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Zaic S, Krajnc N, Macher S, Michl M, Müller N, Mitsch C, Marik W, Novak K, Wöber C, Pemp B, Bsteh G. Therapeutic effect of a single lumbar puncture in idiopathic intracranial hypertension. J Headache Pain 2024; 25:145. [PMID: 39237912 DOI: 10.1186/s10194-024-01851-x] [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: 08/02/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by increased intracranial pressure. Whilst lumbar puncture (LP) is necessary for the diagnosis of IIH, its therapeutic effect remains unclear. Our aim was to evaluate the therapeutic effect of a single LP in people with IIH (pwIIH). METHODS In this prospective observational study, we analysed short-term neurological and ophthalmological outcomes in pwIIH before, one (D1) and seven days (D7) after the LP. The primary outcome was the change in papilledema degree from baseline. Secondary outcomes included visual outcomes, morphological changes in optical coherence tomography (peripapillary retinal nerve fibre layer [pRNFL] thickness and ganglion cell layer [GCL] volume) and transbulbar sonography (arachnoid optic nerve sheath diameter [AONSD]), and headache outcomes (peak and median headache severity and burden related to headache). RESULTS We included 30 pwIIH (mean age 32.8 years [SD 8.4], 93.3% female, median cerebrospinal fluid [CSF] opening pressure 33.0 cmCSF [IQR 26.9-35.3], median body mass index (BMI) 34.8 kg/m2 [IQR 30.9-40.9]). The median papilledema grading at baseline was 2 (Friedman DI (1999) Pseudotumor cerebri. Neurosurg Clin N Am 10(4):609-621 viii); (Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ (2019) The expanding burden of idiopathic intracranial hypertension. Eye Lond Engl 33(3):478-485); (Ab D, Gt L, Nj V, Sl G, Ml M, Nj N et al. (2007) Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol [Internet]. Apr [cited 2024 Jun 2];143(4). https://pubmed.ncbi.nlm.nih.gov/17386271/ ) and was significantly reduced at D7 (2 [1-2], p = 0.011). Median pRNFL thickness had decreased significantly at D7 (-9 μm [-62.5, -1.3], p = 0.035), with pRNFL thickness at baseline being associated with the pRNFL change (F(1,11) = 18.79, p = 0.001). Mean AONSD had decreased significantly at both D1 (-0.74 mm [0.14], p < 0.001) and D7 (-0.65 mm [0.17], p = 0.01), with AONSD at baseline being associated with the change in AONSD at both time points (D1: β= -0.89, 95% CI -1.37, -0.42, p = 0.002; D7: β= -0.85, 95% CI -1.42, -0.28, p = 0.007). Peak headache severity was slightly lower at D7 (-1/10 [-3, 0], p = 0.026), whereas median headache severity and headache burden remained unchanged. CONCLUSIONS This short-term follow-up study in pwIIH undergoing a single LP suggests a moderate effect on ophthalmological but not headache outcomes. The usefulness of LP as a therapeutic measure in IIH remains controversial and should likely be reserved for patients with limited treatment options, e.g., in pregnancy or intolerability to medication.
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Affiliation(s)
- Sina Zaic
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Martin Michl
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Nina Müller
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Mitsch
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
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Corecha Santos R, Gupta B, Santiago RB, Sabahi M, Kaye B, Dabecco R, Obrzut M, Adada B, Velasquez N, Borghei-Razavi H. Endoscopic endonasal optic nerve sheath decompression (EONSD) for idiopathic intracranial hypertension: Technical details and meta-analysis. Clin Neurol Neurosurg 2023; 229:107750. [PMID: 37146367 DOI: 10.1016/j.clineuro.2023.107750] [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: 01/24/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The neurosurgical management of idiopathic intracranial hypertension (IIH) remains controversial. Although shunting and newer endovascular stenting techniques are part of the neurosurgical armamentarium to treat medically refractory IIH symptoms, optic nerve sheath fenestration has traditionally been performed by ophthalmologists. OBJECTIVE We present a detailed cadaveric dissection that simulates the endoscopic endonasal optic nerve sheath decompression (EONSD) technique along with the literature review. METHODS EONSD was performed in four freshly injected cadaveric specimens. Additionally, a systematic review from different electronic databases has been done. RESULTS Bilateral EONSD was performed in all specimens without significant technical difficulties. Based on our experience, there is no need to expose the periorbita or orbital apex. The primary anatomic landmarks were the optic canal, the lateral opticocarotid recess, the tuberculum, the limbus, and the clinoid segment of the internal carotid artery. Based on the systematic review, 68 patients (77.9% female) underwent EONSD, with a mean age of 33.4 ± 6.9 years in adult patients. Follow-up ranged from 3 to 58 months across different studies. The pooled meta-analysis showed headache, papilledema, and visual disturbance improvement in 78% [95%CI 0.65-0.90], 72% [95%CI 0.61-0.83], and 88% [95%CI 0.80-0.96] of cases who underwent EONSD, respectively. The subgroup analysis showed there was no statistically significant difference between unilateral and bilateral EONSD in terms of different measured outcomes. CONCLUSION EONSD is a feasible surgical procedure that may obviate the need for shunting in patients with IIH. Although clinical studies showed that EONSD is a safe and effective technique, further studies are required to establish the preferences of either unilateral or bilateral approaches.
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Affiliation(s)
- Romel Corecha Santos
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Bhavika Gupta
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Raphael Bastianon Santiago
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Mohammadmahdi Sabahi
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Brandon Kaye
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Rocco Dabecco
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Michal Obrzut
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Badih Adada
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Nathalia Velasquez
- Department of Otolaryngology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Hamid Borghei-Razavi
- Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
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Behdad B, Bagheri A, Tavakoli M, Pakravan M. Association of Nephropathic Cystinosis and Pseudotumor Cerebri with Bilateral Duane Syndrome Type I. Neuroophthalmology 2014; 38:74-77. [PMID: 27928278 DOI: 10.3109/01658107.2013.874451] [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: 08/19/2013] [Revised: 10/07/2013] [Accepted: 10/23/2013] [Indexed: 11/13/2022] Open
Abstract
A 15-year-old girl, a known case of nephropathic cystinosis with a history of kidney transplantation, presented for evaluation of lid drooping in lateral gaze and a recent-onset headache. Examination of ocular movements showed bilateral limitation of abduction combined with narrowing of palpebral fissure in adduction. Deposition of polychromatic crystals in the conjunctiva and corneal stroma of both eyes was evident. Both optic discs were oedematous and intracranial pressure was 270 mm CSF, which responded to oral acetazolamide. The patient developed metabolic imbalances and multiple organ failure, from which she expired 3 months after presentation.
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Affiliation(s)
- Bahareh Behdad
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Abbas Bagheri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mehdi Tavakoli
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mohammad Pakravan
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences Tehran Iran
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Faz G, Butler IJ, Koenig MK. Incidence of papilledema and obesity in children diagnosed with idiopathic ''benign'' intracranial hypertension: case series and review. J Child Neurol 2010; 25:1389-92. [PMID: 20357237 PMCID: PMC3099426 DOI: 10.1177/0883073810364853] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Idiopathic intracranial hypertension is an important cause of headaches in the pediatric population and can lead to permanent blindness if not diagnosed in a timely manner. The aim of this study was to characterize the incidence of papilledema and obesity in children with idiopathic intracranial hypertension. We retrospectively analyzed 27 patients followed at The University of Texas Houston Pediatric Neurology Clinic. Papilledema was absent in 13 (48%) patients. The majority of our patients were nonobese (70%). Our results are contrary to the current medical practice of associating papilledema and obesity with idiopathic intracranial hypertension in childhood and highlight the importance of revised diagnostic criteria in this population needed to detect and manage this condition.
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Affiliation(s)
- Gabriel Faz
- The University of Texas Medical School at Houston, Houston, Texas
| | - Ian J. Butler
- The University of Texas Medical School at Houston, Department of Pediatrics, Division of Child & Adolescent Neurology, Houston, Texas
| | - Mary Kay Koenig
- The University of Texas Medical School at Houston, Department of Pediatrics, Division of Child & Adolescent Neurology, Houston, Texas
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Obesity and reproduction: an educational bulletin. Fertil Steril 2008; 90:S21-9. [PMID: 19007633 DOI: 10.1016/j.fertnstert.2008.08.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 08/05/2008] [Indexed: 11/30/2022]
Abstract
This Educational Bulletin describes the effect of obesity on reproduction and discusses treatment options.
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Bassan H, Berkner L, Stolovitch C, Kesler A. Asymptomatic idiopathic intracranial hypertension in children. Acta Neurol Scand 2008; 118:251-5. [PMID: 18341683 DOI: 10.1111/j.1600-0404.2008.01007.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To define characteristics of pediatric asymptomatic idiopathic intracranial hypertension (IIH). PATIENTS AND METHODS We retrospectively reviewed our Neuro-Ophthalmology database (2000-2006) for all cases of symptomatic and asymptomatic pediatric IIH. RESULTS Out of 45 IIH cases, 14 (31.1%) were asymptomatic (incidental examination). When compared with children with symptomatic IIH, asymptomatic cases were younger [5.6 (1.8-15) vs 11.0 (5-17) years, P = 0.007], had lower percentage of obesity (14.3% vs 48.4%, P = 0.046), and had male predominance (71.4% vs 38.7%, P = 0.06). Asymptomatic cases required shorter duration of acetazolamide treatment [3 (0-8), vs 6 (0-20) months, P = 0.021], and resulted in complete resolution of swollen discs. CONCLUSIONS We speculate that asymptomatic IIH may be more common in young children and could represent a milder form or a presymptomatic phase before evolving into classic symptomatic IIH. Further studies to assess the clinical significance of asymptomatic IIH are warranted.
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Affiliation(s)
- H Bassan
- Pediatric Neurology Unit, 'Dana' Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Increased Intracranial Pressure Related to Systemic Lupus Erythematosus: A 26-year Experience. Semin Arthritis Rheum 2008; 38:110-5. [DOI: 10.1016/j.semarthrit.2007.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 09/05/2007] [Accepted: 09/23/2007] [Indexed: 11/18/2022]
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Chebli JMF, Gaburri PD, de Souza AFM, da Silva CEAP, Pinto JRF, Felga GEG. Benign intracranial hypertension during corticosteroid therapy for idiopathic ulcerative colitis: another indication for cyclosporine? J Clin Gastroenterol 2004; 38:827-8. [PMID: 15365415 DOI: 10.1097/01.mcg.0000139032.53816.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Rosa N, Giamundo A, Jura A, Iaccarino G, Romano A. Mesalazine-associated benign intracranial hypertension in a patient with ulcerative colitis. Am J Ophthalmol 2003; 136:212-3. [PMID: 12834704 DOI: 10.1016/s0002-9394(02)02275-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of benign intracranial hypertension related to mesalazine use. DESIGN Observational case report. METHODS A 23-year-old-woman with sudden visual loss, headache, and a history of ulcerative colitis treated with mesalazine underwent ophthalmologic examination, echography, magnetic resonance imaging, and lumbar puncture. RESULTS The examinations disclosed benign intracranial hypertension that resolved when mesalazine was discontinued and recurred when the drug was restarted. CONCLUSIONS We recommend periodic ocular fundus examination for patients undergoing long-term therapy with mesalazine, especially if decreased vision, headaches, or neck stiffness are present, to avoid potentially severe complications of intracranial hypertension
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Affiliation(s)
- Nicola Rosa
- Eye Department, 2nd University of Naples, Naples, Italy.
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Kuensting LL. A 15-year-old with blurred vision, nausea, back pain, and abdominal pain. J Emerg Nurs 2003; 29:171-3. [PMID: 12660705 DOI: 10.1067/men.2003.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Laura L Kuensting
- St John's Mercy Medical Center, 754 Chevron Drive, St Louis, MO 63125, USA.
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Abstract
Headaches are a universal experience and one of the most common causes for physician consultation. The physician must determine whether a neuroimaging study is warranted to aid in the diagnosis of primary or secondary headaches. Guidelines on neuroimaging of headache patients have been developed based on review of the literature; however, their applicability must be adapted to specific clinical situations. In general, neuroimaging is most likely to be useful if the history is not typical of a primary headache type (e.g., tension type, migraine, cluster headaches) or the neurological examination is abnormal. Neuroimaging has been crucial in the investigation of the pathogenesis of migraine and cluster headaches. Secondary headaches, which may be diagnosed by neuroimaging studies, include subarachnoid hemorrhage, cerebral venous thrombosis, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, aqueductal stenosis, and arterial dissection.
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Affiliation(s)
- Dara G Jamieson
- University of Pennsylvania School of Medicine, Pennsylvania Hospital, 330 South 9th Street, Philadelphia, PA 19107, USA.
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Plaza G, Vela L, Herraiz C, de Los Santos G. [Benign intracranial hypertension and sensorineural hearing loss]. Med Clin (Barc) 2001; 116:75. [PMID: 11181275 DOI: 10.1016/s0025-7753(01)71722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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