Does <scp>IIH</scp> Alter Brain Microstructures? – A <scp>DTI</scp>‐Based Approach

Schmidt, Christoph; Wiener, Edzard; Lüdemann, Lutz; Kunte, Hagen; Kreutz, Katharina Maria; Becker, Nils; Harms, Lutz; Klingebiel, Randolf; Hoffmann, Jan

doi:10.1111/head.13039

Cited by 13 publications

(17 citation statements)

References 30 publications

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“…All IIH patients underwent 1.5-T brain MRI including MR angiography (Siemens Magnetom Avanto, Siemens AG, Erlangen, Germany). To further characterize IIH patients, we measured the distension of the optic nerve sheath (ONS) as described in detail previously (19). In brief, in addition to the circularly polarized head coil, a loop surface coil (7 cm diameter) was placed over the eye with worse vision.…”

Section: Methodsmentioning

confidence: 99%

Lumbar puncture rapidly improves olfaction in patients with idiopathic intracranial hypertension: A cohort study

et al. 2020

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Background A lumbar puncture constitutes an important diagnostic procedure in the evaluation of idiopathic intracranial hypertension. Chronic overflow of cerebrospinal fluid into the sheaths of the olfactory nerves appears to be related to olfactory impairment in these patients. Here, we asked whether cerebrospinal fluid drainage in idiopathic intracranial hypertension patients improves olfactory function. Methods Fourteen idiopathic intracranial hypertension patients and 14 neurologic control patients were investigated before and after lumbar puncture using the extended Sniffin’ Sticks procedure. We assessed odor threshold, discrimination, and identification. In idiopathic intracranial hypertension patients, cerebrospinal fluid was drained until cerebrospinal fluid pressure had normalized. In addition, a third group of 14 healthy controls participated in the two smell tests at similar intervals. Results Relative to healthy controls, threshold, discrimination, and identification composite scores before lumbar puncture were significantly lower in idiopathic intracranial hypertension patients and also in neurologic controls. Following lumbar puncture, threshold, discrimination, and identification scores for neurologic controls remained unchanged whereas idiopathic intracranial hypertension patients showed robust improvement on the composite score as well as on all three subscores (all changes: p < 0.003), quickly regaining olfactory function in the normal range. Cerebrospinal fluid opening pressure was significantly correlated with improvement in threshold, discrimination, and identification score upon cerebrospinal fluid drainage ( r = 0.609, p = 0.021). Conclusion Olfactory impairment is an important, yet underappreciated, clinical feature of idiopathic intracranial hypertension. Lowering of increased intracranial pressure improves hyposmia. Our findings shed new light on the pathophysiology of cerebrospinal fluid circulation in idiopathic intracranial hypertension.

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Section: Methodsmentioning

confidence: 99%

Lumbar puncture rapidly improves olfaction in patients with idiopathic intracranial hypertension: A cohort study

et al. 2020

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“…Another typical neuroimaging finding in IIH is the distension of the optic nerve sheath (ONS) observed on T2-weighted MRimages (23,24,28). The distension of the ONS results from increased CSF pressure in the perioptic subarachnoid space.…”

Section: Structural Mrimentioning

confidence: 99%

“…In contrast, although the ONS shows a macroscopic distention and the optic nerve may appear tortuous, the size and volume of the optic nerve remain unchanged (23,24). However, when imaging is performed with diffusion tensor imaging (DTI) to analyze microstructural properties, changes in the optic nerve are identified (28,30). These changes are in line with a microstructural tissue compression and are reversed after normalization of ICP (30).…”

Section: Structural Mrimentioning

confidence: 99%

An Update on Imaging in Idiopathic Intracranial Hypertension

2020

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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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“…Die cMRT dient einerseits dem Ausschluss einer sekundären Genese sowie zur Identifikation von IIH-typischen Auffälligkeiten (26,27). Dazu zählen die Empty Sella, eine Verbreiterung der Optikusscheiden mit oder ohne geschlängeltem Verlauf des N. opticus sowie eine Abflachung des posterioren Augapfels (28)(29)(30). Das Vorliegen der früher häufig diskutierten Verengungen der Liquorräume (Schlitzventrikel) als diagnostisches Merkmal der IIH ist jedoch mit modernen strukturellen und volumetrischen MRT-Verfahren inzwischen widerlegt worden (21,29,31).…”

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Kopfschmerz bei Liquorüberdruck

Hoffmann¹,

Förderreuther²

2018

Nervenheilkunde

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ZusammenfassungDie idiopathische intrakranielle Hypertension beruht auf einer intrakraniellen Drucksteigerung unklarer Ätiologie. Das daraus resultierende klinische Bild ist in erster Linie durch einen weitgehend unspezifischen Kopfschmerz und progrediente, potenziell irreversible Sehstörungen charakterisiert wobei nicht selten auch Hirnnervenlähmungen, Riechstörungen und kognitive Defizite beobachtet werden. Die Ursache der intrakraniellen Drucksteigerung ist nicht eindeutig geklärt. Das Vorliegen einer venösen Abflussstörung, die aufgrund des häufig bestehenden Übergewichts oder auch aufgrund eines vaskulären Hindernisses in Form einer bilateralen Stenose des Sinus transversus auftreten kann, erscheint am nahe liegendsten. Auch hormonelle Faktoren könnten von wesentlicher Bedeutung sein und erklären warum überwiegend Frauen von der Erkrankung betroffen sind. Die Behandlung besteht in erster Linie aus einer Gewichtsreduktion und der oralen Gabe von Carboanhydrasehemmern, wobei lediglich für Acetazolamid Daten aus einer placebo-kontrollierten Studie vorliegen. Invasive Behandlungsverfahren sollten nur in therapierefraktären oder besonders fulminanten Fällen mit drohendem Verlust des Sehvermögens erwogen werden.

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Does IIH Alter Brain Microstructures? – A DTI‐Based Approach

Abstract: The results indicate that IIH is associated with microstructural changes in the optic nerve. These alterations may be the direct consequence of chronically elevated intracranial pressure.

Cited by 13 publications

References 30 publications

Lumbar puncture rapidly improves olfaction in patients with idiopathic intracranial hypertension: A cohort study

Lumbar puncture rapidly improves olfaction in patients with idiopathic intracranial hypertension: A cohort study

An Update on Imaging in Idiopathic Intracranial Hypertension

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