Zhong G. Long-term efficacy of venous sinus stenting in the treatment of idiopathic intracranial hypertension. CNS Neurosci Ther 2024; 30:e14356. [PMID: 37469247 PMCID: PMC10805447 DOI: 10.1111/cns.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUNDS Previous studies have suggested that cerebral dural sinus stenosis could be a possible underlying cause of idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a potential alternative for treating IIH related to dural sinus stenosis. However, most of the documented studies have been conducted in Western countries. In this study, we present the results of 16 Chinese IIH patients who underwent VSS treatment in our single center. METHODS We prospectively collected angiographic and manometric data from IIH patients who underwent angioplasty/stenting. All patients had confirmed dural sinus stenosis and had failed maximal medical therapy (MMT). Demographic, clinical, and radiological presentation, as well as long-term follow-up outcomes were collected retrospectively. RESULTS A total of 16 patients who underwent VSS were enrolled in the present study. Demographic data revealed a mean age of 40 (range 20-55), with 69% (11/16) being female, and a mean body mass index (BMI) of 27.05 (range 19.18-38.04) kg/m2 . All patients presented with papilledema and visual disturbances. During a median follow-up period of 47.5 months, 93.75% (15/16) of patients reported improvement in symptoms, although only 37.5% (6/16) experienced complete resolution. Headaches, blurred vision, and amaurosis related to increased pressure improved in 100% (8/8), 81.25% (13/16), and 75% (3/4) of patients, respectively. However, one patient suffered cerebral infarction and secondary epilepsy soon after VSS, and another patient had recurrence of symptoms due to stent wall thrombosis 2 years later. CONCLUSIONS The significance of venous sinus stenosis in the development of IIH may be undervalued. Our study, based on a Chinese case series, affirms the long-term safety and effectiveness of VSS in treating IIH patients with relatively lower BMI than those from Western countries.
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Affiliation(s)
- Hui Cheng
- Department of Neurology, School of Medicine, Sir Run Run Shaw HospitalZhejiang UniversityHangzhouChina
| | - Haidi Jin
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Yongjun Hu
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Lijiang Chen
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Zhicai Chen
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Genlong Zhong
- Department of NeurologyThe Sixth Affiliated Hospital of Wenzhou Medical UniversityLishuiChina
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Sabt BI, Al Busaidi AS, Azeem S, Al Dhabbari L. Idiopathic intracranial hypertension in Omani adults: A tertiary center experience. Oman J Ophthalmol 2024; 17:19-24. [PMID: 38524327 PMCID: PMC10957044 DOI: 10.4103/ojo.ojo_342_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/31/2023] [Accepted: 01/14/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND To evaluate the clinical profile, risk factors, and ophthalmic diagnostic and monitoring tools in Omani patients with idiopathic intracranial hypertension (IIH) using optical coherence tomography (OCT). METHODS A retrospective single institutional cohort study on Omani patients with a fulfilled diagnosis of IIH from January 1, 2014, to January 1, 2020, was conducted. The data obtained from the neuro-ophthalmic clinic contained age of onset of the disease, gender of patients, body mass index (BMI), presence of other associated conditions, and medication use. RESULTS Our study group comprised 21 patients with IIH with an annual incidence rate of 2.8 per 100,000 population. Female-to-male ratio was 9.5:1 with a mean age of 27.24 ± 7.1. Headaches appeared to be the most prevalent symptom in 21 (100%) patients, followed by transient obscuration of vision in 9 (42.9%) patients and diplopia in 3 (14.3%) patients, and the least common symptom was pulsatile tinnitus in 2 (9.5%) patients. Increased BMI was seen in 19 (90.5%) patients and noted to be the most prevalent predisposing factor among our study group. The use of oral contraceptive pills was documented in 4 (19%) patients and 1 (4.8%) patient was noted to have polycystic ovary syndrome. All patients (100%) had a best-corrected visual acuity of 1.0 in both eyes pre- and postrecovery and 7 (33.3%) patients had an enlarged blind spot on visual field testing. All patients had papilledema on presentation and an average of 14.1 months to resolve to normal clinically and on OCT monitoring. All patients were treated with medications and only 1 (4.8%) continued to have intractable headaches that did not respond to maximum medical therapy and required surgery. CONCLUSION The incidence of IIH in the Omani population was found to be less than neighboring countries but comparable worldwide. OCT is considered a useful tool to confirm and document papilledema and more importantly monitor recovery.
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Affiliation(s)
- Buthaina Issa Sabt
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | | | - Sitara Azeem
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Lojain Al Dhabbari
- College of Medicine and Health Science, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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Ong F, Phillips T, Selkirk G, McAuliffe W. Intracranial venous stenting for idiopathic intracranial hypertension. J Med Imaging Radiat Oncol 2023; 67:526-530. [PMID: 36645196 DOI: 10.1111/1754-9485.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/31/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION There is increasing evidence in the literature to support venous sinus stenting in patients with idiopathic intracranial hypertension who fail first-line therapy. Venous sinus stenting is a safe and successful technique compared with cerebrospinal fluid diversion procedures. This study examines the clinical outcomes of patients post intracranial venous stenting for intracranial hypertension across three tertiary hospitals in Western Australia. METHODS A retrospective analysis was performed on 83 consecutive patients treated with intracranial venous stenting for IIH at three tertiary hospitals from October 2013 to March 2020. Data were collected from outpatient clinic letters, electronic discharge letters, electronic radiological imaging and procedural reports. RESULTS 89.2% patients were able to cease Acetazolomide post stenting. 78.3% patients reported resolution of headaches. 84.3% patients demonstrated resolution of their papilloedema. 91.6% patients demonstrated improvement of their visual acuity. Compared with a recent meta-analysis by Satti and Chaudry in 2015, our results demonstrated a higher technical success rate and lower complication rates. CONCLUSION Our study findings support the paradigm shift from CSF diversion procedures to venous sinus stenting in patients with IIH who fail first-line therapy. Venous sinus stenting has a high technical success rate and significantly lower complication rates than other invasive treatments.
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Affiliation(s)
- Frederick Ong
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Timothy Phillips
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Gregory Selkirk
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - William McAuliffe
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Asal N, Bayar Muluk N, Özdemir A, Say B. Evaluation of peripheral and central olfactory regions by MRI in patients with idiopathic intracranial hypertension. Neurol Res 2023; 45:346-353. [PMID: 36373831 DOI: 10.1080/01616412.2022.2146261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We investigated the peripheral and central smell regions in patients with idiopathic intracranial hypertension (IIH) by cranial MRI. METHODS In this retrospective study, cranial MRI images of 43 adult patients with IIH (Group 1) and 43 healthy adults without IIH (Group 2) were included. In both groups, peripheral [Olfactory bulb (OB) volume and Olfactory sulcus (OS) depth] and central smell regions (insular gyrus and corpus amygdala area, and thalamus volume) were measured in cranial MRI. RESULTS Bilateral OB volume and insular gyrus area, and right corpus amygdala and thalamus volumes of the IIH group were significantly lower than those of the control group (p < 0.05). In the IIH group, OB volume of the right side was significantly lower, and insular gyrus area of the right side was significantly higher than those of the left side (p < 0.05). In the IIH group, there were positive correlations between OB volumes; OS depths; insular gyrus areas; corpus amygdala areas; and thalamus volumes bilaterally (p < 0.05). In older patients, right OS depth and right corpus amygdala area decreased (p < 0.05). CONCLUSION In conclusion, IIH may be related to olfactory impairment. Cranial MRI images showed a decrease in peripheral (OB volume) and central (insular gyrus and corpus amygdala area and thalamus volume) smell regions. To prevent olfactory impairment in IIH patients, treatment should be done in IIH patients to decrease intracranial pressure. It is very important to prevent the circulation of CSF with increased pressure between the sheets of the olfactory nerve in IIH patients.
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Affiliation(s)
- Neşe Asal
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Bahar Say
- Faculty of Medicine, Neurology Department, Kırıkkale University, Kırıkkale, Turkey
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11
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Dural Venous Sinus Thrombosis and Papilledema Related to JAK2 Mutation: A Case Series. Can J Neurol Sci 2023; 50:194-200. [PMID: 34906267 DOI: 10.1017/cjn.2021.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dural venous sinus thrombosis (DVST) is an important cause of papilledema. Patients diagnosed with DVST should undergo work-up for underlying hypercoagulable state, including genetic causes. One important prothrombotic mutation is in the JAK2 gene, which is a driver of myeloproliferative neoplasms including polycythemia vera (PV). We aimed to determine the prevalence of JAK2 mutation in patients in presenting to neuro-ophthalmology clinic with DVST and papilledema. METHODS Retrospective case series of patients seen in a tertiary neuro-ophthalmology practice who presented with papilledema due to DVST and were investigated for presence of JAK2 mutation. RESULTS Four out of 15 patients with DVST (26%) were found to have JAK2 V617F mutation which led to subsequent diagnosis of PV in 2. One additional patient had a known diagnosis of essential thrombocytosis. We describe the clinical presentation of these four patients with papilledema and JAK2 mutation. CONCLUSIONS A significant proportion of patients with papilledema secondary to DVST will harbor mutations in the JAK2 gene. Clinicians should be aware of this mutation as early testing will facilitate timely diagnosis and treatment of myeloproliferative disease to improve prognosis and reduce risk of recurrent thrombotic events.
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12
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Kok LT, Gnoni V, Muza R, Nesbitt A, Leschziner G, Wong SH. Prevalence and utility of overnight pulse oximetry as a screening tool for obstructive sleep apnoea in newly diagnosed idiopathic intracranial hypertension. Eye (Lond) 2023; 37:537-542. [PMID: 35210570 PMCID: PMC8867690 DOI: 10.1038/s41433-022-01971-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP). Obstructive sleep apnoea (OSA) has been shown to cause episodic rises in ICP and is frequently reported in patients with IIH. The aim of this study is to identify the prevalence of OSA in a cohort of IIH patients. METHODS We conducted a retrospective case notes review as part of a service evaluation of newly diagnosed IIH patients who were all referred for OSA screening with overnight pulse oximetry. The 3% oxygen desaturation index (3% ODI) was used to evaluate the presence and severity of OSA. The clinical outcomes of patients who received continuous positive airway pressure (CPAP) therapy as treatment for OSA were reviewed. RESULTS In our cohort of newly diagnosed IIH patients, the yield of overnight pulse oximetry as a screening tool was 48.6% for OSA and 15.3% for moderate to severe OSA. We found that age (p = 0.0008), BMI (p < 0.0001), vitamin B12 (p = 0.0183), and a higher Epworth Sleep Score (p = 0.0269) correlated with more severe OSA. Eleven (10%) patients had CPAP therapy and those with good adherence alongside weight loss or medical therapy found improvements in symptoms of raised ICP. CONCLUSION We report the largest series of consecutive IIH patients screened for OSA using overnight pulse oximetry. The high rate of OSA highlights a potential role for the recognition and management of OSA in the IIH patient cohort. Further studies on the potential contribution of OSA as a cause of raised ICP in the IIH cohort is warranted.
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Affiliation(s)
- Li Teng Kok
- Department of Neuro-Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Valentina Gnoni
- grid.420545.20000 0004 0489 3985Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London (KCL), London, UK
| | - Rexford Muza
- grid.420545.20000 0004 0489 3985Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Alexander Nesbitt
- grid.420545.20000 0004 0489 3985Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Guy Leschziner
- grid.420545.20000 0004 0489 3985Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK ,grid.420545.20000 0004 0489 3985Department of Neurology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764Division of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London (KCL), London, UK
| | - Sui Hsien Wong
- grid.420545.20000 0004 0489 3985Department of Neuro-Ophthalmology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK ,grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK
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13
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Kole MJ, Martinez-Gutierrez JC, Sanchez F, Tang R, Chen PR. Dural venous sinus stenting in patients with idiopathic intracranial hypertension: report of outcomes from a single-center prospective database and literature review. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2139678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Matthew J Kole
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | | | - Rosa Tang
- Eye Wellness Center, Houston, Texas, USA
| | - P Roc Chen
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
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14
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Velusamy A, Anand A, Hameed N. CT Cisternogram Findings in Idiopathic Cerebrospinal Fluid Leaks with Emphasis on Long Term Management. Indian J Otolaryngol Head Neck Surg 2022; 74:1605-1611. [PMID: 36452803 PMCID: PMC9702258 DOI: 10.1007/s12070-021-02766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022] Open
Abstract
To study the various computed tomography (CT) cisternogram findings in idiopathic cerebrospinal fluid (CSF) leaks and the long term treatment modalities after surgical repair of idiopathic CSF leaks. This was a descriptive study conducted among 25 patients in MCV memorial ENT trust hospital, Pollachi between May 2014 and May 2020 amongst patients who underwent CT cisternogram for unilateral or bilateral spontaneous rhinorrhea with or without associated headache, visual disturbances and papilloedema diagnosed to be idiopathic CSF leak by investigations. These patients then underwent CSF leak repair and postoperatively were managed with weight reduction, low salt diet and diuretic therapy. Post surgery these patients were followed up for a period of 12 months and were evaluated on the basis of presence or absence of headache, rhinorrhea and papilloedema at the end of 1st month, 3rd month, 6th month and 1 year and data was collected. CT cisternogram findings were evaluated by proportion method and evaluation of long term management was done using proportion and repeated measures ANOVA for all patients. Evidence of the presence of previously mentioned CT cisternogram or contrast MRI findings at the end of 1 year of post-surgical treatment was recorded where patients were willing for the same. CT Cisternography was done for all patients and 72% patients had empty sella appearance while 28% had partially empty sella. Other findings included perioptic filling, optic blunting and arachnoid pits which were found in 11(44%), 8(32%) and 12(48%) of patients respectively. Only 3(12%) out of 25 patients had an encephalocoele. The commonest site of leak in CT cisternography was the cribriform plate (52%) followed by lateral recess of sphenoid (48%). None of the patients had multiple sites of leak in CT cisternography. On follow up post surgery maximum resolution of symptoms was found at the end of 12 months where 23 out of 25 patients improved. In our study, out of 25 only 5 patients agreed to undergo post diuretic therapy MRI scan out of which 2 patients had partially empty sella and 3 had normal sella indicating resolution of BIH. CT cisternography is an important investigation which aids in the diagnosis of CSF rhinorrhea due to idiopathic intracranial hypertension (IIH). The medical management of IIH post surgery such as weight reduction, salt restriction and diuretic therapy is also crucial to prevent recurrence of symptoms.
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15
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Reier L, Fowler JB, Arshad M, Hadi H, Whitney E, Farmah AV, Siddiqi J. Optic Disc Edema and Elevated Intracranial Pressure (ICP): A Comprehensive Review of Papilledema. Cureus 2022; 14:e24915. [PMID: 35698673 PMCID: PMC9187153 DOI: 10.7759/cureus.24915] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Papilledema is a swelling of the optic disc secondary to elevated intracranial pressure (ICP). We analyzed 79 peer-review journal articles and provided a concise summary of the etiology, epidemiology, pathophysiology, clinical presentation, evaluation, natural history, differential diagnosis, treatment, and prognosis of papilledema. Only studies written in English with the full text available were included. Although many etiologies of papilledema exist, idiopathic intracranial hypertension is the most common and, thus, a large focus of this review.
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16
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Rufai SR, Jeelani NUO, Bowman R, Bunce C, Proudlock FA, Gottlob I. Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol. BMJ Open 2022; 12:e048745. [PMID: 35017232 PMCID: PMC8753392 DOI: 10.1136/bmjopen-2021-048745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER ISRCTN52858719.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Irene Gottlob
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
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17
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Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China. Neurol Ther 2021; 10:1029-1044. [PMID: 34542867 PMCID: PMC8571462 DOI: 10.1007/s40120-021-00281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/03/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION This study aimed to explore the precipitating factors and evaluate the impact of different stenosis types on treatment outcomes in patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). METHODS We recruited patients with IIH who presented with VSS, either intrinsic or extrinsic. We observed the clinical and laboratory findings, and we then compared the outcomes of stenting and medical treatment in different stenosis types. RESULTS Among 145 patients with IIH and VSS, 59 were of the intrinsic type and 86 were of the extrinsic type. Patients in the intrinsic group were older (42 vs. 34 years old, P < 0.001) and presented with higher pre-op gradient pressure (15 mmHg vs. 12 mmHg, P < 0.001). There was no significant difference between groups regarding other precipitating factors (P > 0.05). Stenting was significantly associated with complete resolution of the headache and impaired vision both in intrinsic (adjusted OR 0.017, 95% CI 0.001-0.35, P = 0.011; adjusted OR 0.056, 95% CI 0.004-0.697, P = 0.025, respectively) and extrinsic types of stenosis (adjusted OR 0.072, 95% CI 0.015-0.343, P = 0.001; adjusted OR 0.241, 95% CI 0.062-0.931, P = 0.039, respectively). Meanwhile, stenting was significantly associated with improvement of the papilledema in extrinsic-type stenosis compared with medical treatment (adjusted OR 0.017, 95% CI 0.002-0.135, P < 0.001). CONCLUSION Stenting may provide substantial clinical improvement in patients with IIH regardless of intrinsic or extrinsic stenosis type in our patient population, as noted in other series. TRIAL REGISTRATION Clinical trial registration number ChiCTR-ONN-17010421.
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18
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Morden FTC, Tan C, Carrazana E, Viereck J, Liow KK, Ghaffari-Rafi A. Characterizing idiopathic intracranial hypertension socioeconomic disparities and clinical risk factors: A retrospective case-control study. Clin Neurol Neurosurg 2021; 208:106894. [PMID: 34455402 DOI: 10.1016/j.clineuro.2021.106894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Against the backdrop of the diverse minority-majority state of Hawaii, this study seeks to better characterize associations between idiopathic intracranial hypertension (IIH) with sociodemographic variables and medical comorbidities. METHODS A retrospective case-control study was conducted by utilizing 54 IIH patients and 216 age-, sex-, and race-matched controls, 216 unmatched controls, and 63 age-, sex-, and race-matched migraine patients. RESULTS Relative to controls, IIH were 25 years younger (p < 0.0001) and 10.18 kg/m2 heavier (p < 0.0001), as well as exhibited greater odds of the following variables (p < 0.05): female (odds ratio [OR]: 8.87), the lowest income quartile (OR: 2.33), Native Hawaiian or other Pacific Islander (NHPI; OR: 2.23), Native American or Alaskan Native (OR: 16.50), obesity class 2 (35.0-39.9 kg/m2; OR: 4.10), obesity class 3 (>40 kg/m2; OR: 6.10), recent weight gain (OR: 11.66), current smoker (OR: 2.48), hypertensive (OR: 3.08), and peripheral vascular disease (OR: 16.42). Odds of IIH were reduced (p < 0.05) for patients who were Asian (OR: 0.27) or students (OR: 0.30;). Unique from Whites, NHPI IIH patients exhibited greater odds (p < 0.05) for being from lower socioeconomic status and currently smoking, as well as potential association with seizures (p = 0.08). Compared to migraines, IIH headaches were at increased odds of occurring (p < 0.05) occipitally, for greater than 15 days per month, aggravated by postural changes, and comorbid with dizziness and tinnitus. CONCLUSIONS These results not only better characterize IIH, but also highlight socioeconomic and racial disparities in diagnosis.
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Affiliation(s)
| | - Charissa Tan
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Enrique Carrazana
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; Hawaii Pacific Neuroscience, Brain Research, Innovation and Translation Lab, Honolulu, HI, USA
| | - Jason Viereck
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; Hawaii Pacific Neuroscience, Brain Research, Innovation and Translation Lab, Honolulu, HI, USA
| | - Kore Kai Liow
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; Hawaii Pacific Neuroscience, Brain Research, Innovation and Translation Lab, Honolulu, HI, USA
| | - Arash Ghaffari-Rafi
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA.
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19
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Krishnadas N, Taylor B. Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia. BMJ Neurol Open 2021; 3:e000145. [PMID: 34250485 PMCID: PMC8230989 DOI: 10.1136/bmjno-2021-000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/01/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Anecdotally, the incidence of idiopathic intracranial hypertension (IIH) is increasing, linked to an increase in the obesity rate in Australian society. However, formal incidence and prevalence studies are rare. We therefore sought to determine the incidence and clinical features of IIH in Southern Tasmania, Australia. Method Neurology discharge summaries and lumbar puncture referrals from the single tertiary referral centre in this region were screened for an IIH diagnosis. All regional neurologists were surveyed to capture patients diagnosed through private neurology clinics. A retrospective review of medical records was conducted to confirm the diagnosis and determine whether patients met the Modified Dandy Criteria (MDC). Patients were included if they were above the age of 18 years and received a new diagnosis of IIH between June 2016 and June 2018. Population statistics were obtained from the Australian Bureau of Statistics. Results IIH incidence was 5.4/100 000. All patients were females, aged between 18 and 45 years. Headache was the most commonly reported symptom, with high rates of pre-existing or concurrent migraine diagnoses. Weight loss and commencement of oral acetazolamide were the most common treatment approaches. Four patients were medically refractory and required surgical intervention. Conclusion The incidence of IIH in Southern Tasmania is comparable with the incidence reported in subgroups of females of childbearing age in recent prior studies. The demographic, diagnostic and therapeutic data presented can inform future local health service provision and serve as a baseline for ongoing assessment of change in incidence and treatment of IIH at a community level.
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Affiliation(s)
- Natasha Krishnadas
- Department of Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Bruce Taylor
- Department of Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, The University of Tasmania, Hobart, Tasmania, Australia
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Sunderland GJ, Jenkinson MD, Conroy EJ, Gamble C, Mallucci CL. Neurosurgical CSF Diversion in Idiopathic Intracranial Hypertension: A Narrative Review. Life (Basel) 2021; 11:393. [PMID: 33925996 PMCID: PMC8146765 DOI: 10.3390/life11050393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
The prevalence of idiopathic intracranial hypertension (IIH), a complex disorder, is increasing globally in association with obesity. The IIH syndrome occurs as the result of elevated intracranial pressure, which can cause permanent visual impairment and loss if not adequately managed. CSF diversion via ventriculoperitoneal and lumboperitoneal shunts is a well-established strategy to protect vision in medically refractory cases. Success of CSF diversion is compromised by high rates of complication; including over-drainage, obstruction, and infection. This review outlines currently used techniques and technologies in the management of IIH. Neurosurgical CSF diversion is a vital component of the multidisciplinary management of IIH.
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Affiliation(s)
- Geraint J. Sunderland
- Department of Paediatric Neurosurgery, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool L12 2AP, UK;
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK;
| | - Michael D. Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK;
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK
| | - Elizabeth J. Conroy
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, L69 3GL, UK; (E.J.C.); (C.G.)
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, L69 3GL, UK; (E.J.C.); (C.G.)
| | - Conor L. Mallucci
- Department of Paediatric Neurosurgery, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool L12 2AP, UK;
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7TX, UK
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21
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White I, Tuohy M, Turner M, Lee A. Prepontine Shunting for Pseudotumor Cerebri in Previously Failed Shunt Patients: A 5-Year Analysis. Neurosurgery 2021; 88:306-312. [PMID: 33037814 DOI: 10.1093/neuros/nyaa417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/02/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Shunting procedures have a high failure rate when used to treat pseudotumor cerebri (PTC) patients who have failed medical therapy. This failure is believed to be attributable to the collapsibility of the ventricular system when exposed to increased differential pressure gradients in the cerebral spinal fluid compartments caused by ventriculoperitoneal shunts (VPS). OBJECTIVE To investigate whether prepontine/interpeduncular cistern shunting may be a reasonable alternative to VPS intervention in PTC patients with history of shunt failure. There have been no large series of cisternal-peritoneal shunt (CPS) patients in the PTC population. METHODS A retrospective review of 49 patients with placement of CPS for PTC with 2 failed prior shunting procedures was performed. Shunt survivability was based on shunt patency and resolution of ophthalmologic symptoms and cranial nerve deficits. All patients were followed for a minimum of 3 yr with serial ophthalmologic and neurosurgical evaluations. RESULTS At 3 yr, 44 of the 49 (88.9%) patients had working CPS. Three patients in this group had infections requiring complete shunt removal. Excluding infections, 44 of 46 (95.5%) shunts were functional at 3 yr. There were 3 small, asymptomatic hemorrhages that did not increase patient length of stay, and there were no catastrophic hemorrhages or strokes. There were also no abdominal complications related to shunt placement. CONCLUSION CPS is a viable alternative to VPS in PTC patients who have failed traditional shunting methods to give these patients a persistent benefit of a working shunt. The procedure provides this solution with low operative and perioperative morbidity.
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Affiliation(s)
- Ian White
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Megan Tuohy
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Michael Turner
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Albert Lee
- Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana
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22
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Ezeh E, Akotanchi BN, Ezeh R. Primary empty sella syndrome presenting with profound bilateral visual loss. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ghaffari-Rafi A, Mehdizadeh R, Ko AWK, Ghaffari-Rafi S, Leon-Rojas J. Idiopathic Intracranial Hypertension in the United States: Demographic and Socioeconomic Disparities. Front Neurol 2020; 11:869. [PMID: 33013623 PMCID: PMC7506031 DOI: 10.3389/fneur.2020.00869] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Obesity's risk increases for low-income, female, young, and Black patients. By extrapolation, idiopathic intracranial hypertension (IIH)-a disease associated with body mass index-would potentially display socioeconomic and demographic disparities. Methods: IIH incidence (per 100,000) was investigated with respect to sex, age, income, residence, and race/ethnicity, by querying the largest United States (US) healthcare administrative dataset (1997-2016), the National (Nationwide) Inpatient Sample. Results: Annual national incidence (with 25th and 75th quartiles) for IIH was 1.15 (0.91, 1.44). Females had an incidence of 1.97 (1.48, 2.48), larger (p = 0.0000038) than males at 0.36 (0.26, 0.38). Regarding age, largest incidence was among those 18-44 years old at 2.47 (1.84, 2.73). Low-income patients had an incidence of 1.56 (1.47, 1.82), larger (p = 0.00024) than the 1.21 (1.01, 1.36) of the middle/high. No differences (χ2 = 4.67, p = 0.097) were appreciated between urban (1.44; 1.40, 1.61), suburban (1.30; 1.09, 1.40), or rural (1.46; 1.40, 1.48) communities. For race/ethnicity (χ2 = 57, p = 2.57 × 10-12), incidence was largest for Blacks (2.05; 1.76, 2.74), followed by Whites (1.04; 0.79, 1.41), Hispanics (0.67; 0.57, 0.94), and Asian/Pacific Islanders (0.16; 0.11, 0.19). Year-to-year, incidence rose for all strata subsets except Asian/Pacific Islanders (τ = -0.84, p = 0.00000068). Conclusion: IIH demonstrates several sociodemographic disparities. Specifically, incidences are larger for those low-income, Black, 18-44 years old, or female, while annually increasing for all subsets, except Asian/Pacific Islanders. Hence, IIH differentially afflicts the US population, yielding in healthcare inequalities.
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Affiliation(s)
- Arash Ghaffari-Rafi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, United States
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rana Mehdizadeh
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Wai Kei Ko
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | | | - Jose Leon-Rojas
- Queen Square Institute of Neurology, University College London, London, United Kingdom
- Universidad Internacional del Ecuador Escuela de Medicina, Quito, Ecuador
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Al-Hashel JY, Ismail II, Ibrahim M, John JK, Husain F, Kamel WA, Behbehani R, Ahmed SF. Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience. Front Neurol 2020; 11:672. [PMID: 32903731 PMCID: PMC7438786 DOI: 10.3389/fneur.2020.00672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Idiopathic intracranial hypertension (IIH) affects predominantly obese females during their reproductive age period. The demographics of this condition has not been studied in Kuwait before. Objectives: To determine the demographics, clinical features, risk factors, and treatment modalities of IIH in the main neurology tertiary referral hospital in Kuwait and to compare our data with literature. Methods: A retrospective study was conducted to identify cases of IIH seen between January 1, 2018, and December 31, 2018. Patients were diagnosed in and referred from the neurology and neuro-ophthalmology clinics. Results: Our cohort consisted of 139 patients. We estimated a crude annual incidence rate of IIH of 3.28 per 100,000 population. Female-to-male ratio was 9.6:1. Mean age was 32.1 ± 10.8 years. Mean age of males was 31.46 ± 12.63 and that of females was 32.11 ± 10.67. The median of the duration from the first symptoms till diagnosis was 6 weeks (2-10 weeks). Headache was the most common symptom in 134 (96.4%) patients, followed by visual disturbances in 85 (61.2%) patients, transient visual obscurations (TVOs) in 84 (60.4%) patients, pulsatile tinnitus in 72 (51.8%) patients, diplopia in 22 (15.8%) patients, other symptoms (e.g., nausea, vomiting, radicular neck, and back pain) in 19 (13.7%) patients, and 1 (0.7%) patient had facial weakness. High body mass index (BMI) was seen in 89.9% of patients, either overweight or obese, and it was the most common risk factors in both males (46.2%) and females (61.1%). Anemia was found in 38.1%; 21.6% of patients used OCPs and 7.9% used vitamin A. Bilateral transverse sinus stenosis (BTSS) was detected in 47 (33.8%) patients. Only 2 (1.4%) patients developed "fulminant IIH" characterized by rapidly progressive disease. All the patients received medical treatment and only 12 (8.6%) needed surgical management. Conclusion: Incidence of IIH in Kuwait is similar to other regional studies but higher than Western studies. Demographics and clinical features of IIH in our study are comparable to international and regional figures. Most of our patients had a benign course. IIH is more prevalent in females and strongly associated with obesity.
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Affiliation(s)
- Jasem Youssef Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait.,Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | | | - Mohamed Ibrahim
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | - John K John
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Fatemah Husain
- Department of Ophthalmology, Al-Bahar Eye Center, Kuwait City, Kuwait
| | - Walaa Ahmed Kamel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait.,Department of Neurology, Beni-Suef University, Beni Suef, Egypt
| | - Raed Behbehani
- Department of Ophthalmology, Al-Bahar Eye Center, Kuwait City, Kuwait
| | - Samar Farouk Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait.,Department of Neurology and Psychiatry, Minia University, Minya, Egypt
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Rufai SR, Jeelani NUO, McLean RJ. Detection of intracranial hypertension in children using optical coherence tomography: a systematic review protocol. BMJ Open 2020; 10:e037833. [PMID: 32636287 PMCID: PMC7342863 DOI: 10.1136/bmjopen-2020-037833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children. METHODS AND ANALYSIS Electronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used. ETHICS AND DISSEMINATION Ethical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Noor Ul Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Developmental Biology & Cancer Dept, UCL GOS Institute of Child Health, London, United Kingdom
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
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Lumbo-peritoneal shunt as treatment modality for visual symptoms in idiopathic intracranial hypertension: A single institution experience. Neurocirugia (Astur) 2020; 32:53-61. [PMID: 32482535 DOI: 10.1016/j.neucir.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/23/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the efficacy of lumbo-peritoneal shunt (LPS) in patients of idiopathic intracranial hypertension presenting with visual symptoms. METHODS Between Apr. 2014 and Mar. 2018, 70 patients of Idiopathic Intracranial Hypertension (IIH) underwent treatment at our institution. Patients were evaluated for neurological and ophthalmological status and were subjected to LPS depending on their symptoms. RESULTS Mean opening pressure was 29.97±5.33cm of water and mean Body-Mass Index (BMI) was 26.51±3 and the two were significantly correlated (p-value 0.006). All patients with visual symptoms (23) underwent LPS and others (47) were managed medically. All patients with LPS and 25 of medically managed patients improved, while 22 medically-managed patients required LPS due to deterioration in visual symptomatology. The proportion of patients showing complete resolution of features of IIH was significantly different between the three groups. Of the 7 patients with shunt extrusion/migration, only 2 required revision. CONCLUSION LPS is an equally effective and more technically familiar modality for treatment of IIH for neurosurgeons and should be offered to asymptomatic patients with objective visual signs. Shunt extrusion/migration may not always warrant revision due to "mini-shunt" that drains Cerebro-Spinal Fluid (CSF) through shunt tract even after extrusion.
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27
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An update on idiopathic intracranial hypertension in adults: a look at pathophysiology, diagnostic approach and management. J Neurol 2020; 268:3249-3268. [PMID: 32462350 DOI: 10.1007/s00415-020-09943-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Idiopathic intracranial hypertension is a neurological syndrome determined by a rise in intracranial pressure without a detectable cause. Course and prognosis may be changeable, requiring a multidisciplinary approach for its diagnosis and management. Although its precise pathogenesis is still unknown, many studies have been carried out to define the possible causal and associated factors, such as retinoids, steroid hormones, body mass index and recent weight gains, cytokines and adipokines levels. The clinical presentation can be variable including chronic headache, disturbance of vision, diplopia and tinnitus. Even if papilloedema is considered the most specific sign, it could not be observed in more than 5% of patients during the evaluation of the fundus oculi. Neuroradiological signs acquire greater importance in patients who do not present papilloedema and may suggest the diagnosis of idiopathic intracranial hypertension. Other assessments can be useful in the diagnostic process, such as optical coherence tomography, visual evoked potentials, ocular ultrasonography and fundus fluorescein angiography and autofluorescence. Nonetheless, cerebrospinal fluid pressure measurement is required to establish a definite diagnosis. Management may be different, since surgical procedures or lumbar punctures are often required when symptoms develop rapidly leading to a loss of visual function. Apart from these cases, patients can be treated with a pharmacological approach and low-calorie diet, but they also need to be monitored over time since relapses years later are not uncommon.
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28
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R P, Gupta D, Shetty N, Bhushan AK, Haskar K, Gogineni S, Mehta A, Javali M, Acharya PT, Srinivasa R. Transcranial Doppler for Monitoring and Evaluation of Idiopathic Intracranial Hypertension. J Neurosci Rural Pract 2020; 11:309-314. [PMID: 32405187 PMCID: PMC7214091 DOI: 10.1055/s-0040-1710086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, characterized by features of raised intracranial pressure (ICP). Existing literature is inconclusive about the role of transcranial Doppler (TCD) in the management of IIH. Objective To study the TCD changes in IIH patients, pre- and post-cerebrospinal fluid (CSF) drainage. Materials and Methods This was a prospective study, conducted between July 2017 and December 2019, in a tertiary care referral center in South India. Sixteen consecutive patients, suspected to have IIH, underwent magnetic resonance imaging ofthe brain, a baseline TCD, and lumbar puncture with CSF drainage and pressure monitoring. Post-CSF drainage, TCD was repeated and mean flow velocities, peak systolic velocities, end-diastolic velocities, and pulsatility index (PI), in the middle cerebral artery (MCA), vertebral artery, and basilar artery (BA) were noted. Thirteen patients had elevated CSF pressure, and fulfilled the diagnostic criteria for IIH. These patients were included in the final analysis and pre- and post-CSF drainage TCD blood flow velocities and PI were compared. Results The mean age of study participants was 29.92 ± 6.92 years. There was a significant reduction in the cerebral flow velocities in bilateral MCA, after CSF drainage and normalization of ICP. Flow velocities in posterior circulation and PI in MCA, PCA, and BA showed an insignificant reduction. Two patients, who did not show any reduction in flow velocities after CSF drainage, developed optic atrophy on follow-up. Conclusion TCD-derived systolic blood flow velocities can be used in the management and follow-up of patients with IIH.
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Affiliation(s)
- Pradeep R
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Dhananjay Gupta
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Nikith Shetty
- Department of Neurology, Kasturba Medical College, Manipal, Karnataka, India
| | | | - Krishna Haskar
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Sujana Gogineni
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Anish Mehta
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Mahendra Javali
- Department of Neurology, Ramaiah Medical College, Bengaluru, Karnataka, India
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Togha M, Martami F, Rahmanzadeh R, Ghorbani Z, Refaeian F, Behbahani S, Panahi P, Moghadam NB, Nafissi S, Shahbazi M. The role of opening CSF pressure in response to treatment for idiopathic intracranial hypertension (IIH). J Clin Neurosci 2020; 76:171-176. [PMID: 32331944 DOI: 10.1016/j.jocn.2020.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
Abstract
The aim of the current study was to assess the risk factors, clinical symptoms and Cerebrospinal fluid (CSF) pressure of idiopathic intracranial hypertension (IIH) with emphasis on determining the risk factors which involved in poor response to treatment. We retrospectively included 202 patients who were diagnosed with IIH. Disease severity was classified according to prescribed therapeutic option into 4 groups: acetazolamide (group 1), Acetazolamide plus topiramate or Lasix (group 2), repeated LP (group 3) and surgical intervention (group 4). Being in the higher group was considered as a higher severity of disease and poor response to treatment. Among the evaluated features of IIH, the strongest association were observed between opening CSF pressure and disease severity. So that, the highest CSF pressure was observed in patients who underwent surgery, which represent the highest severity of disease (group 4) and poor response to therapy (mean ± SD: 43.9 ± 21.1 cm H2O). Headache was the most prevalent symptom of IIH in our series which was significantly higher among acetazolamide group. Blurred vision was the second most common symptoms which, unlike the headache was more reported in surgery group. Our results suggested that higher CSF pressure could be the risk factors of poor response to therapy, which may raise need for more intensive treatment. Furthermore, suffering of headache without blurred vision can consider as a prognostic factor for mild severity and good response to treatment.
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Affiliation(s)
- Mansoureh Togha
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran.
| | - Fahimeh Martami
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Reza Rahmanzadeh
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Zeinab Ghorbani
- Guilan University of Medical Sciences, Department of Cardiology, Heshmat Hospital, Cardiovascular Disease Research Center, Rasht, Iran
| | - Farshid Refaeian
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Shirin Behbahani
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Parsa Panahi
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Nahid Beladi Moghadam
- Shahid Beheshti University of Medical Sciences, Department of Neurology, Imam Hossein Hospital, Tehran, Iran
| | - Shahriar Nafissi
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Mojtaba Shahbazi
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
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Kalyvas A, Neromyliotis E, Koutsarnakis C, Komaitis S, Drosos E, Skandalakis GP, Pantazi M, Gobin YP, Stranjalis G, Patsalides A. A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH). Neurosurg Rev 2020; 44:773-792. [PMID: 32335853 DOI: 10.1007/s10143-020-01288-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 01/28/2023]
Abstract
Idiopathic intracranial hypertension denotes raised intracranial pressure in the absence of an identifiable cause and presents with symptoms relating to elevated ICP, namely headaches and visual deterioration. Treatment of IIH aims at reducing intracranial pressure, relieving headache and salvaging patients' vision. Surgical interventions are recommended for medically refractory IIH and include CSF diversion techniques, optic nerve sheath fenestration, bariatric surgery and venous sinus stenting. Prospective studies on the surgical options for IIH are scant and no evidence-based guidelines for the surgical management of medically refractory IIH have been established. A search in Cochrane Library, MEDLINE and EMBASE from 1 January 1985 to 19 April 2019 for controlled or observational studies on the surgical treatment of IIH (defined in accordance with the modified Dandy or the modified Friedman criteria) in adults yielded 109 admissible studies. VSS improved papilledema, visual fields and headaches in 87.1%, 72.7% and 72.1% of the patients respectively, with a 2.3% severe complication rate and 11.3% failure rate. CSF diversion techniques diminished papilledema, visual field deterioration and headaches in 78.9%, 66.8% and 69.8% of the cases and are associated with a 9.4 severe complication rate and a 43.4% failure rate. ONSF ameliorated papilledema, visual field defects and headaches in 90.5, 65.2% and 49.3% of patients. Severe complication rate was 2.2% and failure rate was 9.4%. This is currently the largest systematic review for the available operative modalities for IIH. VSS provided the best results in headache resolution and visual outcomes, with low failure rates and a very favourable complication profile. In light of this, VSS ought to be regarded as the first-line surgical modality for the treatment of medically refractory IIH.
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Affiliation(s)
- Aristotelis Kalyvas
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, ON, Canada. .,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Eleftherios Neromyliotis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsarnakis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Komaitis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Drosos
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios P Skandalakis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mantha Pantazi
- Department of Pediatrics, Hatzikosta General Hospital, Ioannina, Greece
| | - Y Pierre Gobin
- Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - George Stranjalis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece
| | - A Patsalides
- Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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Hermes SM, Miller NR, Waslo CS, Benes SC, Tanne E. Mortality among patients with idiopathic intracranial hypertension enrolled in the IH Registry. Neurology 2020; 95:e921-e929. [PMID: 32221030 DOI: 10.1212/wnl.0000000000009312] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/30/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To determine (1) if mortality among patients with idiopathic intracranial hypertension (IIH) enrolled in the Intracranial Hypertension Registry (IHR) is different from that of the general population of the United States and (2) what the leading underlying causes of death are among this cohort. METHODS Mortality and underlying causes of death were ascertained from the National Death Index. Indirect standardization using age- and sex-specific nationwide all-cause and cause-specific mortality data extracted from the Centers for Disease Control and Prevention Wonder Online Database allowed for calculation of standardized mortality ratios (SMR). RESULTS There were 47 deaths (96% female) among 1437 IHR participants that met inclusion criteria. The average age at death was 46 years (range, 20-95 years). Participants of the IHR experienced higher all-cause mortality than the general population (SMR, 1.5; 95% confidence interval [CI], 1.2-2.1). Suicide, accidents, and deaths from medical/surgical complications were the most common underlying causes, accounting for 43% of all deaths. When compared to the general population, the risk of suicide was over 6 times greater (SMR, 6.1; 95% CI, 2.9-12.7) and the risk of death from accidental overdose was over 3 times greater (SMR, 3.5; 95% CI, 1.6-7.7). The risk of suicide by overdose was over 15 times greater among the IHR cohort than in the general population (SMR, 15.3; 95% CI, 6.4-36.7). CONCLUSIONS Patients with IIH in the IHR possess significantly increased risks of death from suicide and accidental overdose compared to the general population. Complications of medical/surgical treatments were also major contributors to mortality. Depression and disability were common among decedents. These findings should be interpreted with caution as the IHR database is likely subject to selection bias.
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Affiliation(s)
- Sam M Hermes
- From the Intracranial Hypertension Registry (S.M.H., N.R.M., E.T.), Casey Eye Institute, Oregon Health & Science University, Portland; Veterans Affairs Portland Health Care System (C.S.W.), OR; The Ohio State University Wexner Medical Center (S.C.B.), Columbus; and The Eye Center of Columbus (S.C.B.), OH
| | - Nick R Miller
- From the Intracranial Hypertension Registry (S.M.H., N.R.M., E.T.), Casey Eye Institute, Oregon Health & Science University, Portland; Veterans Affairs Portland Health Care System (C.S.W.), OR; The Ohio State University Wexner Medical Center (S.C.B.), Columbus; and The Eye Center of Columbus (S.C.B.), OH
| | - Carin S Waslo
- From the Intracranial Hypertension Registry (S.M.H., N.R.M., E.T.), Casey Eye Institute, Oregon Health & Science University, Portland; Veterans Affairs Portland Health Care System (C.S.W.), OR; The Ohio State University Wexner Medical Center (S.C.B.), Columbus; and The Eye Center of Columbus (S.C.B.), OH
| | - Susan C Benes
- From the Intracranial Hypertension Registry (S.M.H., N.R.M., E.T.), Casey Eye Institute, Oregon Health & Science University, Portland; Veterans Affairs Portland Health Care System (C.S.W.), OR; The Ohio State University Wexner Medical Center (S.C.B.), Columbus; and The Eye Center of Columbus (S.C.B.), OH
| | - Emanuel Tanne
- From the Intracranial Hypertension Registry (S.M.H., N.R.M., E.T.), Casey Eye Institute, Oregon Health & Science University, Portland; Veterans Affairs Portland Health Care System (C.S.W.), OR; The Ohio State University Wexner Medical Center (S.C.B.), Columbus; and The Eye Center of Columbus (S.C.B.), OH.
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Sun WYL, Switzer NJ, Dang JT, Gill R, Shi X, de Gara C, Birch D, Nataraj A, Karmali S. Idiopathic intracranial hypertension and bariatric surgery: a systematic review. Can J Surg 2020; 63:E123-E128. [PMID: 32195557 DOI: 10.1503/cjs.016616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a rare condition typically affecting women with obesity who are of child-bearing age. Patients commonly present with headaches, visual disturbances, pulsatile tinnitus and papilledema. The association between IIH and obesity has been well established in the literature, suggesting that weight loss may contribute to improving IIH. For patients with severe obesity for whom conservative management is not successful, bariatric surgery is an effective modality for weight loss. We aimed to systematically review the literature to determine the efficacy of bariatric surgery in the treatment of IIH Methods We conducted a comprehensive search of MEDLINE, Embase, Scopus, the Cochrane Library and Web of Science (limited to studies in humans published in English between January 1946 and July 2015). Results Twelve primary studies (n = 39 patients) were included in the systematic review. All patients had a preoperative diagnosis of IIH. Preoperative body mass index (BMI) was 47.4 ± 3.6 kg/m2 ; BMI improved to 33.7 ± 2.1 kg/m2 and 33.9 ± 11.6 kg/m2 at 6 and 12 months postoperatively, respectively. Lumbar puncture opening pressures decreased from 34.4 ± 6.9 cmH2O to 14.0 ± 3.6 cmH2O after surgery. Common symptoms of IIH improved after bariatric surgery: headaches (100% preoperatively v. 10% postoperatively), visual complaints (62% v. 44%), tinnitus (56% v. 3%) and papilledema (62% v. 8%). Conclusion Bariatric surgery appears to lead to considerable improvement in IIH. Idiopathic intracranial hypertension is not a well-publicized comorbidity of obesity, but its presence may be considered as an indication for bariatric surgery.
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Affiliation(s)
- Warren Y. L. Sun
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Noah J. Switzer
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Jerry T. Dang
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Richdeep Gill
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Xinzhe Shi
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Christopher de Gara
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Daniel Birch
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Andrew Nataraj
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Shahzeer Karmali
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
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Alimajstorovic Z, Pascual-Baixauli E, Hawkes CA, Sharrack B, Loughlin AJ, Romero IA, Preston JE. Cerebrospinal fluid dynamics modulation by diet and cytokines in rats. Fluids Barriers CNS 2020; 17:10. [PMID: 32036786 PMCID: PMC7008525 DOI: 10.1186/s12987-020-0168-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a neurological disorder characterised by raised cerebrospinal fluid (CSF) pressure in the absence of any intracranial pathology. IIH mainly affects women with obesity between the ages of 15 and 45. Two possible mechanisms that could explain the increased CSF pressure in IIH are excessive CSF production by the choroid plexus (CP) epithelium or impaired CSF drainage from the brain. However, the molecular mechanisms controlling these mechanisms in IIH remain to be determined. Methods In vivo ventriculo-cisternal perfusion (VCP) and variable rate infusion (VRI) techniques were used to assess changes in rates of CSF secretion and resistance to CSF drainage in female and male Wistar rats fed either a control (C) or high-fat (HF) diet (under anaesthesia with 20 μl/100 g medetomidine, 50 μl/100 g ketamine i.p). In addition, CSF secretion and drainage were assessed in female rats following treatment with inflammatory mediators known to be elevated in the CSF of IIH patients: C–C motif chemokine ligand 2 (CCL2), interleukin (IL)-17 (IL-17), IL-6, IL-1β, tumour necrosis factor-α (TNF-α), as well as glucocorticoid hydrocortisone (HC). Results Female rats fed the HF diet had greater CSF secretion compared to those on control diet (3.18 ± 0.12 μl/min HF, 1.49 ± 0.15 μl/min control). Increased CSF secretion was seen in both groups following HC treatment (by 132% in controls and 114% in HF) but only in control rats following TNF-α treatment (137% increase). The resistance to CSF drainage was not different between control and HF fed female rats (6.13 ± 0.44 mmH2O min/μl controls, and 7.09 ± 0.26 mmH2O min/μl HF). and when treated with CCL2, both groups displayed an increase in resistance to CSF drainage of 141% (controls) and 139% (HF) indicating lower levels of CSF drainage. Conclusions Weight loss and therapies targeting HC, TNF-α and CCL2, whether separately or in combination, may be beneficial to modulate rates of CSF secretion and/or resistance to CSF drainage pathways, both factors likely contributing to the raised intracranial pressure (ICP) observed in female IIH patients with obesity.
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Affiliation(s)
- Zerin Alimajstorovic
- School of Life, Health and Chemical Sciences, Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Ester Pascual-Baixauli
- School of Life, Health and Chemical Sciences, Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Cheryl A Hawkes
- School of Life, Health and Chemical Sciences, Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Basil Sharrack
- Department of Neuroscience, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - A Jane Loughlin
- School of Life, Health and Chemical Sciences, Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Ignacio A Romero
- School of Life, Health and Chemical Sciences, Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Jane E Preston
- Institute of Pharmaceutical Science, King's College London, 3rd Floor, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.
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Nagarajan E, Digala LP, Sivaraman M, Bollu PC. Is Magnetic Resonance Imaging Diffusion Restriction of the Optic Disc Head a New Marker for Idiopathic Intracranial Hypertension? J Neurosci Rural Pract 2019; 11:170-174. [PMID: 32140023 PMCID: PMC7055610 DOI: 10.1055/s-0039-3402621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a headache syndrome due to raised intracranial pressure of unknown etiology. Before making the diagnosis of IIH, secondary causes of raised intracranial pressure must be ruled out. The radiological features associated with this condition have variable sensitivity and specificity. In this case series, we aim to describe a potential new radiological marker of IIH, that is, diffusion restriction, in the optic disc head and propose that this can be a specific finding in the appropriate clinical picture. Importance IIH causes vision loss and disabling daily headaches. The diagnosis of this condition is based on history and physical examination findings. Magnetic resonance imaging (MRI) is used to exclude other causes, but specific radiological markers for the diagnosis of IIH are lacking. Observations Five patients presented with the main complaint of headache, which was associated with blurry vision. All of our patients had a formal neuro-ophthalmological evaluation that confirmed the presence of optic disc edema in both eyes. They also underwent an MRI of the brain that showed diffusion restriction in the optic nerve head in either eye or both eyes. Patients underwent lumbar puncture in the lateral decubitus position, which revealed cerebrospinal fluid opening pressures > 25 cm H 2 O. They all responded well to standard treatments, with the resolution of symptoms in their follow-up appointments. Conclusion and Relevance The MRI diffusion restriction in the optic nerve head may be a reliable noninvasive marker for the diagnosis of IIH in the appropriate clinical picture.
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Affiliation(s)
- Elanagan Nagarajan
- Department of Neurology, Columbia University, New York, New York, United States
| | - Lakshmi P Digala
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
| | - Manjamalai Sivaraman
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
| | - Pradeep C Bollu
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
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Eftekhari S, Westgate CSJ, Uldall MS, Jensen RH. Preclinical update on regulation of intracranial pressure in relation to idiopathic intracranial hypertension. Fluids Barriers CNS 2019; 16:35. [PMID: 31767019 PMCID: PMC6878629 DOI: 10.1186/s12987-019-0155-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Elevated intracranial pressure (ICP) is observed in association with a range of brain disorders. One of these challenging disorders is idiopathic intracranial hypertension (IIH), characterized by raised ICP of unknown cause with significant morbidity and limited therapeutic options. In this review, special focus is put on the preclinical research performed in order to understand the pathophysiology behind ICP regulation and IIH. This includes cerebrospinal fluid dynamics, molecular mechanisms underlying disturbances in brain fluids leading to elevated ICP, role of obesity in IIH, development of an IIH model and ICP measurements in rodents. The review also discusses existing and new drug targets for IIH that have been evaluated in vivo. CONCLUSIONS ICP monitoring in rodents is challenging and different methods have been applied. Some of these methods are invasive, depend on use of anesthesia and only allow short-term monitoring. Long-term ICP recordings are needed to study IIH but existing methods are hampered by several limitations. As obesity is one of the most common risk factors for IIH, a rodent obese model has been developed that mimics some key aspects of IIH. The most commonly used drugs for IIH have been evaluated in vivo for their efficacy at lowering ICP in the existing animal models. These studies suggest these drugs, including acetazolamide, might have limited or no reducing effect on ICP. Two drug targets that can impact ICP in healthy rodents are topiramate and a glucagon-like peptide-1 receptor (GLP-1R) agonist. However, it remains to evaluate their effect in an IIH model with more precise and valid ICP monitoring system. Therefore, continued evaluation in the preclinical research with refined tools is of great importance to further understand the pathophysiology behind disorders with raised ICP and to explore new drug targets.
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Affiliation(s)
- Sajedeh Eftekhari
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Nordstjernevej 42, 2600 Glostrup, Denmark
| | - Connar Stanley James Westgate
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Nordstjernevej 42, 2600 Glostrup, Denmark
| | - Maria Schmidt Uldall
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Nordstjernevej 42, 2600 Glostrup, Denmark
| | - Rigmor Hoejland Jensen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Rigshospitalet-Glostrup, University of Copenhagen, Nordstjernevej 42, 2600 Glostrup, Denmark
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Mohammaden MH, Husain MR, Brunozzi D, Hussein AE, Atwal G, Charbel FT, Alaraj A. Role of Resistivity Index Analysis in the Prediction of Hemodynamically Significant Venous Sinus Stenosis in Patient With Idiopathic Intracranial Hypertension. Neurosurgery 2019; 86:631-636. [DOI: 10.1093/neuros/nyz314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/26/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
The resistivity index (RI) in cerebral venous sinus stenosis (VSS) has not been studied in patients with idiopathic intracranial hypertension (IIH).
OBJECTIVE
To evaluate the role of RI measured by quantitative magnetic resonance venogram (QMRV) as a noninvasive tool in the diagnosis of venous hypertension associated with VSS in IIH.
METHODS
Retrospective evaluation of 13 consecutive IIH patients who underwent venous sinus stenting at our institution between 2013 and 2018.
Patients’ demographics, clinical presentation, cerebral mean venous sinus pressure (MVP), and RI both pre- and poststenting were recorded. The baseline RI was also compared to a control group.
RESULTS
Among 13 patients of IIH, 11 had unilateral VSS in dominant sinus, whereas 2 had bilateral VSS. RI was significantly higher in IIH patients compared to the control group in the superior sagittal (SSS) and transverse sinuses (TS) (0.21 vs 0.11, P = .01 and 0.22 vs 0.13, P = .03, respectively). The MVP (in mm Hg) decreased significantly after venous sinus stenting in the SSS (41.9 to 22.5, P < .001) and TS (39.4 to 19.5, P < .001), which was also associated with a significant reduction of the RI (0.22 vs 0.17, P < .01 in SSS and 0.23 vs 0.17, P = .03 in TS) poststenting.
CONCLUSION
RI calculated using QMRV can serve as a noninvasive tool to aid in the diagnosis of hemodynamically significant VSS. The study had a small sample size, and larger multicenter studies would be required to validate the results further.
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Affiliation(s)
| | | | - Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ahmed E Hussein
- Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Gursant Atwal
- Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Illinois
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Hoffmann J, Kreutz KM, Csapó-Schmidt C, Becker N, Kunte H, Fekonja LS, Jadan A, Wiener E. The effect of CSF drain on the optic nerve in idiopathic intracranial hypertension. J Headache Pain 2019; 20:59. [PMID: 31122204 PMCID: PMC6734439 DOI: 10.1186/s10194-019-1004-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/22/2019] [Indexed: 01/03/2023] Open
Abstract
Background Elevation of intracranial pressure in idiopathic intracranial hypertension induces an edema of the prelaminar section of the optic nerve (papilledema). Beside the commonly observed optic nerve sheath distention, information on a potential pathology of the retrolaminar section of the optic nerve and the short-term effect of normalization of intracranial pressure on these abnormalities remains scarce. Methods In this exploratory study 8 patients diagnosed with idiopathic intracranial hypertension underwent a MRI scan (T2 mapping) as well as a diffusion tensor imaging analysis (fractional anisotropy and mean diffusivity). In addition, the clinical presentation of headache and its accompanying symptoms were assessed. Intracranial pressure was then normalized by lumbar puncture and the initial parameters (MRI and clinical features) were re-assessed within 26 h. Results After normalization of CSF pressure, the morphometric MRI scans of the optic nerve and optic nerve sheath remained unchanged. In the diffusion tensor imaging, the fractional anisotropy value was reduced suggesting a tissue decompression of the optic nerve after lumbar puncture. In line with these finding, headache and most of the accompanying symptoms also improved or remitted within that short time frame. Conclusion The findings support the hypothesis that the elevation of intracranial pressure induces a microstructural compression of the optic nerve impairing axoplasmic flow and thereby causing the prelaminar papilledema. The microstructural compression of the optic nerve as well as the clinical symptoms improve within hours of normalization of intracranial pressure.
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Affiliation(s)
- Jan Hoffmann
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Wellcome Foundation Building, Denmark Hill Campus, London, SE5 9PJ, UK.
| | - Katharina Maria Kreutz
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Csapó-Schmidt
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Nils Becker
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Hagen Kunte
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Faculty of Natural Sciences, Medical School Berlin, Berlin, Germany
| | - Lucius Samo Fekonja
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Berlin, Germany
| | - Anas Jadan
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Edzard Wiener
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
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Murphy S, Friesner DL, Rosenman R, Waslo CS, Au J, Tanne E. Emergency department utilization among individuals with idiopathic intracranial hypertension. Int J Health Care Qual Assur 2019; 32:152-163. [PMID: 30859875 PMCID: PMC6750901 DOI: 10.1108/ijhcqa-04-2017-0060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Idiopathic intracranial hypertension (IIH) can be a debilitating disorder that is difficult to identify and treat. Failure to adequately manage IIH symptoms may force patients to present at emergency departments (EDs) seeking symptom relief. The purpose of this paper is to empirically characterize ED use by previously diagnosed IIH patients. DESIGN/METHODOLOGY/APPROACH Patients diagnosed with IIH, and who registered with the Intracranial Hypertension Registry by 2014, were solicited for study inclusion. A survey was designed to elicit ED use during the period 2010-2012. Information on demographic and socioeconomic characteristics, IIH signs and symptoms, time since diagnosis, perspectives of ED use and quality of life was collected. Quality of life was assessed using an adaptation of the Migraine-Specific Quality of Life Questionnaire. Data were analyzed using descriptive statistics and nonparametric hypothesis tests. FINDINGS In total, 39 percent of IIH patients used emergency services over the study period; those that did used the services intensely. These patients were more likely to be non-white, live in households making less than $25,000 annually, have public insurance and have received a diversional shunt procedure. Patients who used the ED were less likely to live in households making $100,000, or more, annually and have private insurance. Participants who used the ED had significantly lower quality-of-life scores, were younger and had been diagnosed with IIH for less time. ORIGINALITY/VALUE ED staff and outside physicians can utilize the information contained in this study to more effectively recognize the unique circumstances of IIH patients who present at EDs.
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Affiliation(s)
- Sean Murphy
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Daniel L Friesner
- College of Health Professions, North Dakota State University , Fargo, North Dakota, USA
- School of Economic Sciences, Washington State University , Pullman, Washington, USA
| | - Robert Rosenman
- School of Economic Sciences, Washington State University , Pullman, Washington, USA
- Initiative for Research and Education to Advance Community Health, Elson Floyd School of Medicine, Washington State University , Pullman, Washington, USA
| | - Carin S Waslo
- Department of Neurology, Veterans Affairs Portland Health Care System , Portland, Oregon, USA
| | - Johnathan Au
- Chicago Medical School, Rosalind Franklin University of Medicine and Science , Chicago, Illinois, USA
| | - Emanuel Tanne
- Casey Eye Institute, Oregon Health and Science University , Portland, Oregon, USA
- Intracranial Hypertension Research Foundation, Vancouver, Washington, USA
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Radojicic A, Vukovic-Cvetkovic V, Pekmezovic T, Trajkovic G, Zidverc-Trajkovic J, Jensen RH. Predictive role of presenting symptoms and clinical findings in idiopathic intracranial hypertension. J Neurol Sci 2019; 399:89-93. [PMID: 30782528 DOI: 10.1016/j.jns.2019.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the presenting symptoms and signs of idiopathic intracranial hypertension (IIH) in a large cohort of patients and to estimate their possible role in establishing the diagnosis of IIH. METHODS This prospective cohort study in two tertiary centers, the Danish Headache Center in Rigshospitalet-Glostrup and the Neurology Clinic of the Clinical Center of Serbia, included 286 patients referred by attending specialists for possible IIH evaluation. Patients were divided into two groups: one with confirmed IIH diagnosis and one with rejected IIH diagnosis. RESULTS The diagnosis of IIH was confirmed in 219 (76.6%) patients. It was more often confirmed if the patient was referred by an ophthalmologist than if the referral was from a neurologist (83.6% vs. 69.8%, p = .029) and in patients with higher body mass index (BMI) (p = .032). Transient visual obscurations (p = .006), double vision (p = .033), neck pain (p = .025), and tinnitus (p = .013) were presenting symptoms more frequently reported by patients with IIH diagnosis. In the same group of patients, papilledema (p < .001) and sixth nerve palsy (p = .010) were noted significantly more often. Papilledema was extracted by multivariate analysis as an independent predictor of IIH diagnosis (p < .001). CONCLUSION Although studies investigating IIH report an abundance of presenting symptoms, our results indicate that these symptoms are not diagnostic for IIH. Papilledema is the most reliable clinical sign predicting the correct IIH diagnosis in patients with suspected IIH.
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Affiliation(s)
- Aleksandra Radojicic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia.
| | - Vlasta Vukovic-Cvetkovic
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Denmark
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Goran Trajkovic
- Department of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Jasna Zidverc-Trajkovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, Denmark
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Kilgore KP, Lee MS, Leavitt JA, Frank RD, McClelland CM, Chen JJ. A Population-Based, Case-Control Evaluation of the Association Between Hormonal Contraceptives and Idiopathic Intracranial Hypertension. Am J Ophthalmol 2019; 197:74-79. [PMID: 30248310 PMCID: PMC6291342 DOI: 10.1016/j.ajo.2018.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine if the use of oral contraceptive pills (OCP) and other hormonal contraceptives are associated with a higher incidence of idiopathic intracranial hypertension (IIH). DESIGN Retrospective, population-based, case-control study. METHODS Setting: Female IIH patients evaluated between January 1, 1990, and December 31, 2016 were identified using the Rochester Epidemiology Project (REP), a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota, residents. STUDY POPULATION Fifty-three female residents of Olmsted County diagnosed with IIH between 15 and 45 years of age. The use of OCPs and other hormonal contraceptives was compared to controls matched for age, sex, and body mass index. Interventions/Exposures: Hormonal contraceptives. MAIN OUTCOME MEASURE Odds of developing IIH. RESULTS Of the 53 women diagnosed with IIH between 15 and 45 years of age, 11 (20.8%) had used hormonal contraceptives within ≤30 days of the date of IIH diagnosis, in contrast to 30 (31.3%) among the control patients. The odds ratio of hormonal contraceptive use and IIH was 0.55 (95% conficence interval [CI]: 0.24-1.23, P = .146). The odds ratio of OCP use was 0.52 (95% CI: 0.20-1.34, P = .174). CONCLUSIONS OCP and other hormonal contraceptives were not significantly associated with a higher incidence of IIH, arguing against the need for women with IIH to discontinue their use.
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Affiliation(s)
- Khin P Kilgore
- College of Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Ryan D Frank
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Collin M McClelland
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
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The expanding burden of idiopathic intracranial hypertension. Eye (Lond) 2018; 33:478-485. [PMID: 30356129 PMCID: PMC6460708 DOI: 10.1038/s41433-018-0238-5] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/23/2018] [Accepted: 09/11/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To quantify the hospital burden and health economic impact of idiopathic intracranial hypertension. Methods Hospital Episode Statistics (HES) national data was extracted between 1st January 2002 and 31st December 2016. All those within England with a diagnosis of idiopathic intracranial hypertension were included. Those with secondary causes of raised intracranial pressure such as tumours, hydrocephalus and cerebral venous sinus thrombosis were excluded. Results A total of 23,182 new IIH cases were diagnosed. Fifty-two percent resided in the most socially deprived areas (quintiles 1 and 2). Incidence rose between 2002 and 2016 from 2.3 to 4.7 per 100,000 in the general population. Peak incidence occurred in females aged 25 (15.2 per 100,000). 91.6% were treated medically, 7.6% had a cerebrospinal fluid diversion procedure, 0.7% underwent bariatric surgery and 0.1% had optic nerve sheath fenestration. Elective caesarean sections rates were significantly higher in IIH (16%) compared to the general population (9%), p < 0.005. Admission rates rose by 442% between 2002 and 2014, with 38% having repeated admissions in the year following diagnosis. Duration of hospital admission was 2.7 days (8.8 days for those having CSF diversion procedures). Costs rose from £9.2 to £50 million per annum over the study period with costs forecasts of £462 million per annum by 2030. Conclusions IIH incidence is rising (by greater than 100% over the study), highest in areas of social deprivation and mirroring obesity trends. Re-admissions rates are high and growing yearly. The escalating population and financial burden of IIH has wide reaching implications for the health care system.
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McCluskey G, Doherty-Allan R, McCarron P, Loftus AM, McCarron LV, Mulholland D, McVerry F, McCarron MO. Meta-analysis and systematic review of population-based epidemiological studies in idiopathic intracranial hypertension. Eur J Neurol 2018; 25:1218-1227. [PMID: 29953685 DOI: 10.1111/ene.13739] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is positively associated with obesity, mostly in young women. The global increase in obesity may influence the burden of IIH. Using the PubMed, Embase, MEDLINE and Web of Science databases, a meta-analysis and systematic review of epidemiological studies of IIH were performed up to June 2017. Temporal changes in IIH incidence were measured, and incidence rates of IIH were correlated with country-specific World Health Organization obesity rates. Prevalence data and shunting rates of IIH were recorded. The quality of epidemiological studies was assessed using the Standards of Reporting of Neurological Disorders (STROND) criteria. In 15 identified studies, there were 889 patients (87% women), mean age 29.8 years. The incidence of IIH ranged from 0.03 to 2.36 per 100 000 per year. The pooled incidence of IIH was 1.20 per 100 000 per year although there was very high heterogeneity (I2 98%). The incidence rates of IIH were correlated with country-specific prevalence of obesity (Spearman's correlation 0.82, P < 0.01). The prevalence of IIH was rarely recorded. A shunting procedure was reported in 8% of patients. STROND criteria were variably reported, median of 26.5 of 43 (range 16-35). IIH is a public health concern as increased obesity prevalence is associated with increased incidence of IIH. A better quality of epidemiological studies is required to improve understanding of IIH and inform health policy for IIH management.
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Affiliation(s)
- G McCluskey
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
| | | | - P McCarron
- National Drug Treatment Centre, Dublin, Ireland
| | | | - L V McCarron
- Medical School, University of Cambridge, Cambridge, UK
| | - D Mulholland
- Department of Ophthalmology, Altnagelvin Hospital, Derry, UK
| | - F McVerry
- Department of Neurology, Altnagelvin Hospital, Derry, UK
| | - M O McCarron
- Department of Neurology, Altnagelvin Hospital, Derry, UK
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Sundholm A, Burkill S, Bahmanyar S, Nilsson Remahl AIM. Improving identification of idiopathic intracranial hypertension patients in Swedish patient register. Acta Neurol Scand 2018; 137:341-346. [PMID: 29192966 DOI: 10.1111/ane.12876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Idiopathic intracranial hypertension (IIH) is often misdiagnosed. This can cause problems if conducting register-based studies. The study purpose was to produce algorithms that better identify patients with correct diagnosis of IIH in the Swedish National Patient Register (NPR). METHODS Patients with ICD-10 code G93.2 for IIH registered in the NPR (2006-2013, Stockholm County) were included and diagnosis validated by medical record reviews. Patients were randomized into two groups: one used to produce the algorithm (n = 105) and one for validation (n = 102). We tested variables possible to extract from registries and used forward stepwise logistic regression which provided a predicted probability of correct diagnosis for each patient. RESULTS We included 207 patients of which 135 had confirmed IIH. This gave a positive predictive value of 65.2% (CI: 58.4-71.4). The algorithm produced with variables extracted from registries, that is, age, number of times with diagnosis code G93.2 recorded (>2 times), and acetazolamide treatment, predicted the diagnosis correctly 88.2% (CI: 80.3-93.3) of the time. Excluding treatment data from the algorithm did not change the prediction notably, 86.3% (CI: 78.1-91.7). CONCLUSION We produced two algorithms that with improved accuracy predict whether an IIH diagnosis in the NPR is correct. This can be a useful tool when performing register-based studies.
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Affiliation(s)
- A. Sundholm
- Department of Clinical Neuroscience; Karolinska Institutet; Solna Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - S. Burkill
- Department of Medicine; Centre for Pharmacoepidemiology; Karolinska Institutet; Solna Sweden
| | - S. Bahmanyar
- Department of Medicine; Centre for Pharmacoepidemiology; Karolinska Institutet; Solna Sweden
| | - A. I. M. Nilsson Remahl
- Department of Clinical Neuroscience; Karolinska Institutet; Solna Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
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Çelebisoy N, Öztürk T, Köse T. Rarebit Perimetry in the Evaluation of Visual Field Defects in Idiopathic Intracranial Hypertension. Eur J Ophthalmol 2018; 20:756-62. [DOI: 10.1177/112067211002000418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Rarebit perimetry (RBP) is a new perimetric technique that has been reported as a sensitive test for the evaluation of the neural structure of the visual system. The aim of this study was to compare RBP with standard automated perimetry in detecting the visual field defects of patients with idiopathic intracranial hypertension (IIH). Methods. Twenty-five patients with IIH and 16 healthy controls were considered. Visual fields were analyzed with Marco automated static perimeter with threshold and central 30–2 programs (MP 30–2) and rarebit perimetry. A visual field was classified into 3 zones for both tests as central, paracentral, and peripheral zones. Mean sensitivity (MS) recorded by the MP 30–2 was compared with the mean hit rate (MHR) recorded by RBP for each zone. Results. MS recorded by MP 30–2 and MHR recorded by RBP for each zone were significantly lower in the IIH group than in healthy control eyes (p<0.001). Good correlation was present between the visual fields recorded by both tests. Although the sensitivity and specificity values for each zone were lower in the RBP group than the MP 30–2 group, RBP was found to be efficient to differentiate between the visual fields of normal and IIH-Affected eyes. The average RBP test duration was significantly shorter than the MP 30–2 test duration (p<0.001). Conclusions. RBP is a rapid, comfortable, and widely accessible perimetric test giving reliable results in detecting visual field defects in IIH.
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Affiliation(s)
- Nese Çelebisoy
- Department of Neurology, Medical School, Ege University, Izmir
| | - Taylan Öztürk
- Department of Ophthalmology, Medical School, Dokuz Eylül University, Izmir
| | - Timur Köse
- Department of Biostatistics and Medical Informatics, Medical School, Ege University, Izmir - Turkey
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Carta A, Bertuzzi F, Cologno D, Giorgi C, Montanari E, Tedesco S. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri): Descriptive Epidemiology, Clinical Features, and Visual Outcome in Parma, Italy, 1990 to 1999. Eur J Ophthalmol 2018; 14:48-54. [PMID: 15005585 DOI: 10.1177/112067210401400108] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To ascertain the annual incidence rate and the clinical features, other than visual outcome, of idiopathic intracranial hypertension (IIH) in Parma, northern Italy. METHODS Neurologic care of people living in the Parma area is entirely provided by one private and two public hospitals. Medical records related to IIH were retrospectively reviewed for all Parma residents from 1990 through 1999. Results Ten patients (8 women and 2 men) were identified as having IIH according to modified Dandy criteria. Their age ranged from 16 to 53 years with a mean of 36 years at diagnosis. The annual age-adjusted rate per 100,000 is 0.28 for the total population. For women in reproductive age, the annual incidence rate is 0.65/100,000. For overweight women in reproductive age, the annual incidence rate is 2.7/100,000. CONCLUSIONS The incidence rate found in this study is lower than the incidence reported in previous US and Libyan studies. A significant difference in overweight distribution is observed comparing percentage of body weight between US and Parma populations. As overweight and obesity are important factors contributing to IIH development, it is possible that their low percentage in the Parma population may, at least partially, explain the low IIH incidence observed.
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Affiliation(s)
- A Carta
- Institute of Ophthalmology, University of Parma, Hospital of Fidenza, Italy.
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Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema. World Neurosurg 2017; 111:e221-e227. [PMID: 29258930 DOI: 10.1016/j.wneu.2017.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is characterized by headaches, visual obscurations, and papilledema, and the diagnosis involves lumbar puncture (LP) with an elevated opening pressure (OP) ≥20 cm H20. When papilledema is absent, the diagnosis becomes less clear. Some physicians have argued that the absence of papilledema rules out IIH, whereas others maintain that elevated OP is sufficient for diagnosis. METHODS The authors performed a single-institution 4-year retrospective analysis of patients who underwent invasive intracranial pressure (ICP) monitoring for presumed IIH. RESULTS A total of 22 patients were reviewed, and 13 had classic symptoms of IIH, documented elevated OP, and absence of papilledema; 5/13 (38%) patients had proven intracranial hypertension as shown by invasive ICP monitoring, whereas 8/13 (62%) had normal ICP. CONCLUSIONS With the use of current diagnostic algorithms of clinical presentation and elevated OP, over half of patients without papilledema in our series would be falsely diagnosed with IIH, which could result in unnecessary medical and surgical intervention. Thus, elevated OP as determined by LP is insufficient to diagnose IIH. On the other hand, the absence of papilledema does not rule out intracranial hypertension.
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Ito CJ, Reyes-Gelves C, Perry C, Kountakis SE. Body Mass Index and Olfactory Fossa Depth in Patients with and without Spontaneous Cerebrospinal Fluid Leaks. ORL J Otorhinolaryngol Relat Spec 2017; 79:331-335. [PMID: 29207380 DOI: 10.1159/000484439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Spontaneous cerebrospinal fluid (SCSF) leaks are associated with a high body mass index (BMI) and an expanded skull base. The purpose of this study is to determine if a correlation exists between BMI and olfactory fossa depth (OFD) in patients with SCSF leaks and those without. METHODS This is a cross-sectional study evaluating the correlation between OFD and BMI in patients with and without SCSF leaks. OFD was measured on computed tomography obtained in temporal proximity to the BMI. RESULTS Patients with SCSF leaks had a deeper mean OFD than controls (6.39 vs. 5.46 mm, p = 0.013) and a larger BMI (38.2 vs. 30.5, p = 0.0003). Pearson correlation was positive between BMI and OFD in women from the control group (R = 0.319, n = 93, p = 0.002 on the left; R = 0.313, n = 93, p = 0.002 on the right) but insignificant in men. CONCLUSIONS The olfactory fossa is deeper and the BMI higher in patients with SCSF leaks than in those without. Differences were statistically significant. Higher BMI may predict deeper olfactory fossa in women but not in men. These findings suggest expansion of weak points in the skull base as precursors to the development of SCSF leaks in response to elevated CSF pressures, particularly in women.
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Affiliation(s)
- Christopher J Ito
- Department of Otolaryngology - Head and Neck Surgery, Augusta University, Augusta, GA, USA
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Fernández-García MÁ, Cantarín-Extremera V, Andión-Catalán M, Duat-Rodríguez A, Jiménez-Echevarría S, Bermejo-Arnedo I, Hortigüela-Saeta M, Rekarte-García S, Babín-López L, Ruano Domínguez D. Secondary Intracranial Hypertension in Pediatric Patients With Leukemia. Pediatr Neurol 2017; 77:48-53. [PMID: 29097019 DOI: 10.1016/j.pediatrneurol.2017.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We investigated the clinical characteristics of a pediatric population with hemato-oncological disease and intracranial hypertension, analyze the therapeutic response and outcome, and compare its characteristics with respect to a control group with idiopathic intracranial hypertension. METHODS We retrospectively analyzed patients with hemato-oncological disease and secondary intracranial hypertension in our center during the past five years. We compared these individuals with a historical cohort with idiopathic intracranial hypertension from our institution (control group). RESULTS We identified eight patients, all with leukemia, and 21 controls. Mean age at diagnosis was 10.6 years, and 62% of individuals were female. Most of them were under treatment with drugs (62% corticosteroids, 75% active chemotherapy). Mean opening pressure of cerebrospinal fluid was 35 cm H2O. All had headache, but only 28% complained of visual symptoms. Only 12.5% exhibited papilledema at the time of diagnosis (versus 71% in controls). All of them were treated with acetazolamide, with average therapy duration of nine months, and all had a favorable outcome (versus 57% of controls who needed second-line treatment). None of them showed long-term visual complications (versus 20% of controls). CONCLUSIONS Patients with hemato-oncological disease and secondary intracranial hypertension may not develop typical symptomatology. Thus, diagnosis and recognition of this entity among this cohort may be difficult. Associated factors are diverse and do not show an obvious causal relationship. A high index of suspicion must be maintained for diagnosis, because a favorable outcome is expected with prompt treatment. Acetazolamide is effective as a first-line therapy and caused few side effects.
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Affiliation(s)
| | | | - Maitane Andión-Catalán
- Pediatric Hemato-Oncology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Anna Duat-Rodríguez
- Pediatric Neurology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Saray Rekarte-García
- Pediatric Neurology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lara Babín-López
- Pediatric Neurology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - David Ruano Domínguez
- Pediatric Hemato-Oncology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Hoffmann J. Impaired cerebrospinal fluid pressure. HANDBOOK OF CLINICAL NEUROLOGY 2017; 146:171-185. [PMID: 29110769 DOI: 10.1016/b978-0-12-804279-3.00011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Abnormalities of cerebrospinal fluid (CSF) pressure are relatively common and may lead to a variety of symptoms, with headache usually being the most prominent one. The clinical presentation of alterations in CSF pressure may vary significantly and show a striking similitude to several primary headache syndromes. While an increase in CSF pressure may be of primary or secondary origin, a pathologic decrease of CSF pressure is usually the result of a meningeal rupture with a resulting leakage of CSF. The pathophysiologic mechanisms of idiopathic intracranial hypertension (IIH) remain largely unknown. However recent evidence indicates that an abnormality in CSF outflow and absorption is likely to play a significant role. Treatment usually consists of a combination of weight loss and a pharmacologic approach using carbonic anhydrase inhibitors. Recent results of the first randomized, double-blind, placebo-controlled trial (RCT) with acetazolamide proved its efficacy in reducing headache and visual disturbances. Clinical evidence suggests efficacy for topiramate and furosemide but no RCT has been conducted to date to confirm these results. In contrast to IIH, spontaneous intracranial hypotension frequently remits spontaneously without specific treatment. If necessary, treatment options range from conservative methods to epidural blood or fibrin sealant patches and surgical interventions.
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Affiliation(s)
- Jan Hoffmann
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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