scholarly journals Idiopathic Intracranial Hypertension: Prognostic Factors and Multidisciplinary Management

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Claire Chagot ◽  
Marie Blonski ◽  
Jean-Loup Machu ◽  
Serge Bracard ◽  
Jean-Christophe Lacour ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Weight Gain ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Visual Outcome ◽  
Transverse Sinus ◽  
Line Treatment ◽  
Obese Women ◽  
University Center ◽  
Poor Visual Outcome

Background. Idiopathic intracranial hypertension (IIH) mostly affects young obese women and can lead to permanent visual impairment. However, prognostic factors and therapeutic strategy remain unclear. Methods. We retrospectively collected data from all patients diagnosed and managed for IIH in our university center from January 2001 to December 2016. Results. Seventy-nine patients were diagnosed with IIH. Bilateral transverse sinus stenosis (TSS) was found in 74% of the population. Visual outcome at 6 months was poor for 46% of patients, including all patients presenting weight gain of at least 5% since diagnosis (p<0.001), whereas mean body mass index at diagnosis was not different between patients with poor versus good outcome (32.9±7.7 versus 34.6 ± 9.4 kg·m−2). Other significant factors of poor prognosis were bilateral TSS (OR = 5.2; 95 CI: 1.24–24.9; p=0.024). Thirteen patients with poor outcome after 6-month assessment underwent unilateral TSS stenting leading to visual improvement in 11 cases. Conclusion. Weight gain, rather than initial weight, emerged as the leading factor of poor visual outcome in patients with IIH, followed by presence of bilateral TSS. Consequently, first-line treatment must include dietary measures to control weight. Unilateral stenting appears to be a safe second-line treatment option for patients with bilateral TSS.

Predictors of poor visual outcome in patients with Idiopathic Intracranial Hypertension (IIH): An ambispective cohort study

2017 ◽  
Vol 159 ◽  
pp. 13-18 ◽  
Author(s):  
Amit Agarwal ◽  
Deepti Vibha ◽  
Kameshwar Prasad ◽  
Rohit Bhatia ◽  
Mamta Bhushan Singh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Visual Outcome ◽  
Poor Visual Outcome

scholarly journals Risk factors for poor visual outcome in patients with idiopathic intracranial hypertension

Neurology ◽  
2015 ◽  
Vol 85 (9) ◽  
pp. 799-805 ◽  
Author(s):  
Michael Wall ◽  
Julie Falardeau ◽  
William A. Fletcher ◽  
Robert J. Granadier ◽  
Byron L. Lam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Visual Outcome ◽  
Poor Visual Outcome

scholarly journals Three-Layered Optic Disc Hemorrhages in Idiopathic Intracranial Hypertension

2021 ◽  
pp. 616-621
Author(s):  
Irina Sverdlichenko ◽  
Jonathan A. Micieli
Keyword(s):  
Magnetic Resonance ◽  
Intracranial Hypertension ◽  
Optic Disc ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Visual Outcome ◽  
Signs And Symptoms ◽  
Field Testing ◽  
Retinal Layers ◽  
Poor Visual Outcome

Papilledema related to idiopathic intracranial hypertension (IIH) may present with optic disc hemorrhaging. The significance and characteristics of these hemorrhages still remains to be clarified. Here, we present 2 unique cases with severe unilateral optic disc hemorrhaging in all 3 retinal layers (preretinal, intraretinal, and subretinal) and a good visual outcome. A 42- and a 44-year-old woman presented with signs and symptoms of raised intracranial pressure. Visual acuity was normal and Humphrey visual field testing showed only mild vision loss with enlarged blind spots. Dilated fundus examination revealed moderate papilledema in both eyes with severe optic disc hemorrhaging in the left eye in the first patient and the right eye in the second patient. The optic disc hemorrhaging occurred in all 3 retinal layers (preretinal, intraretinal, and subretinal), and the fellow eyes had only minimal hemorrhage. All patients had normal magnetic resonance imaging/magnetic resonance venography, and lumbar punctures revealed elevated opening pressures and normal cerebrospinal fluid contents. The papilledema resolved after 4 months in both cases with medical therapy. Optic disc hemorrhaging may be severe in patients with IIH, but this does not necessarily confer a poor visual outcome. The differential diagnosis of hemorrhages in all 3 retinal layers may be expanded to include IIH.

scholarly journals Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
pp. 382
Author(s):  
Dinesh Ramanathan ◽  
Zachary D. Travis ◽  
Emmanuel Omosor ◽  
Taylor Wilson ◽  
Nikhil Sahasrabudhe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Subdural Hygroma ◽  
Presenting Symptoms ◽  
Minimal Improvement ◽  
Sinus Stenosis ◽  
Work Up

We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

scholarly journals Visual Field Mean Deviation at Diagnosis of Idiopathic Intracranial Hypertension Predicts Visual Outcome

2019 ◽  
Vol 39 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Shravani Mikkilineni ◽  
Jonathan D. Trobe ◽  
Wayne T. Cornblath ◽  
Lindsey De Lott
Keyword(s):  
Visual Field ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Visual Outcome ◽  
Mean Deviation

scholarly journals A Case of Pulsatile Tinnitus Related to Idiopathic Intracranial Hypertension

2020 ◽  
Vol 63 (9) ◽  
pp. 422-426
Author(s):  
Jong-Won Bae ◽  
Kyu-Yup Lee ◽  
Myung Hoon Yoo ◽  
Da Jung Jung
Keyword(s):  
Intracranial Hypertension ◽  
Young Women ◽  
Idiopathic Intracranial Hypertension ◽  
Obese Woman ◽  
Pulsatile Tinnitus ◽  
Obese Women ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Early Symptom ◽  
Vascular Abnormalities

Idiopathic intracranial hypertension (IIH) is a disorder that commonly occurs in obese young women of childbearing age and is characterized by symptoms such as pulsatile tinnitus, dizziness, headache, nausea, vomiting, and visual loss without any structural or vascular abnormalities in the intracranial cavity. We recently experienced a case of a 33-year-old obese woman who presented with right-sided pulsatile tinnitus, which is an early symptom for IIH. The patient was successfully treated with weight reduction and carbonic anhydrase inhibitor (acetazolamide). Pulsatile tinnitus requires thorough diagnosis and examination because it can be cured if the anatomical or functional cause is identified and treated. When obese women of childbearing age present with pulsatile tinnitus at the otorhinolaryngology outpatient department, treatment for IIH should be initiated after appropriate examination and diagnosis as pulsatile tinnitus may be the only symptom for IIH.

scholarly journals Clinical and Neuro-ophthalmologic Predictors of Visual Outcome in Idiopathic Intracranial Hypertension

2018 ◽  
Vol 42 (4) ◽  
pp. 201-208 ◽  
Author(s):  
Aastha Takkar ◽  
Manoj Kumar Goyal ◽  
Reema Bansal ◽  
Vivek Lal
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Visual Outcome

External lumbar drainage in progressive pediatric idiopathic intracranial hypertension

2021 ◽  
pp. 1-7
Author(s):  
Gad Dotan ◽  
Natalie Hadar Cohen ◽  
Hanya M. Qureshi ◽  
Mika Shapira Rootman ◽  
Yoram Nevo ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Symptom Relief ◽  
Visual Outcome ◽  
Fiber Layer ◽  
Lumbar Drainage ◽  
Lumbar Drain ◽  
Rnfl Thickness ◽  
External Lumbar Drainage

OBJECTIVE Pediatric idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure despite normal cerebrospinal fluid and neuroimaging findings. Initial management is typically medical; however, nearly 10% of children will eventually require surgery for persistent headache and/or vision loss. External lumbar drainage, which is a considerably safer treatment option, has not been adequately analyzed in children with medically refractory IIH. METHODS The authors conducted a single-institution retrospective analysis of children with medically refractory IIH who had undergone external lumbar drain (ELD) placement because of worsening papilledema, reflected as increased retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT) testing. The main outcome measures were effects of external lumbar drainage on papilledema resolution, symptoms, and vision. RESULTS The authors analyzed the medical records of 13 children with IIH (11 girls, mean age 15.0 ± 2.3 years) whose mean CSF opening pressure was 45.5 ± 6.8 cm H2O. In all children, the average global RNFL thickness in both eyes significantly increased at ELD placement (right eye 371.8 ± 150.2 μm, left eye 400.3 ± 96.9 μm) compared with presentation thickness (right eye 301.6 ± 110.40 μm, left eye 350.2 ± 107.7 μm) despite acetazolamide medical therapy (20–30 mg/kg/day), leading to ELD placement after 9.5 ± 6.9 days (range 3–29 days). After ELD insertion, there was headache resolution, gradual and continuous improvement in optic disc thickness, and preservation of good vision. CONCLUSIONS ELD placement in children with medically refractory IIH who demonstrated worsening papilledema with increased RNFL thickening on OCT testing typically results in symptom relief and disc edema resolution with good visual outcome, often preventing the need for additional definitive surgeries that carry greater failure and morbidity risks.

Idiopathic intracranial hypertension

2020 ◽  
pp. 6054-6059
Author(s):  
Alexandra Sinclair
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Poor Quality ◽  
Raised Intracranial Pressure ◽  
Obese Women ◽  
Pseudotumour Cerebri ◽  
Chronic Headaches ◽  
Considerable Morbidity

Idiopathic intracranial hypertension (IIH) (also called pseudotumour cerebri and, previously, benign intracranial hypertension) is a syndrome of raised intracranial pressure in the absence of an intracranial mass lesion, enlargement of the cerebral ventricles, or venous sinus thrombosis. IIH affects predominantly obese women of childbearing age (>90%). The condition has considerable morbidity from permanent visual loss (up to 25% of cases) and chronic disabling headaches, which result in poor quality of life. Patients presenting acutely with papilloedema must be evaluated urgently for secondary causes of raised intracranial pressure (e.g. space occupying lesion and venous thrombosis). After this, the priority is to assess accurately the threat to vision. In most patients, the condition becomes chronic and the disease burden is mostly from chronic headaches, which need active management, alongside visual monitoring. This chapter does not cover paediatric IIH.

scholarly journals Intracranial hypertension due to spinal cord tumor misdiagnosed as pseudotumor cerebri syndrome: case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wanglu Hu ◽  
Chun Wang ◽  
Qun Wu ◽  
Yike Chen ◽  
Wei Gao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Pseudotumor Cerebri ◽  
Transverse Sinus ◽  
Pathologic Evaluation ◽  
Spinal Imaging ◽  
One Year

Abstract Background Isolated onset of intracranial hypertension due to spinal cord tumor is rare, thus, easily leading to misdiagnosis and delay in effective treatment. Case presentation Herein, we describe a 45-year-old female patient who manifested isolated symptoms and signs of intracranial hypertension and whose condition was initially diagnosed as idiopathic intracranial hypertension and transverse sinus stenosis. The patient received a stent implantation; however, no improvements were observed. One year later her symptoms exacerbated, and during rehospitalization a spinal imaging examination revealed a lumbar tumor. Pathologic evaluation confirmed schwannoma, and tumor resection significantly improved her symptoms, except for poor vision. Conclusions Space-occupying lesions of the spine should be considered in the differential diagnosis of idiopathic intracranial hypertension, even in the absence of spine-localized signs or symptoms.

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