1
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Arpa A, Yigit A, Basar I, Yilmaz T. The Effect of Hydrocephalus on the Optic Nerve in the Presence of Intracranial Mass. World Neurosurg 2024; 187:e656-e664. [PMID: 38704142 DOI: 10.1016/j.wneu.2024.04.142] [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: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The measurement of optic nerve sheath diameter is a noninvasive, practical, and economical method used to identify increased intracranial pressure. The purpose of this study is to detect the preoperative and postoperative changes in optic nerve sheath diameter in patients with intracranial mass, to correlate these changes with optic nerve diameter variations, and to evaluate the impact of hydrocephalus on these alterations. MATERIAL AND METHOD This study was conducted with patients who presented to our clinic with complaints of intracranial mass, were decided for surgery, and underwent surgical procedures. FINDINGS The optic nerve and optic nerve sheath diameter measurement values were different preoperatively and postoperatively, with a significant decrease in the optic nerve sheath diameter in all groups in postoperative measurements, while the optic nerve diameter significantly increased. CONCLUSIONS Although there was no significant difference between the effects of hydrocephalus and intracranial mass-related increase in intracranial pressure on the optic nerve and optic nerve sheath, it was observed that hydrocephalus increased intracranial pressure when considering the Evans ratio. It has been determined that as ventricular dilatation increases, so does intracranial pressure, which leads to an increase in the diameter of the optic nerve sheath, resulting in papilledema and thinning of the optic nerve. These findings indicate the importance of early cerebrospinal fluid diversion and monitoring optic nerve sheath diameter in the management.
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Affiliation(s)
- Abdurrahman Arpa
- Department of Neurosurgery, Dicle University School of Medicine, Diyarbakir, Turkey.
| | - Abdullah Yigit
- Department of Neurosurgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Ibrahim Basar
- Department of Neurosurgery, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Tevfik Yilmaz
- Department of Neurosurgery, Dicle University School of Medicine, Diyarbakir, Turkey
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2
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Fujii N, Nomura S, Izuma H, Ishihara H. Which Theory of Cerebrospinal Fluid Production and Absorption Do Neurosurgeons Teach to Medical Students? Survey from Medical Universities in Japan, 2022. Neurol Med Chir (Tokyo) 2024; 64:241-246. [PMID: 38719580 PMCID: PMC11230870 DOI: 10.2176/jns-nmc.2023-0277] [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: 11/24/2023] [Accepted: 02/27/2024] [Indexed: 06/18/2024] Open
Abstract
Several new studies have been conducted on cerebrospinal fluid (CSF) dynamics. Our educational guidelines, the Model Core Curriculum for Medical University, recommend access to the best current information. However, we do not know whether or when to introduce changes to this concept.We surveyed which theory of CSF dynamics taught to students by neurosurgeons. The old theory is the bulk flow theory, and the new theory explains that CSF is produced from the choroid plexus and capillaries; CSF then pulsates and drains into the venous and lymphatic systems through newly discovered pathways.Old and new theories were taught to 64.8% and 27.0% of students, respectively. The reason for teaching the old theory was to help them understand the pathogenesis of noncommunicating hydrocephalus (77.1%), whereas the reason for teaching the new theory was to teach the latest knowledge (40.0%). Physicians who wished to teach the new theory in the near future accounted for 47.3%, which was higher than those who would teach the new theory in 2022 (27.0%), and those who still wished to teach the old theory in the near future accounted for 43.2%.An education policy on CSF dynamics will be established when we interpret ventricular enlargement and its improvement by third ventriculostomy in noncommunicating hydrocephalus based on the new theory. The distributed answers in the survey shared that it is difficult to teach about CSF dynamics and provided an opportunity to discuss these issues.
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Affiliation(s)
- Natsumi Fujii
- Department of Neurosurgery, Yamaguchi University School of Medicine
| | - Sadahiro Nomura
- Department of Neurosurgery, Yamaguchi University School of Medicine
| | - Hiroshi Izuma
- Department of Neurosurgery, Yamaguchi University School of Medicine
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3
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El-Haddad NSEDM, Ismael SA, Shabaan N, Ghoraba Y, Elhamrawy EA, Lamie N, Atwaa F, Mohamed SA, Mansour MN. Can optic disc vessel density help in cases of residual disc elevation after shunt surgery in cases of idiopathic intracranial hypertension? Lasers Med Sci 2024; 39:125. [PMID: 38713436 PMCID: PMC11076362 DOI: 10.1007/s10103-024-04064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
AIM To detect if we can use the reduction in the optic disc vessel density as an indicator to the reduction in intracranial tension in patients with residual optic disc elevation after shunt surgery as fundus examination in those cases is not conclusive. PATIENTS AND METHOD 21 patients with papilledema due to idiopathic intracranial hypertension underwent shunt surgery. Full neurological and ophthalmological assessments were done. The optic disc vessel density was measured before and 3 months after surgery. Patients were then divided according to the resolution of papilledema into 2 groups: 1) Residual disc elevation group. 2) Completely resolved disc edema group. CSF pressure was measured via lumber puncture preoperative for all patients and 3 months post-operative only for patients with residual disc edema. A comparison between both groups was done. RESULTS There was a highly statistically significant difference between the two groups as regard the papilledema grade (the residual disc elevation group had a higher grade of papilledema) with P-value=0.000. As regard the difference in the preoperative optic disc vessel density between the two groups, there were statistically significant differences (optic disc vessel density was more in the residual disc elevation group). As regard the postoperative optic disc vessel density, there were non-significant differences between the two groups in whole image, inside disc and peripapillary vessel density (either in macro or microvasculature). CONCLUSION The optic disc vessel density decreased with normal postoperative CSF opening pressure in cases with residual disc elevation postoperatively. Thus, in cases of residual optic disc swelling after shunt surgery, we can detect the reduction of intracranial pressure by the reduction in the optic disc vessel density which is a safe non-invasive technique. That may help in cases of residual disc elevation.
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Affiliation(s)
| | | | | | | | | | - Nashwaa Lamie
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fatma Atwaa
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Jukkola J, Kaakinen M, Singh A, Moradi S, Ferdinando H, Myllylä T, Kiviniemi V, Eklund L. Blood pressure lowering enhances cerebrospinal fluid efflux to the systemic circulation primarily via the lymphatic vasculature. Fluids Barriers CNS 2024; 21:12. [PMID: 38279178 PMCID: PMC10821255 DOI: 10.1186/s12987-024-00509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Inside the incompressible cranium, the volume of cerebrospinal fluid is directly linked to blood volume: a change in either will induce a compensatory change in the other. Vasodilatory lowering of blood pressure has been shown to result in an increase of intracranial pressure, which, in normal circumstances should return to equilibrium by increased fluid efflux. In this study, we investigated the effect of blood pressure lowering on fluorescent cerebrospinal fluid tracer absorption into the systemic blood circulation. METHODS Blood pressure lowering was performed by an i.v. administration of nitric oxide donor (sodium nitroprusside, 5 µg kg-1 min-1) or the Ca2+-channel blocker (nicardipine hydrochloride, 0.5 µg kg-1 min-1) for 10, and 15 to 40 min, respectively. The effect of blood pressure lowering on cerebrospinal fluid clearance was investigated by measuring the efflux of fluorescent tracers (40 kDa FITC-dextran, 45 kDa Texas Red-conjugated ovalbumin) into blood and deep cervical lymph nodes. The effect of nicardipine on cerebral hemodynamics was investigated by near-infrared spectroscopy. The distribution of cerebrospinal fluid tracers (40 kDa horse radish peroxidase,160 kDa nanogold-conjugated IgG) in exit pathways was also analyzed at an ultrastructural level using electron microscopy. RESULTS Nicardipine and sodium nitroprusside reduced blood pressure by 32.0 ± 19.6% and 24.0 ± 13.3%, while temporarily elevating intracranial pressure by 14.0 ± 7.0% and 18.2 ± 15.0%, respectively. Blood pressure lowering significantly increased tracer accumulation into dorsal dura, deep cervical lymph nodes and systemic circulation, but reduced perivascular inflow along penetrating arteries in the brain. The enhanced tracer efflux by blood pressure lowering into the systemic circulation was markedly reduced (- 66.7%) by ligation of lymphatic vessels draining into deep cervical lymph nodes. CONCLUSIONS This is the first study showing that cerebrospinal fluid clearance can be improved with acute hypotensive treatment and that the effect of the treatment is reduced by ligation of a lymphatic drainage pathway. Enhanced cerebrospinal fluid clearance by blood pressure lowering may have therapeutic potential in diseases with dysregulated cerebrospinal fluid flow.
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Affiliation(s)
- Jari Jukkola
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Mika Kaakinen
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Abhishek Singh
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Sadegh Moradi
- Opto-Electronics and Measurement Technique Research Unit, Infotech Oulu, University of Oulu, Oulu, Finland
| | - Hany Ferdinando
- Research Unit of Health Science and Technology, University of Oulu, Oulu, Finland
| | - Teemu Myllylä
- Opto-Electronics and Measurement Technique Research Unit, Infotech Oulu, University of Oulu, Oulu, Finland
- Research Unit of Health Science and Technology, University of Oulu, Oulu, Finland
| | - Vesa Kiviniemi
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Oulu University Hospital, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Lauri Eklund
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland.
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Wang H, Cao L, Kwapong WR, Liu G, Wang R, Liu J, Wu B. Optic Nerve Head Changes Measured by Swept Source Optical Coherence Tomography and Angiography in Patients with Intracranial Hypertension. Ophthalmol Ther 2023; 12:3295-3305. [PMID: 37792243 PMCID: PMC10640446 DOI: 10.1007/s40123-023-00822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION This study explored the structural and microvascular changes in the optic nerve head (ONH) of patients with intracranial hypertension (IH) by using swept-source optical coherence tomography (SS-OCT)/OCT angiography (OCTA) and evaluated their association with clinical features. METHODS The optic disc morphology, peripapillary retinal nerve fiber layer (pRNFL), ganglion cell-inner plexiform layer (GCIPL), and microvascular densities of the nerve fiber layer plexus (NFLP), superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP) were measured by the SS-OCT/OCTA tool. Frisen score, visual acuity, and intracranial pressure were assessed and recorded in patients with IH. RESULTS Sixty-one patients with IH and 65 controls were included in this study. Patients with IH showed thicker pRNFL and GCIPL thickness with larger ONH rim area when compared to controls (P < 0.001). Microvascular densities were increased in NFLP while densities were reduced in SVP, ICP, and DCP when compared to controls (P < 0.001). Structural thickness and microvascular densities were significantly correlated with Frisen scores (P < 0.05) and intracranial pressure (P < 0.05) in patients with IH. CONCLUSION Structural and microvasculature variations of the ONH were found in patients with IH compared to controls. Importantly, we showed that structural and microvascular changes in the ONH were correlated with their Frisen score and intracranial pressure in patients with IH.
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Affiliation(s)
- Hang Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Guina Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Ruilin Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
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Alpergin BC, Zaimoglu M, Beger O, Kılınç MC, Mete EB, Hasimoglu S, Eroglu U. Interthalamic Adhesion: Can it be used to Diagnose Idiopathic Intracranial Hypertension? World Neurosurg 2023; 180:e408-e414. [PMID: 37769844 DOI: 10.1016/j.wneu.2023.09.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE This retrospective study aimed at determining the dimension of the interthalamic adhesion (ITA) in patients with the idiopathic intracranial hypertension (IIH) for assisting in preoperative radiologic diagnosis. METHODS The study universe consisted of magnetic resonance images of 20 patients with IIH (age: 22.70 ± 4.04 years, sex: 14 females and 6 males) and 20 normal subjects (age 22.30± 2.94 years, sex: 14 females and 6 males). To determine the morphology of ITA, its height (vertical diameter) and width (horizontal diameter) were measured on the coronal and axial planes, respectively. RESULTS The height and width of ITA in IIH were measured as 2.58 ± 0.71 mm (range: 1.40-4.20 mm) and 2.73 ± 0.77 mm (range: 1.70-4.40 mm), respectively. Its height and width in controls were measured as 4.99 ± 1.04 mm (range: 2.70-6.30 mm) and 4.92 ± 1.11 mm (range: 2.60-6.50 mm), respectively. ITA height and width in IIH was significantly smaller compared with controls (P < 0.001). For an arbitrary cutoff of 3.85 mm, the sensitivity of the height of ITA was 85% with 95% specificity. For an arbitrary cutoff of 4.45 mm, the sensitivity of the width of ITA was 75% with 100% specificity. CONCLUSIONS The height and width of ITA are approximately 50% smaller in IIH than controls; therefore alterations in the dimension of ITA may be a valuable radiologic sign for the diagnosis of IIH.
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Affiliation(s)
- Baran Can Alpergin
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Murat Zaimoglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Orhan Beger
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Mustafa Cemil Kılınç
- Department of Neurosurgery, Çorum Erol Olçok Training and Research Hospital, Hitit University, Çorum, Turkey
| | - Emre Bahir Mete
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Siavash Hasimoglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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7
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Domingues R, Senne C, Lacerda CB. Higher cerebrospinal fluid (CSF) opening pressure in patients with idiopatic intracranial hypertension (IIH) with permanent visual impairment. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective
The aim of this study was to identify potential visual prognostic markers in patients with idiopathic intracranial hypertension (IIH).
Methods
Patients with IIH of an outpatient headache clinic in São Paulo, Brazil, were retrospectively evaluated and divided in two groups with and without the presence of permanent visual deficit attributed to IIH. Body mass index (BMI), opening CSF pressure, and the frequency of IIH related MRI abnormalities were compared between these two groups.
Results
Twenty-nine patients, with 35,39±9,93 years, being twenty-eight female (96.55%) were included in the study. Reduced visual acuity attributed to IIH was registered in 16 (55.17%). According to BMI 17.4% had overweight and 82.6% were obese. Brain MRI was normal in 6 (20.69%). BMI, obesity, and the presence of MRI abnormalities were not associated with visual impairment. Initial CSF opening pressure was significantly higher in the group of patients with reduced visual acuity (40.4±13.14 x 30.5±3.41, P=0,015).
Conclusion
Higher CSF opening pressure at onset was significantly associated with a higher percentage of visual impairment in patients with IIH suggesting this measure as a potential prognostic marker for patients with IIH.
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8
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Souza MNP, Costa BDAL, Santos FRDR, Fortini I. Update on Idiopathic Intracranial Hypertension Management. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:227-231. [PMID: 35976300 PMCID: PMC9491417 DOI: 10.1590/0004-282x-anp-2022-s110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Idiopathic Intracranial Hypertension (IIH) is a secondary headache with a steadily growing incidence. Currently, there is little evidence to guide the treatment of IIH. OBJECTIVE To review the pathophysiology of IIH, with focus on the role of obesity as a risk factor, and the implications for new therapeutic perspectives. METHODS in this narrative review, we summarized the current knowledge on treatment options highlighting available evidence for managing intracranial hypertension, obesity, and headache. RESULTS Clinical Presentation: headache is the most common symptom and a significant cause of quality-of-life impairment. Visual loss is common in the diagnosis. Pathophysiology: there is no unified theory able to explain all symptoms and the evolution of the disease. There is growing data pointing to metabolic changes and obesity with a central role in IIH pathophysiology. Treatment: most published data on IIH treatment is related to pressure control and protection from visual loss. Acetazolamide and cerebrospinal fluid diversion are the best options available. Optic nerve sheath fenestration might be useful to temporally control the pressure over the optic nerve and thus protect from visual deterioration. Recently, venous sinus stenting has proven to be a safe option in selected cases. Finally, bariatric surgery has proven to effectively control elevated intracranial pressure. CONCLUSION IIH is a potential cause of high disability. Early recognition is important, and treatment should be tailored to the needs of each case. There is a lack of research on headache management, which might persist after ICP control.
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Affiliation(s)
| | | | | | - Ida Fortini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil
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9
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Kapadia A, Wong E, Heyn C. Reversal of Imaging Findings of Idiopathic Intracranial Hypertension After Lumbar Puncture. JAMA Neurol 2022; 79:416-417. [PMID: 35254418 DOI: 10.1001/jamaneurol.2022.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anish Kapadia
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Erin Wong
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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10
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Petrayevsky AV, Trishkin KS, Gndoyan IA, Lomakina VE, Adelshina NA. [Idiopathic intracranial hypertension (case study)]. Vestn Oftalmol 2021; 137:122-129. [PMID: 34726866 DOI: 10.17116/oftalma2021137051122] [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] [Indexed: 11/17/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a rare pathological condition that without proper therapy often results in permanent vision loss. Diagnosis of IIH is often difficult, since it is characterized by a combination of numerous specific and non-specific ophthalmological and neurological criteria. Difficulties in diagnosis significantly delay the prescription of treatment, which affects the visual prognosis. The description of this clinical case is intended to present our own experience in the diagnosis and management tactics of a patient with this pathology, which will be useful for practicing ophthalmologists.
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Affiliation(s)
| | - K S Trishkin
- Volgograd State Medical University, Volgograd, Russia.,Volgograd Regional Clinical Hospital No. 1, Volgograd, Russia
| | - I A Gndoyan
- Volgograd State Medical University, Volgograd, Russia.,Volgograd Regional Clinical Hospital No. 1, Volgograd, Russia
| | - V E Lomakina
- Volgograd State Medical University, Volgograd, Russia.,Volgograd Regional Clinical Hospital No. 1, Volgograd, Russia
| | - N A Adelshina
- Volgograd State Medical University, Volgograd, Russia.,Volgograd Regional Clinical Hospital No. 1, Volgograd, Russia
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11
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Taşcioğlu T. The diagnostic value of cranial MRI findings in idiopathic intracranial hypertension: evaluating radiological parameters associated with intracranial pressure. Acta Radiol 2021; 63:1390-1397. [PMID: 34424106 DOI: 10.1177/02841851211038803] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a disease that can result in blindness if there is a delay in diagnosis. Although it is stated that cranial imaging should be normal among the diagnostic criteria, we know that some radiological parameters can be used for the pre-diagnosis of IIH. PURPOSE To determine the predictive value of radiological parameters for the diagnosis of IIH with cranial magnetic resonance imaging (MRI). MATERIAL AND METHODS The study included a group of 19 patients with IIH ("IIH Group"), a group of 34 patients with hyperintensity around the optic nerve in cranial MRI ("Radiological Increased Intracranial Pressure Group"), and a "Control Group" consisting of 45 healthy individuals. All patients were evaluated using cranial MRI with respect to the presence/absence of empty sella, flattening of the posterior globe, hyperintensity around the optic nerve, optic nerve tortuosity, and optic nerve protrusion. In addition, optic nerve sheath diameter measurement was performed in all patients using cranial axial T2 sequence. RESULTS It was found that optic nerve tortuosity (P = 0.002), flattening of the posterior globe (P = 0.013), and optic nerve protrusion (P = 0.033) were the best parameters to distinguish patients with IIH and those with optic nerve subarachnoid space enlargement. A scoring system was developed according to these data. CONCLUSION In the presence of hyperintensity around the optic nerve, it may be possible to evaluate optic nerve tortuosity, flattening of the posterior globe, and optic nerve protrusion using cranial MRI in order to come upon a preliminary diagnosis of IIH.
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Affiliation(s)
- Tuncer Taşcioğlu
- Department of Neurosurgery, Ankara Training and Research Hospital, Ankara, Turkey
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12
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Transient changes in white matter microstructure during general anesthesia. PLoS One 2021; 16:e0247678. [PMID: 33770816 PMCID: PMC7997710 DOI: 10.1371/journal.pone.0247678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Cognitive dysfunction after surgery under general anesthesia is a well-recognized clinical phenomenon in the elderly. Physiological effects of various anesthetic agents have been studied at length. Very little is known about potential effects of anesthesia on brain structure. In this study we used Diffusion Tensor Imaging to compare the white matter microstructure of healthy control subjects under sevoflurane anesthesia with their awake state. Fractional Anisotropy, a white mater integrity index, transiently decreases throughout the brain during sevoflurane anesthesia and then returns back to baseline. Other DTI metrics such as mean diffusivity, axial diffusivity and radial diffusivity were increased under sevoflurane anesthesia. Although DTI metrics are age dependent, the transient changes due to sevoflurane were independent of age and sex. Volumetric analysis shows various white matter volumes decreased whereas some gray matter volumes increased during sevoflurane anesthesia. These results suggest that sevoflurane anesthesia has a significant, but transient, effect on white matter microstructure. In spite of the transient effects of sevoflurane anesthesia there were no measurable effects on brain white matter as determined by the DTI metrics at 2 days and 7 days following anesthesia. The role of white matter in the loss of consciousness under anesthesia will need to be studied and MRI studies with subjects under anesthesia will need to take these results into account.
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Abstract
Objective To review and discuss the clinical presentation and treatment of
idiopathic intracranial hypertension. Discussion Visual alterations and headache are the two main symptoms of
idiopathic intracranial hypertension, although additional
features including cranial nerve palsies, cognitive deficits,
olfactory deficits and tinnitus are not uncommon. The headache
associated with idiopathic intracranial hypertension frequently
has a migrainous phenotype. The underlying cause of the disorder
has not yet been elucidated. Several hypotheses have been
postulated but none of them can explain the full clinical
picture. Therapeutic options remain limited, focusing mainly on
reduction in body weight and the reduction of CSF production
with carbonic anhydrase inhibitors. Conclusion The accurate diagnosis of idiopathic intracranial hypertension is
essential as visual deterioration due to papilledema may be
irreversible. Given its phenotypic similarity and frequent
overlap with chronic migraine it is essential to consider
idiopathic intracranial hypertension in the diagnostic workup of
chronic headache; in particular, when considering its increasing
prevalence. Understanding in detail the pathophysiological
mechanisms behind the associated headache would also allow study
of current and future therapeutic options in a structured
way.
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Affiliation(s)
- Naz Raoof
- Department of Paediatrics, Strabismus and Neuro-ophthalmology, Moorfields Eye Hospital, London, UK.,Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Jan Hoffmann
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, UK
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14
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Quantitative magnetic resonance image assessment of the optic nerve and surrounding sheath after spaceflight. NPJ Microgravity 2020; 6:30. [PMID: 33083526 PMCID: PMC7545196 DOI: 10.1038/s41526-020-00119-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022] Open
Abstract
A subset of long-duration spaceflight astronauts have experienced ophthalmic abnormalities, collectively termed spaceflight-associated neuro-ocular syndrome (SANS). Little is understood about the pathophysiology of SANS; however, microgravity-induced alterations in intracranial pressure (ICP) due to headward fluid shifts is the primary hypothesized contributor. In particular, potential changes in optic nerve (ON) tortuosity and ON sheath (ONS) distension may indicate altered cerebrospinal fluid dynamics during weightlessness. The present longitudinal study aims to provide a quantitative analysis of ON and ONS cross-sectional areas, and ON deviation, an indication of tortuosity, before and after spaceflight. Ten astronauts undergoing ~6-month missions on the International Space Station (ISS) underwent high-resolution magnetic resonance imaging (MRI) preflight and at five recovery time points extending to 1 year after return from the ISS. The mean changes in ON deviation, ON cross-sectional area, and ONS cross-sectional area immediately post flight were −0.14 mm (95% CI: −0.36 to 0.08, Bonferroni-adjusted P = 1.00), 0.13 mm2 (95% CI −0.66 to 0.91, Bonferroni-adjusted P = 1.00), and −0.22 mm2 (95% CI: −1.78 to 1.34, Bonferroni-adjusted P = 1.00), respectively, and remained consistent during the recovery period. Terrestrially, ONS distension is associated with increased ICP; therefore, these results suggest that, on average, ICP was not pathologically elevated immediately after spaceflight. However, a subject diagnosed with optic disc edema (Frisen Grade 1, right eye) displayed increased ONS area post flight, although this increase is relatively small compared to clinical populations with increased ICP. Advanced quantitative MRI-based assessment of the ON and ONS could help our understanding of SANS and the role of ICP.
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Shpanskaya K, Quon JL, Lober RM, Nair S, Johnson E, Cheshier SH, Edwards MSB, Grant GA, Yeom KW. Diffusion tensor magnetic resonance imaging of the optic nerves in pediatric hydrocephalus. Neurosurg Focus 2020; 47:E16. [PMID: 31786546 DOI: 10.3171/2019.9.focus19619] [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: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While conventional imaging can readily identify ventricular enlargement in hydrocephalus, structural changes that underlie microscopic tissue injury might be more difficult to capture. MRI-based diffusion tensor imaging (DTI) uses properties of water motion to uncover changes in the tissue microenvironment. The authors hypothesized that DTI can identify alterations in optic nerve microstructure in children with hydrocephalus. METHODS The authors retrospectively reviewed 21 children (< 18 years old) who underwent DTI before and after neurosurgical intervention for acute obstructive hydrocephalus from posterior fossa tumors. Their optic nerve quantitative DTI metrics of mean diffusivity (MD) and fractional anisotropy (FA) were compared to those of 21 age-matched healthy controls. RESULTS Patients with hydrocephalus had increased MD and decreased FA in bilateral optic nerves, compared to controls (p < 0.001). Normalization of bilateral optic nerve MD and FA on short-term follow-up (median 1 day) after neurosurgical intervention was observed, as was near-complete recovery of MD on long-term follow-up (median 1.8 years). CONCLUSIONS DTI was used to demonstrate reversible alterations of optic nerve microstructure in children presenting acutely with obstructive hydrocephalus. Alterations in optic nerve MD and FA returned to near-normal levels on short- and long-term follow-up, suggesting that surgical intervention can restore optic nerve tissue microstructure. This technique is a safe, noninvasive imaging tool that quantifies alterations of neural tissue, with a potential role for evaluation of pediatric hydrocephalus.
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Affiliation(s)
| | - Jennifer L Quon
- 2Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Robert M Lober
- 3Department of Neurosurgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Sid Nair
- 4Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - Eli Johnson
- 1Stanford University School of Medicine, Stanford
| | - Samuel H Cheshier
- 5Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | - Michael S B Edwards
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - Gerald A Grant
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - Kristen W Yeom
- 4Division of Pediatric Neuroradiology, Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
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16
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Elsaid N, Ahmed O, Belal T, Razek A, Azab A. Pathogenesis and Evaluation of the Effects of Idiopathic Intracranial Hypertension on the Optic Nerves. Neuroophthalmology 2020; 44:281-289. [PMID: 33012916 PMCID: PMC7518303 DOI: 10.1080/01658107.2020.1751859] [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: 01/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a clinical syndrome of raised intracranial pressure of unknown aetiology. Although papilloedema and visual alterations are among the most important manifestations of the disease, their pathophysiological mechanisms are not fully understood. We aim to review the up-to-date evidence regarding how the optic nerves are affected, the possible pathophysiology and the methods of their assessment.
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Affiliation(s)
- Nada Elsaid
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Omar Ahmed
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Tamer Belal
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Ahmed Razek
- Faculty of Medicine, Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Ahmed Azab
- Faculty of Medicine, Department of Neurology, Mansoura University, Mansoura, Egypt
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17
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Moreno-Ajona D, McHugh JA, Hoffmann J. An Update on Imaging in Idiopathic Intracranial Hypertension. Front Neurol 2020; 11:453. [PMID: 32587565 PMCID: PMC7297913 DOI: 10.3389/fneur.2020.00453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/28/2020] [Indexed: 11/20/2022] Open
Abstract
Neuroimaging plays an essential role in the diagnostic workup of idiopathic intracranial hypertension with the aims to exclude secondary causes of elevated intracranial pressure and to identify imaging signs that are commonly observed in this disorder. As a valuable expansion of brain imaging, the imaging of the retina using optical coherence tomography has been of increasing value. In particular, this is the case with the latest devices that allow a more accurate distinction between a reduction in retinal nerve fiber layer thickness due to an improvement of papilledema or due to a worsening caused by optic nerve atrophy. Although optical coherence tomography does not yet replace the other elements of the diagnostic workup, it is likely to play an increasing role in diagnosis and follow-up of idiopathic intracranial hypertension. The review focuses on the main findings in neuroimaging, including structural and vascular alterations as well as on the relevance of optical coherence tomography.
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Affiliation(s)
- David Moreno-Ajona
- Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, United Kingdom
| | | | - Jan Hoffmann
- Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, United Kingdom
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18
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Asal N, İnal M, Şahan MH, Say B. Assessment of the optic nerve using strain and shear-wave elastography in patients with pseudotumour cerebri. Clin Radiol 2020; 75:629-635. [PMID: 32381345 DOI: 10.1016/j.crad.2020.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the optic nerve using strain elastography (SE) and shear-wave elastography (SWE) in idiopathic intracranial hypertension (IIH) patients in comparison to participants in the control group. MATERIALS AND METHODS Eighty eyes were evaluated in 40 cases consisting of 20 IIH patients and 20 participants in the control group. This study was conducted using SE and SWE in addition optic nerve sonography measurements of participants in the IIH patient group and the control group. SE patterns were categorised using three main types and two subtypes. Quantitative measurements of optic nerve stiffness with SWE were expressed in kilopascals. RESULTS In the IIH patient group, type 2 and type 1 elasticity patterns were primarily observed, followed by type 3 patterns. In the control group, type 3 elasticity patterns were most often observed, while type 2 elasticity patterns were seen less frequently. Statistically significance differences in the types of elasticity strain patterns were observed between the groups (p<0.01). Quantitative analysis was also performed, and the SWE moduli were obtained for the control group (10.1±0.28 kPa) and the IIH patient group (26.97±1 kPa). A statistically significant difference in the SWE modulus was found between the groups (p<0.01). CONCLUSION Biomechanical changes may have occurred in the optic nerve secondary to increased intracranial pressure in IIH patients. Strain and shear elastography may have potential as assistive diagnostic techniques for the detection and follow-up of these changes.
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Affiliation(s)
- N Asal
- Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey.
| | - M İnal
- Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - M H Şahan
- Department of Radiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - B Say
- Department of Neurology, Kirikkale University School of Medicine, Kirikkale, Turkey
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Wong H, Sanghera K, Neufeld A, Maxner C, Shankar JJS. Clinico-radiological correlation of magnetic resonance imaging findings in patients with idiopathic intracranial hypertension. Neuroradiology 2019; 62:49-53. [PMID: 31506733 DOI: 10.1007/s00234-019-02288-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/28/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Although several studies have reported imaging findings associated with idiopathic intracranial hypertension (IIH), less is known about the correlation between imaging findings and IIH-related symptoms or signs. Our study aimed to determine if clinical features of IIH are correlated with magnetic resonance imaging (MRI) features. METHODS A retrospective chart review was conducted on consecutive patients presenting at the neuro-ophthalmology department over the last 15 years. All patients diagnosed with IIH were identified and those with available MRI were included in the final analysis. All MRI images were reviewed by a neuroradiologist blinded to the presenting symptoms and signs. Statistical analysis was performed to determine the correlation between the MRI findings with each clinical symptom or sign. RESULTS Thirty-one out of 88 patients with the initial diagnosis of IIH had MRI available and were included in the study. Significant correlations were observed between colour vision and amount of perineural fluid around the optic nerve on MRI (r = - 0.382; p = 0.004), disc assessment and intraocular optic nerve protrusion (r = 0.364; p = 0.004), disc assessment and perineural fluid around the optic nerve (r = 0.276; p = 0.033) and disc assessment and venous sinus stenosis (r = 0.351; p = 0.009). CONCLUSION Our study highlights correlations between imaging and clinical findings of IIH. MRI findings in IIH may be useful in ruling out ominous causes of intracranial pressure and risk stratifying ophthalmologic intervention and management of patients with headaches possibly due to IIH.
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Affiliation(s)
- H Wong
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - K Sanghera
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - A Neufeld
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - C Maxner
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Jai Jai Shiva Shankar
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada.
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Room 807K-JBRC/715 Mc Dermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
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