Current concepts in pseudotumor cerebri

Hainline, Clotilde; Rucker, Janet C.; Balcer, Laura J.

doi:10.1097/wco.0000000000000273

Cited by 21 publications

(33 citation statements)

References 42 publications

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“…20,21 Other symptoms may include photopsy, diplopia, pulsatile tinnitus, and vertigo. 22,23 In our patient group, patients had headache, blurred vision, photopsy, eye pain, diplopia, tinnitus, and vertigo complaints, being consistent with the literature. The frequency of IIH patients without papilledema was reported as 11.9%.…”

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confidence: 91%

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Visual evoked potentials follow-up in idiopathic intracranial hypertension

Hamamcı

Tombul

2019

NSJ

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37.8±12.02 ‫ض‬ ّ َ ‫ر‬ َ ‫حُ‬ ‫امل‬ ّ ‫ِيحُ‬ ‫ر‬ ‫َصَ‬ ‫الب‬ ‫دحُ‬ ْ ‫ه‬ ‫حُ‬ ‫اجل‬ ‫مرضى‬ ‫عمر‬ ‫متوسط‬ ‫كان‬ ‫النتائج:‬ ‫الذكور.‬ ‫من‬)16%(5 ‫و‬ ‫اإلناث‬ ‫من‬)84%(27 ‫بينهم‬ ‫من‬ ‫عام.‬ ‫نتائج‬ ‫مع‬ ‫األولية‬ VEP ‫لقيم‬ ‫إحصائية‬ ‫داللة‬ ‫ذو‬ ‫ارتباط‬ ‫هناك‬ ‫كان‬ ‫على‬ ‫عالوة‬ .)p=0.040(‫ار‬ ‫اإلبصَ‬ ‫حُ‬ ‫ة‬ ّ ‫دَ‬ ‫وحِ‬)p=0.011(‫البصري‬ ‫املجال‬ ‫التحكم‬ ‫مجموعة‬ ‫بني‬ ‫إحصائية‬ ‫داللة‬ ‫ذات‬ ‫فرق‬ ‫على‬ ‫العثور‬ ‫مت‬ ‫ذلك،‬ ‫واليسرى‬)p<0.001(‫اليمنى‬ P100 ‫قيم‬ ‫حيث‬ ‫من‬ IIH ‫ومرضى‬ IIH ‫ملرضى‬ ‫األولية‬ VEPs ‫من‬)56%(18 ‫أن‬ ‫حني‬ ‫في‬ .)p<0.001(‫وهذا‬ ، ‫مرضية‬ ‫كانت‬ ‫الثانية‬ VEPs ‫(%44)من‬ 14 ، ‫مرضية‬ ‫كانت‬ .)p=0.125(‫إحصائية‬ ‫داللة‬ ‫ذات‬ ‫يكن‬ ‫لم‬ ‫االختالف‬ ‫وشدة‬ VEP P100 ‫قيم‬ ‫بني‬ ‫عالقة‬ ‫وجود‬ ‫عن‬ ‫الكشف‬ ‫مت‬ ‫اخلامتة:‬ ‫مرضى‬ ‫متابعة‬ ‫في‬ VEP ‫قيم‬ ‫مراقبة‬ ‫أهمية‬ ‫تثبت‬ ‫لم‬ ‫حني‬ ‫في‬ ‫املرض،‬ .IIH Objectives: To demonstrate the importance of visual evoked potential)VEP(in determining the severity and prognosis of the disease and in monitoring the clinical course in patients with idiopathic intracranial hypertension)IIH(. Methods: This is a prospective cross-sectional study conducted covering the period between March 2014 and January 2015. The study included 32 patients recently diagnosed with IIH and 30 healthy volunteers. The initial VEP values of the IIH patients were compared to the VEP values of the healthy control group. Furthermore, the initial VEP values of the IIH patients were compared with their VEP values after one month of treatment. Results: The mean age of the IIH patients was 37.8±12.02 years. Of the IIH patients, 27)84%(were females and 5)16%(were males. There was a statistically significant association of the initial VEP values with the visual field findings)p=0.011(and visual acuity)p=0.040(. Moreover, a statistically significant difference was found between the control group and IIH patients in terms of right)p<0.001(and left P100 values)p<0.001(. While 18)56%(of the initial VEPs of IIH patients were pathological, 14)44%(of the second VEPs were pathological, and this difference was not statistically significant)p=0.125(. Conclusion: A relationship between the VEP P100 values and the severity of the disease was detected, while the importance of monitoring VEP values in the follow-up of IIH patients was not demonstrated.

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supporting

confidence: 91%

“…The disease results in blindness in approximately 10% of patients and this figure may increase up to 32% in untreated cases. 22,26 In 29-35% of patients with IIH, abnormal findings in visual acuity )Snellen chart test( was reported. 22,27 Visual field defect was reported in 80% of patients.…”

mentioning

confidence: 99%

Visual evoked potentials follow-up in idiopathic intracranial hypertension

Hamamcı

Tombul

2019

NSJ

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“…The disease results in blindness in about 10% of patients. Other symptoms that may be seen include blurred vision, loss of vision, diplopia (due to undefined sixth cranial nerve paralysis), pulsatile tinnitus, and vertigo (6,8,9). Headache can be typically bilateral frontal or retro-orbital, pulsating or in the form of pressure sensation.…”

Section: Discussionmentioning

confidence: 99%

“…With increasing obesity in the world, the incidence of PTCS is also increasing. Before puberty, the female/male ratio is equal and secondary PTCS is commonly seen (6,7). When seen in males, secondary causes should be well researched (1).…”

Section: Discussionmentioning

confidence: 99%

Clinical and Demographic Features of Pseudotumor Cerebri Syndrome Diagnosed in a University Hospital

Arslan¹,

Arıkanoğlu²,

Akıl³

2017

tnd

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Objective: Pseudotumor cerebri syndrome (PTCS) is characterized by symptoms and signs of increased intracranial pressure without ventriculomegaly, intracranial tumor or mass. This study aimed to explore and analyze 34 patients with PTCS according to age, sex, symptoms of the disorder, cranial magnetic resonance images findings, etiology, and treatment. Materials and Methods:A total of 34 patients who were diagnosed as having PTCS and followed up between January 2011 and August 2016 by Dicle University Medical School Neurology Department were included in this study. PTCS was diagnosed in accordance with the modified Dandy criteria. Results:Thirty-four patients were identified as having PTCS. Twenty-one (91.2%) had headache, 19 (55.9%) had blurred vision, 6 (17.6%) had diplopia, 2 (5.9%) had vertigo, 1 (2.9%) had tinnitus, and 1 (2.9%) had numbness of the face. Twenty-seven patients were diagnosed as having idiopathic intracranial hypertension, 21 (61.8%) had no etiologic factors. Six (17.6%) patients were obese, one of whom had recently gained weight and another had polycystic ovary syndrome. Seven patients were thought to have secondary PTCS with the following etiologic factors: 2 (5.9%) patients had Hashimoto's thyroiditis, 1 (2.9%) had a history of all-trans retinoic acid intake due to a malignancy, 1 (2.9%) had choroid plexus granuloma, 2 (5.9%) had sinus venous thrombosis, and 1 (2.9%) had Familial Meditteranian Fever.Conclusion: Although PTCS was described many years ago, its physiopathology and exact treatment procedures are not clearly understood. The most important target of its treatment is to prevent loss of vision and improve symptoms. With a better understanding of its pathophysiology, effective treatment protocols will be developed. Keywords: Idiopathic intracranial hypertension, pseudotumor cerebri syndrome, headacheAmaç: Psödotümör serebri sendromu (PTSS) ventrikülomegali, intrakraniyal tümör veya kitle olmaksızın intrakraniyal basıncın (İKB) arttığı bir sendromdur. Bu çalışmada kliniğimizde PTSS tanısı ile takip edilen 34 hastanın yaş, cinsiyet dağılımı, semptomları, kraniyal manyetik rezonans görüntüleme bulguları, etiyolojileri ve tedavileri tartışılmaktadır. Gereç ve Bulgular:Olguların 31'inde (%91,2) baş ağrısı, 19'unda (%55,9) bulanık görme, 6'sında (%17,6) diplopi, 1'inde (%2,9) tinnitus, 1'inde (%2,9) yüzde uyuşma, 2'sinde (%5,9) vertigo yakınması vardı. Yirmi yedi hasta idiyopatik intrakraniyal hipertansiyon (İİH) olarak kabul edildi. Yirmi bir hastada (%61,8) etiyoloji saptanamadı. Altı hastada (%17,6) obezite, bunların 1 tanesinde yakın zamanda kilo alma öyküsü, 1 tanesinde de polikistik over sendromu saptandı. Yedi hastada sekonder PTSS düşünüldü. Sekonder sebepler olarak; 2 hastada (%5,9) Hashimoto tiroiditi, 1 hastada (%2,9), malignite nedeniyle all-trans retinoik asit kullanımı, 1 hastada (%2,9) koroid pleksus granülomu, 2 hastada (%5,9) sinüs trombozu, 1 hastada (%2,9) Ailesel Akdeniz Ateşi etiyolojik neden olarak saptandı. Clinical and Demographic Features of Pseudotumor

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“…Papilledema is typically present. [2][3][4][5] The underlying pathophysiological mechanisms that lead to this disease remain unknown, and the best-accepted theories are that the change in cranial pressure is linked to increased abdominal pressure, hormonal changes and unrecognized disorders in the cerebral venous system and in relation to cerebrospinal fluid resorption. 4,5 Headache is the most common symptom of PC and is present in over 90% of these patients.…”

Section: Introductionmentioning

confidence: 99%

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

et al. 2017

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CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of childbearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH 2 O. She presented a body mass index of 39.5 kg/m 2 , also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH 2 O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm. RESUMOCONTEXTO: O pseudotumor cerebri ocorre quando há aumento na pressão intracraniana sem causa subjacente, comumente levando a perda visual. É mais comum em mulheres obesas em idade fértil. RELATO DE CASO: Mulher de 46 anos, foi admitida com hipertensão intracraniana idiopática diagnosticada há dois anos, que levou a cefaleia refratária crônica e perda estimada de 30% da acuidade visual, associada a papiledema bilateral. Apresentou melhora parcial da cefaleia com acetazolamida, mas a perda visual persistiu. A pressão intracraniana era de 34 cmH 2 O. Apresentava índice de massa corpórea de 39,5 kg/m 2 , associado a hipertensão arterial. Tomografia computadorizada com contraste endovenoso de crânio não apresentou anormalidades. Foi submetida ao bypass gástrico em Y de Roux, com evolução pós-operatória sem intercorrências. Um mês após a cirurgia, apresentou perda de peso em excesso de 24%. Um exame oftalmológico demonstrou ausência de perda visual e remissão do papiledema; não houve novos episódios de cefaleia após a cirurgia. Houve também resolução completa da hipertensão arterial. A pressão intracraniana caiu para 24 cmH 2 O após seis meses da cirurgia. CONCLUSÃO: Embora a condição seja usualmente associada à obesidade, há escassos relatos de cirurgia bariátrica em indivíduos com pseudotumor cerebri. Nos casos previamente estudados, há alta pre...

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Current concepts in pseudotumor cerebri

Abstract: Recent changes in defining IIH, understanding the impact and treatment of mild visual loss, and the roles that cerebral venous stenting and optical coherence tomography might have in clinical practice provide the framework to better treat patients with IIH.

Cited by 21 publications

References 42 publications

Visual evoked potentials follow-up in idiopathic intracranial hypertension

Visual evoked potentials follow-up in idiopathic intracranial hypertension

Clinical and Demographic Features of Pseudotumor Cerebri Syndrome Diagnosed in a University Hospital

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

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