Fulminant Idiopathic Intracranial Hypertension and Venous Stasis Retinopathy Resulting in Severe Bilateral Visual Impairment

2017 ◽  
Vol 27 (2) ◽  
pp. e25-e27 ◽  
Author(s):  
Alexander Voldman ◽  
Breanna Durbin ◽  
John Nguyen ◽  
Brian Ellis ◽  
Monique Leys
Keyword(s):  
Optic Nerve ◽  
Magnetic Resonance ◽  
Intracranial Hypertension ◽  
Optic Atrophy ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Stasis ◽  
Fundus Examination ◽  
History Of ◽  
Venous Stasis Retinopathy ◽  
Central Retinal Vein

Purpose To report a complicated case of fulminant idiopathic intracranial hypertension and concomitant venous stasis retinopathy leading to postpapilledema optic atrophy. Methods Case report. Results A 34-year-old morbidly obese woman with a history of idiopathic intracranial hypertension (IIH) presented with a 1-month history of bilateral vision loss, diplopia, and left eye pain after being lost to follow-up for 6 years. Fundus examination revealed florid papilledema with venous tortuosity bilaterally. Brain and orbit magnetic resonance imaging showed bilateral globe flattening, intraocular optic nerve swelling in both eyes, and no abnormality on magnetic resonance venography. After additional workup including lumbar puncture with an opening pressure of 55 cm H2O, a diagnosis of IIH was confirmed. Medical treatment with oral carbonic anhydrase inhibitors was initiated, followed by same-day bilateral optic nerve sheath decompression and ventriculoperitoneal shunt placement the following week. Fundus examination 2 months later revealed a persistent blood and thunder fundus suggestive of bilateral central retinal vein occlusions. Over the course of 6 months, both eyes displayed postpapilledema optic atrophy with light perception and hand motion vision in the right and left eyes, respectively. On Goldmann perimetry, the patient had vague limited isolated responses in both eyes to the largest target. Conclusions Fulminant IIH can present with profoundly blinding complications recalcitrant to aggressive medical and surgical intervention. Central retinal vein occlusion is an uncommon blinding complication of IIH.

scholarly journals Addison’s Disease, Idiopathic Intracranial Hypertension and Empty Sella - In a 40-Year-Old Woman

2012 ◽  
Vol 30 (1) ◽  
pp. 53-55
Author(s):  
MAJ Chowdhury ◽  
U Salma ◽  
QMU Ahmed ◽  
M Fariduddin ◽  
A Alam ◽  
...  
Keyword(s):  
Physical Examination ◽  
Intracranial Hypertension ◽  
Optic Atrophy ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Radiological Investigation ◽  
Menstrual History ◽  
History Of ◽  
Background History ◽  
Medical University

A 40-year-old woman having normal menstrual history got  admitted into Bangabandhu Sheikh Mujib Medical  University (BSMMU) because of vomiting for previous two  months, with a background history of irregular steroid  intake for her bodyache for about six years. She was gaining  weight and gradually losing vision in her right eye and  noticed increased body pigmentation. Physical examination  revealed BMI 29 kg/m2, generalized pigmentation more  marked in palmar crease and oral mucosa, secondary optic  atrophy in right eye and papilloedema in left eye. After  biochemical and radiological investigation she was  diagnosed as a case of Addison’s disease with idiopathic  intracranial hypertension (IIH) with empty sella   DOI: http://dx.doi.org/10.3329/jbcps.v30i1.11368   J Bangladesh Coll Phys Surg 2012; 30: 53-55  

scholarly journals Idiopathic intracranial hypertension leading to bilateral optic atrophy in a patient with recent COVID-19 infection: a case report

2021 ◽  
Vol 9 (1) ◽  
pp. 46
Author(s):  
Anu Yarky ◽  
Vipan Kumar ◽  
Nidhi Chauhan ◽  
Priyesh Sharma
Keyword(s):  
Intracranial Hypertension ◽  
Optic Atrophy ◽  
Idiopathic Intracranial Hypertension ◽  
Immune Dysfunction ◽  
Fundus Examination ◽  
Opening Pressure ◽  
Sensory Deficits ◽  
Mri Brain ◽  
Direct Injury ◽  
Ophthalmic Complication

Neurologic complications are common in patients hospitalised with COVID-19 infection. Most common complications are myalgias, headaches, encephalopathy and dizziness. Uncommon complications are stroke, motor and sensory deficits, seizures, ataxia and movement disorders. Multiple neuro-ophthalmological manifestations have also been reported in association with COVID-19. These complications may be the result of a range of pathophysiological mechanisms like hypoxic neuronal injury during active COVID-19 infection, RAS dysfunction, immune dysfunction and direct injury by the virus etc throughout the course of the disease. Here we reported a case of neuro-ophthalmic complication of Idiopathic intracranial hypertension (IIH) followed by bilateral optic atrophy in a middle-aged man with recent COVID-19 infection. He presented to the emergency with complaints of headache, dizziness and sudden painless bilateral diminution of vision for 3 days. His fundus examination was suggestive of bilateral papilledema, his MRI brain was normal and opening pressure of CSF was raised on lumbar puncture. His MRV was normal, there was no evidence of CSVT. He was started on steroids and acetazolamide. His headache improved but there was no improvement in visual acuity. Repeat fundus showed pale disc and MRI orbit was suggestive of bilateral optic atrophy.

scholarly journals “Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Ali R. Hamdan ◽  
Amr M. Tayel ◽  
Eslam El Sayed El Khateeb ◽  
Osama Elsoghiar
Keyword(s):  
Cerebrospinal Fluid ◽  
Visual Acuity ◽  
Magnetic Resonance ◽  
Visual Field ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
The Other ◽  
Benign Intracranial Hypertension ◽  
Fundus Examination ◽  
Opening Pressure

Abstract Objective Assessment of visual field outcomes following the medical or surgical management of increased intracranial pressure in patients with idiopathic intracranial hypertension. Patient and methods Thirty-two patients diagnosed with idiopathic intracranial hypertension who met all the modified Dandy criteria were included in this study. Magnetic resonance brain imaging with contrast and magnetic resonance venography were performed to exclude the presence of secondary causes of intracranial hypertension. Following normal neuroimaging, a lumbar puncture was performed for all patients with papilledema to measure the cerebrospinal fluid opening pressure. The assessment of visual function, including visual acuity, fundus examination (dilated fundus examination to confirm the presence and the grade of papilledema and to exclude the other ocular causes of optic disc swelling), and formal visual field assessment by perimetry when visual acuity was more than 1/60 were performed by the ophthalmologist before and after medical or surgical treatment. Results Thirty-two patients were included, the majority of whom were females of childbearing age (29/32; 90.6%). All patients complained of headache. Visual assessment revealed the presence of blurry vision in all patients. Papilledema with different grades was observed in 31/32 (96.9%) patients, while the other patient (3.1%) showed optic atrophy; 30/32 (93.8%) patients had visual acuity ˃ 1/60. The average visual field was − 18 dB ± 9.97 SD in the right eye and − 19.47 dB ± 5.43 SD in the left eye. Twenty-nine patients received medical treatment in the form of acetazolamide, which succeeded in controlling idiopathic intracranial hypertension in 24/29 (82.7%) patients, while a theco-peritoneal shunt was inserted in 8/32 (25%) patients. After management, statistically significant improvements in cerebrospinal fluid opening pressure, presenting manifestation, visual acuity, and field were noticed. Conclusions Permanent visual loss is the most feared complication of idiopathic intracranial hypertension; therefore, early diagnosis and multidisciplinary treatment are necessary to improve visual acuity and visual field.

scholarly journals Diagnostic value of brain MR imaging and its correlation with clinical presentation and cognitive functions in idiopathic intracranial hypertension patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ali Ahmed Abou Elmaaty ◽  
Carmen Ali Zarad ◽  
Tamer Ibrahim Belal ◽  
Tamer Sabry Elserafy
Keyword(s):  
Cognitive Impairment ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Brain Magnetic Resonance Imaging ◽  
Education Level ◽  
Unknown Etiology ◽  
Control Subjects ◽  
Low Education

Abstract Background Idiopathic intracranial hypertension (IIH) is a neurological disorder of unknown etiology and ambiguous pathophysiology due to cerebrospinal fluid dysregulation. This study is designed to evaluate the role of brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in diagnosis of IIH, to clarify the nature and extent of cognitive deficits, and to detect if there is a correlation between radiology, clinical findings, and cognitive dysfunctions in those patients. Results The study included 34 patients and 34 age-, sex-, body mass index (BMI)-, and education-matched healthy control subjects. MR brain imaging and Montreal cognitive assessment (MoCA) test were used for both groups. MRI and MRV sensitivity for IIH diagnosis were 85.2% and 85.3% with 100% and 94.1% specificity respectively. 44.1% had cognitive impairment, memory was the most affected domain, followed by attention, abstraction, and orientation with statistically significantly lower total MoCA score (p < 0.005). Domain comparisons reveal a statistically significantly lower memory/delayed recall (p < 0.001) and abstract scores (p < 0.007) in IIH cases versus control subjects. In comparing patients with cognitive impairment (CI) versus those without CI, there were statistically significantly higher CI in low education level, presence of diplopia, hormonal contraceptive use, abnormal MRI brain, papilledema grades, BMI, and opening pressure. Conclusions Presence of more than or equal 3 MR imaging findings, bilateral transverse sinus stenosis, and less than or equal 4 combined conduit score increase the specificity and sensitivity of MRI and MRV for IIH diagnosis. IIH had detrimental effect on different cognitive domains especially when patient have low education level, diplopia, papilledema ≥ grade III, high OP ≥ 61.5 cm H2O, and BMI ≥ 34 Kg/m2 with abnormal MRI and MRV findings.

Sign in / Sign up

Export Citation Format

Share Document