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Rajabi MT, Rafizadeh SM, Aghajani AH, Pirzadeh M. L'hypertension intracrânienne idiopathique en tant que manifestation neurologique du COVID-19: un rapport de cas. J Fr Ophtalmol 2022; 45:e303-e305. [PMID: 35659426 PMCID: PMC9152708 DOI: 10.1016/j.jfo.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/24/2022]
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2
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Idiopathic Intracranial Hypertension and Pregnancy: A Comprehensive Review of Management. Clin Neurol Neurosurg 2022; 217:107240. [DOI: 10.1016/j.clineuro.2022.107240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
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3
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The Effect of Optic Nerve Sheath Fenestration on Intraocular Pressure in Patients With Idiopathic Intracranial Hypertension. J Neuroophthalmol 2022; 42:97-100. [DOI: 10.1097/wno.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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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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Donaldson L, Margolin E. Approach to patient with unilateral optic disc edema and normal visual function. J Neurol Sci 2021; 424:117414. [PMID: 33799215 DOI: 10.1016/j.jns.2021.117414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/28/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
In patients with swollen optic nerve head and normal visual function, optic disc drusen (ODD) is the most common diagnosis. The best tests for detecting ODD are funds autofluorescence and enhanced-depth imaging ocular coherence tomography (EDIOCT). After ODD has been ruled out, asymmetric papilledema should be assumed to be the cause and MRI of the brain and orbits with contrast and venography should be performed in all patients. It allows one to look for indirect signs of increased inctracranial pressure (ICP), optic perineuritis, and other inflammatory or compressive processes affecting optic nerve or its sheath such as optic nerve sheath meningioma. If imaging signs of raised ICP are present, lumbar puncture should be performed with measurement of opening pressure and analysis of cerebrospinal fluid (CSF) contents in all patients with fever, meningismus or neurologic deficits as well as patients who are not in the typical demographic group for idiopathic intracranial hypertension (IIH). Optic nerve sheath enhancement on MRI should prompt work-up for causes of optic perineuritis. When the appropriate neuroimaging is normal, the differential diagnosis is limited and ophthalmological consultation is necessary to determine whether other subtle ocular abnormalities are present on biomicroscopic and dilated fundus examination.
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Affiliation(s)
- Laura Donaldson
- University of Toronto, Faculty of Medicine, Department of Ophthalmology and Vision Sciences, Toronto, Ontario, Canada
| | - Edward Margolin
- University of Toronto, Faculty of Medicine, Department of Ophthalmology and Vision Sciences, Toronto, Ontario, Canada; University of Toronto, Faculty of Medicine, Department of Medicine, Division of Neurology, Toronto, Ontario, Canada.
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6
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Visual Field Mean Deviation at Diagnosis of Idiopathic Intracranial Hypertension Predicts Visual Outcome. J Neuroophthalmol 2020; 39:186-190. [PMID: 30153119 DOI: 10.1097/wno.0000000000000709] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A robust predictor of visual outcome in idiopathic intracranial hypertension (IIH) would be useful in management, but there is limited information on this point. The purpose of this study was to ascertain whether visual field mean deviation on standard static perimetry performed at diagnosis in a large patient cohort is a reliable predictor of visual outcome. METHODS We retrospectively reviewed the automated visual field mean deviations at diagnosis and at final encounter in 79 patients with IIH examined in the neuro-ophthalmology clinics at a single academic medical center from 1999 to 2015. RESULTS Of the 79 study patients, 66 (84%) entered with visual field mean deviations of -7 dB or better. Of those 66 patients, 59 (89%) had final mean deviations of -4 dB or better and 33 (56%) had final mean deviations of -2 dB or better. The single patient who had an initial mean deviation of -7 dB or better and a poor final mean deviation (-32 dB) was nonadherent to prescribed medication. Of the 13 (21%) patients who entered with mean deviations worse than -7 dB, 11 (85%) ended up with poor visual outcomes, their final mean deviations ranging from -5 dB to -32 dB. Over half of those 13 patients had required surgery for IIH, often within 3 weeks of diagnosis, owing to severe papilledema and visual dysfunction at the time of diagnosis. CONCLUSIONS Based on this retrospective study, patients with IIH who have relatively mild visual dysfunction at diagnosis are likely to have a favorable visual outcome, provided they are adherent to recommended treatment. Many of those with poor visual function at diagnosis will have unfavorable visual outcomes despite aggressive treatment.
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Laiginhas R, Guimarães M, Cardoso P, Santos-Sousa H, Preto J, Nora M, Chibante J, Falcão-Reis F, Falcão M. Retinal Nerve Fiber Layer Thickness Decrease in Obesity as a Marker of Neurodegeneration. Obes Surg 2020; 29:2174-2179. [PMID: 30864103 DOI: 10.1007/s11695-019-03806-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a serious condition that is frequently associated with irreversibly vision loss, having a higher incidence among obese women. Our aims were to screen subclinical IIH in obese patients scheduled to bariatric surgery using peripapillary retinal nerve fiber layer (RNFL) thickness and to evaluate if the findings demand the possible need of a preoperative evaluation in this population. METHODS This study included 111 eyes from 36 obese patients (86% female, body mass index > 35 kg/m2) scheduled to bariatric surgery and 20 non-obese (body mass index < 25 kg/m2) age-matched controls. We measured sectorial and mean RNFL thickness in a 3.5-mm-diameter circular scan centered on the optic nerve head, using optical coherence tomography (Heidelberg Spectralis SD-OCT) in all participants. Multivariate linear regression was used for adjustments. RESULTS No patient had subclinical IIH corresponding to increased RNFL thickness. However, in obese individuals, global peripapillary RNFL was thinner than in controls (104 ± 6 μm versus 99 ± 12 μm, p = 0.005). Overall, RNFL thickness was superior in the control group for all sectors. The differences reached significance for the nasal, temporal, superior temporal, and inferior temporal sectors. These differences remained even after adjusting for possible confounders (hypertension, dyslipidemia, diabetes, age, sleep apnea syndrome, and sex). CONCLUSIONS Routine screening asymptomatic obese patients undergoing bariatric surgery for IIH using RNFL thickness was not clinically relevant in our study. However, we found that severe obesity is associated with neurodegeneration independently of the other components of the metabolic syndrome, what may justify future investigation on the need of monitoring these patients.
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Affiliation(s)
- Rita Laiginhas
- PDICSS, Faculty of Medicine of Porto University (FMUP), Porto, Portugal.,Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Marta Guimarães
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal.,Department of Anatomy, Institute of Biomedical Science Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Pedro Cardoso
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal
| | - Hugo Santos-Sousa
- Department of Surgery, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Department of Surgery, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
| | - John Preto
- Department of Surgery, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Mário Nora
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal.,Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - João Chibante
- Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal. .,Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), Porto, Portugal.
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Correlation Between Optic Disc Peripapillary Capillary Network and Papilledema Grading in Patients With Idiopathic Intracranial Hypertension: A Study of Optical Coherence Tomography Angiography. J Neuroophthalmol 2020; 41:48-53. [DOI: 10.1097/wno.0000000000000877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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SARAÇ Ö, ALGIN O, BEYAZAL M, ANLAR B, VARAN A, KANSU T. Assessment of the visual pathways in patients with neurofibromatosis-1 by 3S-space
technique with 3-Tesla MRI. Turk J Med Sci 2019; 49:1626-1633. [PMID: 31655505 PMCID: PMC7518666 DOI: 10.3906/sag-1906-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/07/2019] [Indexed: 11/09/2022] Open
Abstract
Background/aim We aimed to evaluate the size/tortuosity of the optic nerve (ON) and the dilatation of the ON sheath (ONS) in neurofibromatosis type 1 (NF-1) patients with 3T-MRI, and to assess the usefulness of 3D-SPACE in imaging the optic pathway, ON, and ONS in NF-1 patients. Materials and methods Twenty consecutive NF-1 patients without optic pathway glioma (OPG) (Group 1), 16 consecutive NF-1 patients with OPG (Group 2), and 19 controls were included in this study. The thickness and tortuosity of the ON and the diameter of the ONS were measured on STIR and 3D-SPACE images. Results The thickness of the ON was similar in all groups on STIR images (P>0.05). The mean ONS diameter was higher in Group 2 with this sequence (P=0.009). Controls had significantly lower grades of ON tortuosity than Groups 1 and 2 (P=0.001), and Group 1 had significantly lower ON tortuosity compared to Group 2 (P=0.001). Severe tortuosity was only detected in Group 2. Conclusion ON tortuosity and ONS diameter were increased in NF-1 patients in the presence of OPG. High-resolution cranium imaging with the 3D-SPACE technique using 3T-MRI seems to be helpful for detection of the optic pathway morphology and pathologies in NF-1 patients.
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Affiliation(s)
- Özge SARAÇ
- Department of Ophthalmology, City Hospital, Yıldırım Beyazıt University, Bilkent, AnkaraTurkey
| | - Oktay ALGIN
- Department of Radiology, City Hospital, Yıldırım Beyazıt University, Bilkent, AnkaraTurkey
- National MR Research Center (UMRAM), Bilkent University, Bilkent, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Mehmet BEYAZAL
- Department of Radiology, Faculty of Medicine, Recep Tayyip Erdoğan University, RizeTurkey
| | - Banu ANLAR
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Sıhhıye, AnkaraTurkey
| | - Ali VARAN
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Sıhhıye, AnkaraTurkey
| | - Tülay KANSU
- Department of Neurology, Faculty of Medicine, Hacettepe University, Sıhhıye, AnkaraTurkey
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Anzeljc AJ, Frias P, Hayek BR, Canter Weiner N, Wojno TH, Kim HJ. A 15-year review of secondary and tertiary optic nerve sheath fenestration for idiopathic intracranial hypertension. Orbit 2018; 37:266-272. [PMID: 29313398 DOI: 10.1080/01676830.2017.1423337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Optic nerve sheath fenestration (ONSF) is a common surgical option for patients with idiopathic intracranial hypertension (IIH) with vision loss refractory to medical management. Little is known about the visual benefit of repeated ONSF. The authors aimed to assess the efficacy of secondary and tertiary ONSF in patients with IIH. METHODS A retrospective chart review was performed on all patients with repeat ONSF for IIH at Emory University from 1999 to 2016. Primary outcome measures included visual acuity, optic nerve head findings, and visual field results. RESULTS A total of nine eyes in seven patients (five females and two males) with repeat ONSF were identified. Two of the seven patients had repeat ONSF in both eyes, while the remaining five patients had only one eye repeated. Five of seven patients (five eyes) improved or remained stable after the secondary ONSF. Two patients (three eyes) continued to worsen despite the secondary fenestration surgery and underwent tertiary ONSF at an average of 13.2 months (SD 5.5 months) after the failed secondary ONSF. Both patients that underwent the tertiary fenestration showed improvement. Six of the patients had either improvement or stability in their clinical findings at their last documented follow-up, but one continued to worsen despite intervention. CONCLUSIONS This study suggests that secondary and tertiary nerve sheath fenestration is a viable management option for patients with progressive vision loss from IIH. Repeat ONSFs do not appear to have increased complication or failure rates compared to prior documented studies regarding primary fenestrations.
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Affiliation(s)
- Andrew J Anzeljc
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | - Patrick Frias
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | - Brent R Hayek
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | | | - Ted H Wojno
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | - H Joon Kim
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
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Sodhi M, Sheldon CA, Carleton B, Etminan M. Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome: Nested case-control study. Neurology 2017; 89:792-795. [PMID: 28754842 DOI: 10.1212/wnl.0000000000004247] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/24/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To quantify the risk of secondary pseudotumor cerebri syndrome (PTCS) with fluoroquinolones. METHODS A case-control study of people 15-60 years of age from the LifeLink Database (QuintilesIMS, Parsippany, NJ) was conducted. Cases had the first ICD-9-CM code for benign intracranial hypertension (BIH) as well as having received a procedure code for an MRI or CT scan and a lumbar puncture within 15 days or 30 days of the BIH code. For each case, 10 controls were selected using density-based sampling. Current users of fluoroquinolones received a prescription within 15 days or 30 days of the date of the diagnosis. For the sensitivity analysis, risk periods for 30 and 60 days were also examined. Adjusted rate ratios (RRs) were computed from a conditional logistic regression model. RESULTS From a cohort of 6,110,723 people, there were 339 cases of PTCS and 3,390 corresponding controls. In the primary analysis, the adjusted RR for current users of fluoroquinolones for both the 15-day and 30-day definitions were 5.67 (95% confidence interval [CI] 2.72-11.83) and 4.15 (95% CI 2.29-7.50), respectively. The risk with tetracycline antibiotics was also increased, with RRs for 15 and 30 days of current use of 2.68 (0.89-8.11) and 3.64 (1.67-7.91), respectively. CONCLUSION Our study suggests an increase in the risk of PTCS with current users of fluoroquinolones. Although this adverse event is rare, patients who experience symptoms of raised intracranial pressure including headaches, tinnitus, and double vision while taking fluoroquinolones should seek medical attention.
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Affiliation(s)
- Mohit Sodhi
- From the Department of Ophthalmology and Visual Sciences (M.S., C.A.S., M.E.), the Department of Experimental Medicine (M.S.), Division of Translational Therapeutics, Department of Pediatrics (B.C.), Faculty of Medicine, and BC Children's Hospital Research Institute (B.C.), University of British Columbia; and Pharmaceutical Outcomes Programme (B.C.), British Columbia Children's Hospital, Vancouver, Canada
| | - Claire A Sheldon
- From the Department of Ophthalmology and Visual Sciences (M.S., C.A.S., M.E.), the Department of Experimental Medicine (M.S.), Division of Translational Therapeutics, Department of Pediatrics (B.C.), Faculty of Medicine, and BC Children's Hospital Research Institute (B.C.), University of British Columbia; and Pharmaceutical Outcomes Programme (B.C.), British Columbia Children's Hospital, Vancouver, Canada
| | - Bruce Carleton
- From the Department of Ophthalmology and Visual Sciences (M.S., C.A.S., M.E.), the Department of Experimental Medicine (M.S.), Division of Translational Therapeutics, Department of Pediatrics (B.C.), Faculty of Medicine, and BC Children's Hospital Research Institute (B.C.), University of British Columbia; and Pharmaceutical Outcomes Programme (B.C.), British Columbia Children's Hospital, Vancouver, Canada
| | - Mahyar Etminan
- From the Department of Ophthalmology and Visual Sciences (M.S., C.A.S., M.E.), the Department of Experimental Medicine (M.S.), Division of Translational Therapeutics, Department of Pediatrics (B.C.), Faculty of Medicine, and BC Children's Hospital Research Institute (B.C.), University of British Columbia; and Pharmaceutical Outcomes Programme (B.C.), British Columbia Children's Hospital, Vancouver, Canada.
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Idiopathic Intracranial Hypertension Progressing to Venous Sinus Thrombosis, Subarachnoid Hemorrhage, and Stroke. J Neuroophthalmol 2017; 38:60-64. [PMID: 28742639 DOI: 10.1097/wno.0000000000000540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure (ICP), the absence of structural lesions on neuroimaging, and normal cerebrospinal fluid composition. Cerebral venous sinus thrombosis (CVST) is a common cause of increased ICP and can be differentiated from IIH with magnetic resonance venography. We describe a young woman with typical IIH who underwent lumbar puncture and was treated with a short course of high-dose corticosteroids followed by acetazolamide. She subsequently developed CVST, subarachnoid hemorrhage, and stroke. Risk factors that may have resulted in CVST are discussed.
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13
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Takagi M, Oku H, Kida T, Akioka T, Ikeda T. Case of Primary Leptomeningeal Lymphoma Presenting with Papilloedema and Characteristics of Pseudotumor Syndrome. Neuroophthalmology 2017; 41:149-153. [PMID: 28512506 DOI: 10.1080/01658107.2017.1292533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 10/19/2022] Open
Abstract
The authors describe an immunocompetent, 50-year-old man who complained of a daily transient blurring of his vision with bilateral papilloedema. His visual acuity was 20/20 OU, and the blind spot was enlarged bilaterally. There was intracranial hypertension, but imaging for systemic and brain tumours were negative. These findings suggested a diagnosis of the pseudotumor syndrome. However, MRI showed leptomeningeal enhancement, and acetazolamide successfully resolved his visual symptoms and papilloedema. Cytology and flow cytometry of the CSF led to the final diagnosis of primary leptomeningeal lymphoma (PLML). Clinicians need to be aware that a case of PLML may be misdiagnosed as peudotumor cerebri.
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Affiliation(s)
- Mai Takagi
- Department of Ophthalmology, Osaka Medical College, Osaka, Japan
| | - Hidehiro Oku
- Department of Ophthalmology, Osaka Medical College, Osaka, Japan
| | - Teruyo Kida
- Department of Ophthalmology, Osaka Medical College, Osaka, Japan
| | - Toshikazu Akioka
- Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Tsunehiko Ikeda
- Department of Ophthalmology, Osaka Medical College, Osaka, Japan
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Garza-Urroz YM, Chávez-Caraza KL, Franco-López I. Daño ocular severo secundario a un seudotumor cerebri. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Esin OR, Esin RG, Khairullin IK. Headache in pregnancy. Zh Nevrol Psikhiatr Im S S Korsakova 2017. [DOI: 10.17116/jnevro201711721136-142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Heyman J, Ved R, Amato-Watkins A, Bhatti I, Te Water Naude J, Gibbon F, Leach P. Outcomes of ventriculoperitoneal shunt insertion in the management of idiopathic intracranial hypertension in children. Childs Nerv Syst 2017; 33:1309-1315. [PMID: 28536838 PMCID: PMC5527065 DOI: 10.1007/s00381-017-3423-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The ventriculoperitoneal (VP) shunt has become the procedure of choice for treatment of idiopathic intracranial hypertension (IIH). We aimed to assess the efficacy of frameless stereotactic placement of VP shunts for the management of medically resistant IIH in children and to assess the role of gender and obesity in the aetiology of the condition. METHODS This is a retrospective analysis of the case notes of 10 patients treated surgically at the University Hospital of Wales in Cardiff, from May 2006 to September 2012. RESULTS VP shunts were successful in relieving headache, papilloedema and stabilising vision. No sex predilection was identified, and increased BMI was a feature throughout the population, regardless of age. CONCLUSIONS Neuronavigated VP shunt insertion is an effective mode of treatment for medically resistant IIH in children. The aetiological picture in children does not seem to be dominated by obesity, as in adults. Literature on childhood IIH is sparse, and larger scale, comparative studies would be of benefit to treating clinicians.
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Affiliation(s)
- J. Heyman
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Ronak Ved
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK. .,Department of Neurosurgery, University Hospital of Wales, B4 Office, Cardiff, CF14 4XW, UK.
| | - A. Amato-Watkins
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - I. Bhatti
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - J. Te Water Naude
- Department of Paediatric Neurology, University Hospital of Wales, Cardiff, UK
| | - F. Gibbon
- Department of Paediatric Neurology, University Hospital of Wales, Cardiff, UK
| | - P. Leach
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
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Idiopathic Intracranial Hypertension Induced by Topical Application of Vitamin A. J Neuroophthalmol 2016; 36:412-413. [DOI: 10.1097/wno.0000000000000374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spitze A, Lam P, Al-Zubidi N, Yalamanchili S, Lee AG. Controversies: Optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension. Indian J Ophthalmol 2016; 62:1015-21. [PMID: 25449938 PMCID: PMC4278113 DOI: 10.4103/0301-4738.146012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) has been increasing in prevalence in the past decade, following the obesity epidemic. When medical treatment fails, surgical treatment options must be considered. However, controversy remains as to which surgical procedure is the preferred surgical option - optic nerve sheath fenestration (ONSF) or cerebrospinal fluid (CSF) shunting - for the long-term treatment of this syndrome. PURPOSE To provide a clinical update of the pros and cons of ONSF versus shunt placement for the treatment of IIH. DESIGN This was a retrospective review of the current literature in the English language indexed in PubMed. METHODS The authors conducted a PubMed search using the following terms: Idiopathic IIH, pseudotumor cerebri, ONSF, CSF shunts, vetriculo-peritoneal shunting, and lumbo-peritoneal shunting. The authors included pertinent and significant original articles, review articles, and case reports, which revealed the new aspects and updates in these topics. RESULTS The treatment of IIH remains controversial and lacks randomized controlled clinical trial data. Treatment of IIH rests with the determination of the severity of IIH-related visual loss and headache. CONCLUSION The decision for ONSF versus shunting is somewhat institution and surgeon dependent. ONSF is preferred for patients with visual symptoms whereas shunting is reserved for patients with headache. There are positive and negative aspects of both procedures, and a prospective, randomized, controlled trial is needed (currently underway). This article will hopefully be helpful in allowing the reader to make a more informed decision until that time.
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Affiliation(s)
| | | | | | | | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital; Department of Ophthalmology, Baylor College of Medicine, Houston; Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX, USA
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19
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Frič R, Eide PK. Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension. J Neurosurg 2016; 126:1312-1322. [PMID: 27341045 DOI: 10.3171/2016.4.jns152862] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Several lines of evidence suggest common pathophysiological mechanisms in Chiari malformation Type I (CMI) and idiopathic intracranial hypertension (IIH). It has been hypothesized that tonsillar ectopy, a typical finding in CMI, is the result of elevated intracranial pressure (ICP) combined with a developmentally small posterior cranial fossa (PCF). To explore this hypothesis, the authors specifically investigated whether ICP is comparable in CMI and IIH and whether intracranial volumes (ICVs) are different in patients with CMI and IIH, which could explain the tonsillar ectopy in CMI. The authors also examined whether the symptom profile is comparable in these 2 patient groups. METHODS The authors identified all CMI and IIH patients who had undergone overnight diagnostic ICP monitoring during the period from 2002 to 2014 and reviewed their clinical records and radiological examinations. Ventricular CSF volume (VV), PCF volume (PCFV), and total ICV were calculated from initial MRI studies by using volumetric software. The static and pulsatile ICP scores during overnight monitoring were analyzed. Furthermore, the authors included a reference (REF) group consisting of patients who had undergone ICP monitoring due to suspected idiopathic normal-pressure hydrocephalus or chronic daily headache and showed normal pressure values. RESULTS Sixty-six patients with CMI and 41 with IIH were identified, with comparable demographics noted in both groups. The occurrence of some symptoms (headache, nausea, and/or vomiting) was comparable between the cohorts. Dizziness and gait ataxia were significantly more common in patients with CMI, whereas visual symptoms, diplopia, and tinnitus were significantly more frequent in patients with IIH. The cranial volume measurements (VV, PCFV, and ICV) of the CMI and IIH patients were similar. Notably, 7.3% of the IIH patients had tonsillar descent qualifying for diagnosis of CMI (that is, > 5 mm). The extent of tonsillar ectopy was significantly different between the CMI and IIH cohorts (p < 0.001) but also between these 2 cohorts and the REF group. Pulsatile ICP was elevated in both cohorts without any significant between-group differences; however, static ICP was significantly higher (p < 0.001) in the IIH group. CONCLUSIONS This study showed comparable and elevated pulsatile ICP, indicative of impaired intracranial compliance, in both CMI and IIH cohorts, while static ICP was higher in the IIH cohort. The data did not support the hypothesis that reduced PCFV combined with increased ICP causes tonsillar ectopy in CMI. Even though impaired intracranial compliance seems to be a common pathophysiological mechanism behind both conditions, the mechanisms explaining the different clinical and radiological presentations of CMI and IIH remain undefined.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet; and
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet; and.,Faculty of Medicine, University of Oslo, Norway
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Loo KGB, Lim SA, Lim ILZ, Chan DWS. Guiding follow-up of paediatric idiopathic intracranial hypertension with optical coherence tomography. BMJ Case Rep 2016; 2016:bcr-2015-213070. [PMID: 26941344 DOI: 10.1136/bcr-2015-213070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is uncommon in the paediatric population. Papilloedema is the hallmark sign and patients can suffer permanent vision loss as a consequence. We describe the role of optical coherence tomography (OCT) in the follow-up of two paediatric patients with newly diagnosed IIH. Patient A presented with vomiting and examination showed ophthalmoplaegia and papilloedema. She was treated with acetazolamide, furosemide and therapeutic lumbar punctures. Patient B presented with incidental papilloedema and was treated with acetazolamide and she reported intermittent headache during follow-up. Fundoscopic examinations for both patients showed persistent blurred disc margins but OCT examinations documented improvement of average retinal nerve fibre layers. OCT may be of value in monitoring for recurrence in paediatric IIH.
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Affiliation(s)
- Kai Guo Benny Loo
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Su Ann Lim
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
| | - I-Linn Zena Lim
- Department of Paediatric Ophthalmology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Derrick Wei Shih Chan
- Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
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21
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Chih A, Patel B. Idiopathic Intracranial Hypertension in Pregnancy. Fed Pract 2015; 32:36-40. [PMID: 30766032 PMCID: PMC6364811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Treatment for a patient who presented with severe headaches and decreased vision caused by idiopathic intracranial hypertension was complicated by nonadherence and pregnancy, but the patient's symptoms resolved after a successful delivery.
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Affiliation(s)
- Andreea Chih
- is a staff optometrist and residency coordinator and was a resident at the time the article was written, both at the William Chappell Jr. VA Satellite Outpatient Clinic in Daytona, Florida. Dr. Patel currently practices at Phillips, Salomon and Parrish in Lakeland, Florida
| | - Binal Patel
- is a staff optometrist and residency coordinator and was a resident at the time the article was written, both at the William Chappell Jr. VA Satellite Outpatient Clinic in Daytona, Florida. Dr. Patel currently practices at Phillips, Salomon and Parrish in Lakeland, Florida
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22
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Rigi M, Almarzouqi SJ, Morgan ML, Lee AG. Papilledema: epidemiology, etiology, and clinical management. Eye Brain 2015; 7:47-57. [PMID: 28539794 PMCID: PMC5398730 DOI: 10.2147/eb.s69174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Papilledema is optic disc swelling due to high intracranial pressure. Possible conditions causing high intracranial pressure and papilledema include intracerebral mass lesions, cerebral hemorrhage, head trauma, meningitis, hydrocephalus, spinal cord lesions, impairment of cerebral sinus drainage, anomalies of the cranium, and idiopathic intracranial hypertension (IIH). Irrespective of the cause, visual loss is the feared morbidity of papilledema, and the main mechanism of optic nerve damage is intraneuronal ischemia secondary to axoplasmic flow stasis. Treatment is directed at correcting the underlying cause. In cases where there is no other identifiable cause for intracranial hypertension (ie, IIH) the available options include both medical and surgical modalities. Weight loss and diuretics remain the mainstays for treatment of IIH, and surgery is typically reserved for patients who fail, are intolerant to, or non-compliant with maximum medical therapy.
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Affiliation(s)
| | | | - Michael L Morgan
- Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute
| | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute.,Baylor College of Medicine.,Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, UTMB Galveston, UT MD Anderson Cancer Center, Houston, TX, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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23
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Platts SH, Bairey Merz CN, Barr Y, Fu Q, Gulati M, Hughson R, Levine BD, Mehran R, Stachenfeld N, Wenger NK. Effects of sex and gender on adaptation to space: cardiovascular alterations. J Womens Health (Larchmt) 2015; 23:950-5. [PMID: 25401939 DOI: 10.1089/jwh.2014.4912] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sex and gender differences in the cardiovascular adaptation to spaceflight were examined with the goal of optimizing the health and safety of male and female astronauts at the forefront of space exploration. Female astronauts are more susceptible to orthostatic intolerance after space flight; the visual impairment intracranial pressure syndrome predominates slightly in males. Since spaceflight simulates vascular aging, sex-specific effects on vascular endothelium and thrombotic risk warrant examination as predisposing factors to atherosclerosis, important as the current cohort of astronauts ages. Currently, 20% of astronauts are women, and the recently selected astronaut recruits are 50% women. Thus there should be expectation that future research will reflect the composition of the overall population to determine potential benefits or risks. This should apply both to clinical studies and to basic science research.
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Affiliation(s)
- Steven H Platts
- 1 National Aeronautics and Space Administration Johnson Space Center , Houston, Texas
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24
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Konrad J, Vogt R, Helbig H, Oberacher-Velten I. [Intracranial hypertension and jugular vein thrombosis]. Ophthalmologe 2015; 112:1002-5. [PMID: 25755026 DOI: 10.1007/s00347-015-3248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pseudotumor cerebri is an idiopathic increase in intracranial pressure, which commonly affects obese women of fertile age. The diagnostic criteria according to the guidelines of the German Society for Neurology are increased cerebrospinal fluid (CSF) pressure, symptoms of increased CSF pressure, normal results of CSF examination, no relevant medication and a lack of structural and vascular lesions in magnetic resonance imaging (MRI). CASE REPORT This article presents the case of a 39-year-old male patient who presented at hospital with visual obscuration and recently occurred double vision. Except for a recently diagnosed thrombosis of the left jugular vein of unknown origin, there was nothing else of note in the medical history. Biomicroscopic examination showed papilledema with hemorrhages and cotton wool spots. The CSF opening pressure was initially > 50 cmH2O. During therapy by lumbar puncture (three times), oral carbonic anhydrase inhibitors and loop diuretics, the abducens nerve palsy and papilledema receded. Anticoagulation therapy (initially with coumarin derivatives, then with low molecular weight heparins) was unsuccessful in eliminating the thrombosis of the jugular vein. Surgical intervention was not recommended by the vascular surgeons. CONCLUSION This case report demonstrates the unusual combination of (idiopathic) intracranial hypertension and thrombosis of the jugular vein, which occurred spontaneously and without any detectable coagulation disorders.
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Affiliation(s)
- J Konrad
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - R Vogt
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - H Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - I Oberacher-Velten
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Pollak L, Zohar E, Glovinsky Y, Huna-Baron R. The laboratory profile in idiopathic intracranial hypertension. Neurol Sci 2015; 36:1189-95. [DOI: 10.1007/s10072-015-2071-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/09/2015] [Indexed: 11/29/2022]
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26
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Hopkins AN, Alshaeri T, Akst SA, Berger JS. Neurologic disease with pregnancy and considerations for the obstetric anesthesiologist. Semin Perinatol 2014; 38:359-69. [PMID: 25176638 DOI: 10.1053/j.semperi.2014.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Women with neurologic conditions present a challenge during pregnancy and in the peripartum period. Given the low prevalence of these diseases during pregnancy, most management decisions are guided by retrospective reviews and case reports. This article reviews current literature for some of the more common or complex neurologic conditions affecting pregnancy with special consideration for anesthetic management. In particular, epilepsy; multiple sclerosis; primary intracranial hypertension; secondary intracranial hypertension-Arnold-Chiari malformations and intracranial neoplasms; spinal cord injury; neuromuscular junction disorders-myasthenia gravis; and hereditary neuromuscular disorders-myotonic dystrophy and spinal muscular atrophy will be discussed. By increasing understanding of anesthetic issues for parturients with neurologic disease, providers may more effectively anticipate anesthetic considerations, thereby optimizing care plans.
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Affiliation(s)
- Amanda N Hopkins
- Department of Anesthesiology & Critical Care Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | | | - Seth A Akst
- Department of Anesthesiology & Critical Care Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Jeffrey S Berger
- Department of Anesthesiology & Critical Care Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC.
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27
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Abstract
Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space occupying lesions. ICP is usually measured by lumbar puncture and a cerebrospinal fluid (CSF) pressure above 250 mm H2O is one of the diagnostic criteria of IIH. Recently, we have encountered two patients who complained of headaches and exhibited disc swelling without an increased ICP. We prescribed acetazolamide and followed both patients frequently; because of the definite disc swelling with IIH related symptoms. Symptoms and signs resolved in both patients after they started taking acetazolamide. It is generally known that an elevated ICP, as measured by lumbar puncture, is the most important diagnostic sign of IIH. However, these cases caution even when CSF pressure is within the normal range, that suspicion should be raised when a patient has papilledema with related symptoms, since untreated papilledema may cause progressive and irreversible visual loss.
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Affiliation(s)
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul National University College of Medicine, Seoul, Korea
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28
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Pseudo-Foster Kennedy syndrome due to idiopathic intracranial hypertension. CANADIAN JOURNAL OF OPHTHALMOLOGY 2014; 49:e99-e102. [DOI: 10.1016/j.jcjo.2014.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/20/2014] [Accepted: 05/08/2014] [Indexed: 11/19/2022]
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29
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Istek S. Chiari type 1 malformation in a pseudotumour cerebri patient: is it an acquired or congenital Chiari malformation? BMJ Case Rep 2014; 2014:bcr-2013-201845. [PMID: 24898995 DOI: 10.1136/bcr-2013-201845] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chiari malformation type 1 (CM1) is a developmental abnormality of the cerebellar tonsils. Patients with CM1 commonly present with headache. Papilloedema is rarely seen in CM1. However, a 52-year-old woman presented to the hospital with a headache and her ophthalmological examination revealed bilateral papilloedema. Her cranial MRI was compatible with borderline CM1. Bilateral papilloedema and headache suggested idiopathic intracranial hypertension (IIH) as the preliminary diagnosis. IIH is a rare case in CM1. This article argues about this association and discusses as to whether it is an acquired or congenital Chiari malformation.
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30
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Kesler A, Stolovic N, Bluednikov Y, Shohat T. The incidence of idiopathic intracranial hypertension in Israel from 2005 to 2007: results of a nationwide survey. Eur J Neurol 2014; 21:1055-1059. [PMID: 24698554 DOI: 10.1111/ene.12442] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disorder related to increased intracranial pressure without clinical, laboratory or radiological evidence of an intracranial space occupying lesion or cerebral sinus vein thrombosis, predominantly affecting obese women of childbearing age. Our aim was to determine the incidence and clinical features of IIH in Israel. METHODS In a cross-sectional study, all medical records of patients discharged from the hospital with a primary diagnosis of IIH during 2005-2007 were reviewed. RESULTS Four hundred and twenty-eight patients with a new onset of IIH were diagnosed. The average annual incidence rate was 2.02 per 100,000 with an incidence of 3.17 per 100,000 for women and 0.85 per 100,000 for men. The incidence rate in females of childbearing age (18-45) was 5.49 per 100,000. The female to male ratio for >17 years old was 6.1:1 (252 females and 41 males) and 2.1:1 (60 females and 28 males) for ages 11-17. Obesity was documented in 83.4% of patients. Body mass index (BMI) data were available for 159 (37.1%) patients; of these, 59.1% had a BMI ≥ 30. CONCLUSION The incidence of IIH in Israel has increased during the last decade. This finding could be related to the increasing rates of obesity. The association of IIH and obesity should be further explored especially with regard to the effect of weight reduction for primary prevention.
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Affiliation(s)
- A Kesler
- Neuro-ophthalmology Unit, Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Stolovic
- Neuro-ophthalmology Unit, Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Y Bluednikov
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
| | - T Shohat
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel.,Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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33
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Cerebrospinal fluid diversion procedures in the treatment of patients with idiopathic intracranial hypertension. Int Ophthalmol Clin 2013; 54:51-9. [PMID: 24296371 DOI: 10.1097/iio.0000000000000003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
We describe 2 patients with inexorably progressive pseudotumor syndrome (intracranial hypertension without mass lesion or ventriculomegaly) both initially misdiagnosed as having idiopathic intracranial hypertension and who were eventually found to have spinal leptomeningeal lymphoma. Neither had, at any time, any clinical signs of a spinal cord or root lesion. We discuss the possible implications of these observations regarding the diagnosis and mechanism of the pseudotumor syndrome.
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35
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36
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Pollak L, Zohar E, Glovinsky Y, Huna-Baron R. Reevaluation of presentation and course of idiopathic intracranial hypertension--a large cohort comprehensive study. Acta Neurol Scand 2013; 127:406-12. [PMID: 23278763 DOI: 10.1111/ane.12060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We analyzed the clinical and ophthalmological findings in a large group of patients with idiopathic intracranial hypertension (IIH) trying to find factors that might influence the course of the disease. MATERIALS AND METHODS Medical records of patients with IIH were retrospectively reviewed. The patients included were women after menarche and men older than 18 years of age who were followed up for at least 1 year. RESULTS Eighty-two patients (89% women) with a mean age of 30.2 ± 12.0 years were included. The prevailing complaint was headache and transient visual obscurations followed by tinnitus and double vision. Eighty-two percent of patients were overweight at the time of diagnosis. Overweight patients had higher opening cerebrospinal fluid (CSF) pressure than patients with normal weight did. The grade of papilledema correlated with the CSF opening pressure. Inverse correlation was found between the depression of the visual field sensitivity and the grade of papilledema. The mean follow-up time was 61.3 ± 62.3 months. Eighty-four percent of the patients have improved while in 22% CSF diversion procedures or optic nerve decompression was required. The mean body mass index (BMI) at the end of follow-up decreased significantly. Sixty-seven percent of the patients suffered a recurrence of IIH. The number of recurrences inversely correlated with weight loss. Visual field defects on presentation were encountered more frequently in patients with recurrence. Women with recurrence had a history of more pregnancies. CONCLUSIONS Our results confirm the strong association between overweight and IIH. The recurrence rate seemed to be influenced by the obstetrical history and the severity of visual field defects at presentation. In contrast to some previous studies, we have found an interrelation between the CSF opening pressure, grade of papilledema and depression of the visual field sensitivity.
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Affiliation(s)
- L. Pollak
- Sackler School of Medicine; Tel Aviv University; Tel Aviv; Israel
| | - E. Zohar
- Sackler School of Medicine; Tel Aviv University; Tel Aviv; Israel
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Halimi E, Wavreille O, Rosenberg R, Bouacha I, Lejeune JP, Defoort-Dhellemmes S. Optic Nerve Sheath Meningocele: A Case Report. Neuroophthalmology 2013; 37:78-81. [PMID: 28163760 DOI: 10.3109/01658107.2013.766219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 11/27/2012] [Accepted: 11/30/2012] [Indexed: 01/12/2023] Open
Abstract
Isolated optic nerve sheath meningocele is a rare affection defined as the cystic enlargement of the optic nerve sheath filled with cerebrospinal fluid. We report the case of a 39-year-old woman presenting with bilateral meningocele uncovered during a routine examination for headache complaints. A 5-year follow-up validated the lesion's clinical and imaging stability. Magnetic resonance imaging (MRI) is an essential tool in the diagnosis of this pathology, alongside characteristic symptoms indicating that the meningocele might have progressively expanded into the orbit. In this case we present a therapeutic approach based on pathophysiological hypotheses and review of the literature.
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Affiliation(s)
- E Halimi
- Service des Explorations de la Vision et Neuro-Opthalmologie, Hôpital Roger Salengro CHRU, Lille France
| | - O Wavreille
- Service des Explorations de la Vision et Neuro-Opthalmologie, Hôpital Roger Salengro CHRU, Lille France
| | - R Rosenberg
- Service des Explorations de la Vision et Neuro-Opthalmologie, Hôpital Roger Salengro CHRU, Lille France
| | - I Bouacha
- Service des Explorations de la Vision et Neuro-Opthalmologie, Hôpital Roger Salengro CHRU, Lille France
| | - J-P Lejeune
- Service de Neurochirurgie, Hôpital Roger Salengro CHRU, Lille France
| | - S Defoort-Dhellemmes
- Service des Explorations de la Vision et Neuro-Opthalmologie, Hôpital Roger Salengro CHRU, Lille France
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Ridha MA, Saindane AM, Bruce BB, Riggeal BD, Kelly LP, Newman NJ, Biousse V. MRI findings of elevated intracranial pressure in cerebral venous thrombosis versus idiopathic intracranial hypertension with transverse sinus stenosis. Neuroophthalmology 2013; 37:1-6. [PMID: 24019557 DOI: 10.3109/01658107.2012.738759] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine whether MRI signs suggesting elevated intracranial pressure (ICP) are preferentially found in patients with idiopathic intracranial hypertension (IIH) than in those with cerebral venous thrombosis (CVT). METHODS Among 240 patients who underwent standardized contrast-enhanced brain MRI/MRV at our institution between 9/2009 and 9/2011, 60 with abnormal imaging findings on MRV were included: 27 patients with definite IIH, 2 patients with presumed IIH, and 31 with definite CVT. Medical records were reviewed, and imaging studies were prospectively evaluated by the same neuroradiologist to assess for presence or absence of transverse sinus stenosis (TSS), site of CVT if present, posterior globe flattening, optic nerve sheath dilation/tortuosity, and the size/appearance of the sella turcica. RESULTS 29 IIH patients (28 women, 19 black, median-age 28, median-body mass index, 34) had bilateral TSS. 31 CVT patients (19 women, 13 black, median-age 46, median-BMI 29) had thrombosis of the sagittal (3), sigmoid (3), cavernous (1), unilateral transverse (7), or multiple (16) sinuses or cortical veins (1). Empty/partially-empty sellae were more common in IIH (3/29 and 24/29) than in CVT patients (1/31 and 19/31) (p<0.001). Flattening of the globes and dilation/tortuosity of the optic nerve sheaths were more common in IIH (20/29 and 18/29) than in CVT patients (13/31 and 5/31) (p<0.04). CONCLUSION Although abnormal imaging findings suggestive of raised ICP are more common in IIH, they are not specific for IIH and are found in patients with raised ICP from other causes such as CVT.
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Affiliation(s)
- Maysa A Ridha
- Department of Ophthalmology (MR, BB, BR, LK, NN, VB), Emory University, Atlanta, Georgia, USA
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40
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Galveia JN, Mendonça AP, Costa JM. Paediatric idiopathic intracranial hypertension. BMJ Case Rep 2013; 2013:bcr-2012-007578. [PMID: 23354860 DOI: 10.1136/bcr-2012-007578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) can occur in paediatric age with clinical characteristics that may differ from adult presentation. The authors present a case of an 11-year-old boy, presenting with severe holocranial headaches for the past 4 weeks. Best-corrected visual acuities (BCVA) were 20/200 bilaterally and the fundus examination showed marked bilateral optical disc and macular oedema. CT scan with contrast as well as MRI showed no space occupying lesions, normal permeability of the dural venous sinuses and a partially empty sella. Lumbar puncture revealed an opening pressure of 540 mm Hg, with clear cerebrospinal fluid, with normal biochemistry and cytology. The patient was treated medically and subsequently submitted to a ventriculoperitoneal shunting procedure. 3 months after surgery the symptoms got completely resolved and his BCVA were 20/20 bilaterally.
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Al-Zubidi N, Spitze A, Yalamanchili S, Lee AG. Neuro-ophthalmology Annual Review. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:42-56. [PMID: 26107867 DOI: 10.1097/apo.0b013e3182782e64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To provide a clinical update of the neuro-ophthalmology literature over the last twelve months. DESIGN This is an annual review of current literature from August 1, 2011 to August 1, 2012. METHODS The authors conducted a one year English language neuro-ophthalmology literature search using PubMed from August 1, 2011 to August 1, 2012 using the following search terms: pupil abnormalities, eye movements, diseases of muscle and musculoskeletal junction, optic nerve disorders, optic neuritis and multiple sclerosis, chiasm and posterior primary visual pathway lesions, increased intracranial pressure and related entities, tumors (e.g., meningioma) and aneurysm affecting the visual pathways, vascular diseases, higher visual functions, advances in neuroimaging, and miscellaneous topics in neuro-ophthalmology. The authors included original articles, review articles, and case reports, which revealed the new aspects and updates in neuro-ophthalmology. Letters to the editor, unpublished work, and abstracts were not included in this annual literature review. We propose to update the practicing clinical ophthalmologist on the most clinically relevant literature from the past year. However, this review is not meant to be all-inclusive and highlights only the literature most applicable to the practicing clinical ophthalmologist. RESULTS We reviewed the literature over the past year in neuro-ophthalmology of potential interest and relevance to the comprehensive ophthalmologist. CONCLUSION This annual review provides a brief update on a number of neuroophthalmic conditions that might be of interest to the practicing clinical ophthalmologist.
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Affiliation(s)
- Nagham Al-Zubidi
- From the *Department of Ophthalmology, The Methodist Hospital, Houston, TX; †Department of Ophthalmology and Visual Science, Robert Cizik Eye Clinic, The University of Texas-Houston Medical School, Houston, TX; ‡Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX; §Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; ¶Department ofOphthalmology, Baylor College of Medicine, Houston, Texas; and ∥Departmentof Ophthalmology, The University of Texas Medical Branch, Galveston, TX
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Riggeal BD, Bruce BB, Saindane AM, Ridha MA, Kelly LP, Newman NJ, Biousse V. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology 2012; 80:289-95. [PMID: 23269597 DOI: 10.1212/wnl.0b013e31827debd6] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Transverse sinus stenosis (TSS) is common in idiopathic intracranial hypertension (IIH), but its effect on the course and outcome of IIH is unknown. We evaluated differences in TSS characteristics between patients with IIH with "good" vs. "poor" clinical courses. METHODS All patients with IIH seen in our institution after September 2009 who underwent a high-quality standardized brain magnetic resonance venogram (MRV) were included. Patients were categorized as having a good or poor clinical course based on medical record review. The location and percent of each TSS were determined for each patient, and were correlated to the clinical outcome. RESULTS We included 51 patients. Forty-six patients had bilateral TSS. The median average percent stenosis was 56%. Seventy-one percent of patients had stenoses >50%. Thirty-five of the 51 patients (69%) had no final visual field loss. Eight patients (16%) had a clinical course classified as poor. There was no difference in the average percent stenosis between those with good clinical courses vs those with poor courses (62% vs. 56%, p = 0.44). There was no difference in the percent stenosis based on the visual field grade (p = 0.38). CSF opening pressure was not associated with either location or degree of TSS. CONCLUSION TSS is common, if not universal, among patients with IIH, and is almost always bilateral. There is no correlation between the degree of TSS and the clinical course, including visual field loss, among patients with IIH, suggesting that clinical features, not the degree of TSS, should be used to determine management in IIH.
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Affiliation(s)
- Bryan D Riggeal
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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Vakharia VN, Lote H. Introduction of Sprotte needles to a single-centre acute neurology service: before and after study. JRSM SHORT REPORTS 2012; 3:82. [PMID: 23476725 PMCID: PMC3545339 DOI: 10.1258/shorts.2012.012090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives To introduce atraumatic (Sprotte) lumbar puncture needles and compare complication rates with traumatic (Quincke) needles. Design Complication rates associated with traumatic needle use were retrospectively analysed over a four-week period. Atraumatic needles were then implemented and a prospective analysis of the complication rates was undertaken for a further six weeks. Setting A single-centre acute neurology unit in a London teaching hospital Participants Traumatic needles (n = 24 patients); atraumatic needles (n = 36 patients) Main outcome measures Headache rates, use of over-the-counter medications, further medical assistance, time off work, nausea and vomiting, traumatic taps (as per the count of red blood cells per millilitre in the first sample of cerebrospinal fluid [CSF]) and back pain. Results A comparison of traumatic and atraumatic needles revealed a significant reduction in the incidence of post-lumbar puncture headaches (*P < 0.01), headaches requiring over-the-counter medication (*P < 0.00001), need for further medical assistance (*P < 0.006), time off work (*P < 0.003), nausea and vomiting (*P < 0.01) and traumatic taps as per the count of red blood cells per millilitre in the first sample of CSF (*P < 0.02). There was no significant difference in the incidence of back pain (P > 0.05). Conclusions Most complication outcomes are significantly lower with the use of atraumatic lumbar puncture needles. We present for the first time in the literature that the rate of ‘traumatic taps’ are significantly lower with atraumatic needles. The implementation of atraumatic needles in an acute neurology service is safe and produces reliable, reproducible results in keeping with previously published randomized controlled trials.
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Abstract
Although PTC most frequently occurs in obese females of childbearing age, the syndrome occurs in children as well.(3),(5) Prepubertal children with PTC have a lower incidence of obesity compared with adults and there is no sex predilection. The onset of puberty is best defined by the onset of secondary sexual characteristics such has menarche, pubic hair, and breast development. Children with PTC have a higher incidence of associated conditions and cranial nerve deficits compared with adults. Similar to adult patients, children are at risk for the development of permanent visual loss. In rare instances, children initially diagnosed with PTC will be found to harbor an intracranial neoplasm such as gliomatosis cerebri. An intracranial pressure of 28 cm H2O has recently been established as the upper limit of normal in children.31 Treatment is indicated for the symptomatic management of headaches and to preserve vision. Most children respond to medications such as acetazolamide, furosemide, or topiramate. Surgical treatment such as ONSF and shunting procedures are indicated for children with severe headaches, visual loss, or both despite maximal tolerated medical treatment.
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Affiliation(s)
- Paul H Phillips
- Arkansas Children's Hospital, 1 Children’s Way – Slot 111, Little Rock, AR 72201, USA
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The twists and turns of optic disk swelling in a teenager. Surv Ophthalmol 2012; 58:273-7. [PMID: 22795941 DOI: 10.1016/j.survophthal.2012.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 11/20/2022]
Abstract
A 17-year-old girl developed headaches, transient visual obscuration, pulsatile tinnitus, and hearing loss during an episode of pneumonia. Neuro-ophthalmologic examination disclosed severe bilateral optic disk swelling and macular exudate in the right eye. Lumbar puncture showed an opening pressure of 55 cm H2O without neurochemical abnormalities. Subsequent magnetic resonance imaging showed no mass lesion or signs of venous sinus thrombosis, confirming the diagnosis of idiopathic intracranial hypertension. Following the lumbar puncture, the papilledema resolved but visual acuity decreased to 20/40 in the right eye despite normal color vision. Perimetric signs of psychogenic visual loss developed. This case underscores that hyperacute papilledema can simulate bilateral optic neuritis and illustrates the importance of color vision testing in distinguishing macular visual loss from optic neuropathy. It also illustrates the confounding effect of psychogenic visual loss in judging the clinical course of idiopathic intracranial hypertension.
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Dolinsky DH, Armstrong S. An 8-year-old girl with headache and syncope. Pediatr Ann 2011; 40:594-7. [PMID: 22148273 DOI: 10.3928/00904481-20111103-04] [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: 11/20/2022]
Affiliation(s)
- Diana H Dolinsky
- Department of Pediatrics, Duke University Medical Center, NC, USA.
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