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Ranliang Hu, John Holbrook, Nancy J Newman, Valerie Biousse, Beau B Bruce, Deqiang Qiu, John Oshinski, Amit M Saindane
BACKGROUND: Optic nerve sheath tortuosity is a previously reported, but incompletely characterized, finding in idiopathic intracranial hypertension (IIH). We hypothesized that optic nerve angle (ONA), as a quantitative measure of tortuosity, would change dynamically with cerebrospinal fluid (CSF) pressure status of patients with IIH immediately before and after lumbar puncture (LP). METHODS: Consecutive patients with suspected IIH referred for MRI and diagnostic LP were prospectively enrolled in this single institution, institutional review board-approved study...
March 16, 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Alberto Raggi, Licia Grazzi, Stefania Bianchi Marzoli, Paola Ciasca, Luisa Chiapparini, Alessandra Erbetta, Giuseppe Faragò, Matilde Leonardi, Domenico D'Amico
Idiopathic intracranial hypertension (IIH) is associated with obesity, and weight loss is important to reduce intracranial pressure and improve visual function. A 38-year-old woman with IIH followed an extreme diet, which resulted in 30% weight loss (BMI moved from 34.9 to 24.6). Weight loss resulted in a significant reduction of papilloedema, normalization of intracranial pressure and improvement in headache pattern, but also induced a state of initial malnutrition, relevant depression and disability. She was discharged with the indication to start a controlled diet and improve physical activity: clinical situation get back to stability, with the patient loosing further weight (BMI=21...
March 13, 2018: International Journal of Rehabilitation Research. Revue Internationale de Recherches de Réadaptation
Hussain N Alhamami, Md Main Uddin, A S M Hasan Mahmood, Karen P Briski
The hypothalamic energy sensor adenosine 5'-monophosphate-activated protein kinase (AMPK), an important regulator of counter-regulatory responses to hypoglycemia, responds to pharmacological manipulation of hindbrain AMPK activity. Dorsomedial hindbrain A2 noradrenergic neurons express hypoglycemia-sensitive metabolo-sensory biomarkers, including AMPK. Here, adult male rats were pretreated by intra-caudal fourth ventricular administration of the selective neurotoxin 6-hydroxydopamine (6-OHDA) to determine if catecholamine signaling from the aforesaid site governs hypothalamic AMPK activation during insulin-induced hypoglycemia (IIH)...
March 10, 2018: Neuroscience
J P Funnell, C L Craven, L D'Antona, S D Thompson, A Chari, L Thorne, L D Watkins, A K Toma
OBJECTIVES: Papilloedema is a clinical manifestation of chronically raised intracranial pressure (ICP), often seen in idiopathic intracranial hypertension (IIH). However, the extent of intracranial hypertension required to produce papilloedema is not known. We compare ICP values in IIH patients who developed papilloedema and those who did not. We aim to identify a pathological ICP threshold predictive of the development of papilloedema in IIH patients. MATERIALS AND METHODS: Single-centre cohort of IIH patients (2006-2016) who underwent 24-hour ICP monitoring (ICPM) and ophthalmology assessments, prior to intervention...
March 12, 2018: Acta Neurologica Scandinavica
Cameron M McDougall, Vin Shen Ban, Jeffrey Beecher, Lee Pride, Babu G Welch
OBJECTIVE The role of venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) is not well understood. The aim of this systematic review is to attempt to identify subsets of patients with IIH who will benefit from VSS based on the pressure gradients of their venous sinus stenosis. METHODS MEDLINE/PubMed was searched for studies reporting venous pressure gradients across the stenotic segment of the venous sinus, pre- and post-stent pressure gradients, and clinical outcomes after VSS. Findings are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines...
March 2, 2018: Journal of Neurosurgery
Cyrille Capel, Marc Baroncini, Catherine Gondry-Jouet, Roger Bouzerar, Marek Czosnyka, Zofia Czosnyka, Olivier Balédent
OBJECTIVES: Cerebrospinal fluid (CSF) and blood flows have a strong relationship during a cardiac cycle. Idiopathic intracranial hypertension (IIH) is a pathology that seems to present hemodynamic and hydrodynamic disturbance. The aim of this study was to establish CSF and blood interaction in IIH. MATERIAL AND METHODS: We retrospectively studied cerebral hydrodynamic and hemodynamic flows by phase-contrast MRI (PCMRI) in 13 IIH subjects (according Dandy's criteria) and 16 controls...
2018: Acta Neurochirurgica. Supplement
Vigdis Andersen Eidsvaag, Hans-Arne Hansson, Kjell Heuser, Erlend A Nagelhus, Per Kristian Eide
AIM: Idiopathic intracranial hypertension (IIH) is characterized by symptoms indicative of increased intracranial pressure (ICP), such as headache and visual impairment. We have previously reported that brain biopsies from IIH patients show patchy astrogliosis and increased expression of the water channel aquaporin-4 (AQP4) at perivascular astrocytic endfeet. METHODS: The present study was undertaken to investigate for ultrastructural changes of the cerebral capillaries in individuals with IIH...
February 22, 2018: Brain Research
Ebru Apaydın Doğan, Selen Doğan, Ethem Taner Göksu, Sibel Özkaynak, Çile Aktan, İnanç Mendilcioğlu
Idiopathic intracranial hypertension (IIH) is a relatively uncommon disorder characterised by raised intracranial pressure without an established pathogenesis. Diagnosis of IIH requires the demonstration of symptoms and signs referable only to elevated intracranial pressure; cerebrospinal fluid (CSF) opening pressure >25cm H2 O measured in the lateral decubitus position; normal CSF composition; and no evidence for an underlying structural cause demonstrated by using MRI or contrast-enhanced CT scan for typical patients and MRI and MR venography for atypical patients such as man, children and those with low body mass index...
February 6, 2018: Neurologia i Neurochirurgia Polska
Aubrey L Gilbert, Bart Chwalisz, Robert Mallery
There are a number of surgical options for treatment of idiopathic intracranial hypertension (IIH) when it is refractory to medical treatment and weight loss. Optic nerve sheath fenestration (ONSF) is one of these options. Use of this procedure varies among centers due to experience with the procedure and concern for associated complications that can result in severe loss of vision. This review summarizes the literature concerning post-surgical complications of ONSF for IIH.
2018: Seminars in Ophthalmology
Shuaishuai Xu, Shidong Ruan, Shanfeng Liu, Jianrong Xu, Ruozhen Gong
PURPOSE: This aimed to evaluate the prevalence and extent of bilateral sigmoid sinus dehiscence (SSD) and to explore the presence of idiopathic intracranial hypertension (IIH) in patients with unilateral pulsatile tinnitus (PT) with CTA/V. METHODS: Sixty PT patients (52 females; 40.4 ± 11.6 years [20-72]) who underwent CTA/V and 30 non-PT patients (27 females; 38.4 ± 14.7 years [12-62]) were enrolled in this study. The primary outcome measure was the radiographic presence of SSD...
February 7, 2018: Neuroradiology
Christina F Hatem, Hanne M Yri, Anne L Sørensen, Marianne Wegener, Rigmor H Jensen, Steffen Hamann
PURPOSE: Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure (ICP), normal cerebrospinal composition and exclusion of alternative causes to increased ICP. The aim of this study was to evaluate long-term visual outcome in a Danish population of IIH patients. METHODS: Retrospective chart review of 41 women diagnosed with IIH between June 2007 and March 2013. Best-corrected visual acuity (BCVA), colour vision, grade and type of visual field (VF) defects and grade of papilloedema according to the Modified Frisén Score were recorded at baseline visit (V0), 2-6 months (V1) and 13 months follow-up visit (V2) from time of diagnosis...
February 6, 2018: Acta Ophthalmologica
Eoin Mulroy, Thiyaga Krishnan, Stephen Best, Neil E Anderson
Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure without evidence of intracranial mass lesion or venous thrombosis, and bland cerebrospinal fluid examination. It mostly affects overweight women of childbearing age and if left untreated, can lead to permanent visual loss. Visual decline in this condition is generally slow, over months to years. However, a small proportion of patients develop rapidly progressive visual loss within days or weeks of onset of headaches. We describe a 29 year-old patient with fulminant IIH in whom inadequate fundoscopy and assessment of vision contributed to a delay in diagnosis and poor outcome...
January 26, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Michael Karsy, Hussam Abou-Al-Shaar, Christian A Bowers, Richard H Schmidt
OBJECTIVE Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a complex and difficult-to-manage condition that can lead to permanent vision loss and refractory headaches if untreated. Traditional treatment options, such as unilateral ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt placement, have high complication and failure rates and often require multiple revisions. The use of bilateral proximal catheters has been hypothesized as a method to improve shunt survival. The use of stereotactic technology has improved the accuracy of catheter placement and may improve treatment of IIH, with fewer complications and greater shunt patency time...
February 2, 2018: Journal of Neurosurgery
Francois Okoroafor, Muhammad Ali Karim, Abdulmajid Ali
OBJECTIVE: There is paucity of data concerning the impact of bariatric surgery on idiopathic intracranial hypertension (IIH). We therefore present the clinical course of two cases that were managed at our centre, which is a regional referral centre for bariatric surgery and present a literature review of patients with IIH who underwent bariatric surgery for the treatment of obesity. METHOD: Two patients were referred for bariatric surgery who were both morbidly obese and were diagnosed with IIH...
January 31, 2018: British Journal of Neurosurgery
Susana B Zanello, Vasisht Tadigotla, James Hurley, Johan Skog, Brian Stevens, Eusebia Calvillo, Eric Bershad
The visual impairment and intracranial pressure (VIIP) syndrome is a neuro-ophthalmologic condition described in astronauts returning from long duration space missions. Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is characterized by a chronic elevation of intracranial pressure (ICP) in the absence of an intracranial mass lesion. Because VIIP and IIH share some neurologic and ophthalmologic manifestations, the latter might be used as a model to study some of the processes underlying VIIP...
2018: NPJ Microgravity
Getaw Worku Hassen, Mohammed Al-Juboori, Barbara Koppel, Gokhan Akfirat, Hossein Kalantari
Measurement of optic nerve sheath diameter (ONSD) using point of care ultrasound has been used to indirectly assess the intracranial pressure (ICP) particularly in conditions where it is raised. Direct pressure measurements using probes reaching the ventricle system correlated with ONSD using ultrasound. Attempts were made to measure the ONSD pre and post lumbar puncture (LP) after draining cerebrospinal fluid (CSF) as well as post ventricular shunt placement. We report ONSD measurement and demonstrate dynamic changes during LP in a patient with known idiopathic intracranial hypertension (IIH)...
January 10, 2018: American Journal of Emergency Medicine
Yao Chen, Lin Wang, Yun Zhang, Yaxiong Zhou, Wei Wei, Zhi Wan
BACKGROUND: To determine the cerebral protective effects of mild hypothermia (MH) on cerebral microcirculation. METHODS: We established ischemia-reperfusion (I/R) injury and MH treatment models with rat brain microvascular endothelial cells (RBMECs) in vitro and examined the apoptotic changes. The cultured RBMECs were randomly divided into the control group, I/R group, and MH group, which was further divided into two subgroups: intra-ischemia hypothermia (IIH) and post-ischemia hypothermia (PIH)...
January 11, 2018: Neurocritical Care
Andrew J Anzeljc, Patrick Frias, Brent R Hayek, Nancy Canter Weiner, Ted H Wojno, H Joon Kim
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...
January 9, 2018: Orbit
Anuriti Aojula, Susan P Mollan, John Horsburgh, Andreas Yiangou, Kiera A Markey, James L Mitchell, William J Scotton, Pearse A Keane, Alexandra J Sinclair
BACKGROUND: Optical Coherence Tomography (OCT) imaging is being increasingly used in clinical practice for the monitoring of papilloedema. The aim is to characterise the extent and location of the Retinal Nerve Fibre Layer (RNFL) Thickness automated segmentation error (SegE) by manual refinement, in a cohort of Idiopathic Intracranial Hypertension (IIH) patients with papilloedema and compare this to controls. METHODS: Baseline Spectral Domain OCT (SDOCT) scans from patients with IIH, and controls with no retinal or optic nerve pathology, were examined...
January 4, 2018: BMC Ophthalmology
J Vijay Ananth, S Sudharshan, Ambika Selvakumar, Bella J Devaleenal, Kavitha Kalaivani, Jyotirmay Biswas
Papilledema in a patient with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome is an alarming finding. Any condition giving rise to raised intracranial tension (ICT) can cause papilledema, and in these patients, it could be secondary to opportunistic infections like meningitis to neoplasm. We report a case of a 28-year old female with HIV on antiretroviral therapy, who presented to us, with papilledema. Her fundus examination revealed superficial hemorrhages and Roth's spots along with papilledema...
January 2018: Indian Journal of Ophthalmology
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