Dural sinus collapsibility, idiopathic intracranial hypertension, and the pathogenesis of chronic migraine

Simone, Roberto De; Ranieri, Angelo; Sansone, Mattia; Marano, E; Russo, Cinzia Valeria; Saccà, Francesco; Bonavita, V.

doi:10.1007/s10072-019-03775-w

Cited by 37 publications

(28 citation statements)

References 123 publications

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“…The findings suggest a continuum in ICP may exist from definite or probable IIH to those with headache plus papilledema to those without enough evidence to suggest IIH but having chronic headaches. De Simone et al suggested that a continuum exists between IIH, IIH without papilledema (IIHWOP) and chronic migraine [ 12 ]. The clinical presentation of IIHWOP may be indistinguishable from chronic migraine [ 13 ] and 14% of patients with refractory transformed migraine had IIHWOP at lumbar puncture [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

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The incidence of obesity, venous sinus stenosis and cerebral hyperaemia in children referred for MRI to rule out idiopathic intracranial hypertension at a tertiary referral hospital: a 10 year review

Bateman

Subramanian

Yap

et al. 2020

Fluids Barriers CNS

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Background Children referred to a tertiary hospital for the indication, “rule out idiopathic intracranial hypertension (IIH)” may have an increased risk of raised venous sinus pressure. An increase in sinus pressure could be due to obesity, venous outflow stenosis or cerebral hyperemia. The purpose of this paper is to define the incidence of each of these variables in these children. Methods Following a data base review, 42 children between the ages of 3 and 15 years were found to have been referred over a 10 year period. The body mass index was assessed. The cross sectional areas and circumferences of the venous sinuses were measured at 4 levels to calculate the hydraulic and effective diameters. The arterial inflow, sagittal and straight sinus outflows were measured. Automatic cerebral volumetry allowed the brain volume and cerebral blood flow (CBF) to be calculated. The optic nerve sheath diameter was used as a surrogate marker of raised intracranial pressure (ICP). The sagittal sinus percentage venous return was used as a surrogate marker of elevated venous pressure. Age and sex matched control groups were used for comparison. Results Compared to controls, the obesity rates were not significantly different in this cohort. Compared to controls, those at risk for IIH had a 17% reduction in transverse sinus and 14% reduction in sigmoid sinus effective cross sectional area (p = 0.005 and 0.0009). Compared to controls, the patients at risk for IIH had an arterial inflow increased by 34% (p < 0.0001) with a 9% larger brain volume (p = 0.02) giving an increase in CBF of 22% (p = 0.005). The sagittal and straight sinus venous return were reduced by 11% and 4% respectively (p < 0.0001 and 0.0009) suggesting raised venous sinus pressure. Forty five percent of the patients were classified as hyperemic and these had optic nerve sheath diameters 17% larger than controls (p < 0.0002) suggesting raised ICP. Conclusion In children with the chronic headache/ IIH spectrum, the highest associations were with cerebral hyperemia and mild venous sinus stenosis. Obesity was not significantly different in this cohort. There is evidence to suggest hyperemia increases the venous sinus pressure and ICP.

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Section: Discussionmentioning

confidence: 99%

“…Up to 90% of adults with IIH have been found to have an outflow stenosis (the first component of Ohm's law) raising the venous resistance and therefore the venous pressure [12]. The stenoses tend to be of high grade, with pressure gradients ranging between 4 and 41 mmHg in one series [25].…”

Section: Obesity and Venous Sinus Stenosis In Patients At Risk For Iihmentioning

confidence: 99%

The incidence of obesity, venous sinus stenosis and cerebral hyperaemia in children referred for MRI to rule out idiopathic intracranial hypertension at a tertiary referral hospital: a 10 year review

Bateman

Subramanian

Yap

et al. 2020

Fluids Barriers CNS

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“…To date, many issues regarding the anatomy and physiology of the venous and lymphatic systems, in the brain as well as in other parts of the body, are not completely understood. For example, the routes of venous drainage from the brain are quite complex and may vary with posture and external conditions [34–37]) and the mechanisms regulating the flow of lymph through the various parts of the brain are still under investigation [38, 39]. These aspects will be included in future developments of the work.…”

Section: Methodsmentioning

confidence: 99%

Biofluid modeling of the coupled eye-brain system and insights into simulated microgravity conditions

et al. 2019

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This work aims at investigating the interactions between the flow of fluids in the eyes and the brain and their potential implications in structural and functional changes in the eyes of astronauts, a condition also known as spaceflight associated neuro-ocular syndrome (SANS). To this end, we propose a reduced (0-dimensional) mathematical model of fluid flow in the eyes and brain, which is embedded into a simplified whole-body circulation model. In particular, the model accounts for: (i) the flows of blood and aqueous humor in the eyes; (ii) the flows of blood, cerebrospinal fluid and interstitial fluid in the brain; and (iii) their interactions. The model is used to simulate variations in intraocular pressure, intracranial pressure and blood flow due to microgravity conditions, which are thought to be critical factors in SANS. Specifically, the model predicts that both intracranial and intraocular pressures increase in microgravity, even though their respective trends may be different. In such conditions, ocular blood flow is predicted to decrease in the choroid and ciliary body circulations, whereas retinal circulation is found to be less susceptible to microgravity-induced alterations, owing to a purely mechanical component in perfusion control associated with the venous segments. These findings indicate that the particular anatomical architecture of venous drainage in the retina may be one of the reasons why most of the SANS alterations are not observed in the retina but, rather, in other vascular beds, particularly the choroid. Thus, clinical assessment of ocular venous function may be considered as a determinant SANS factor, for which astronauts could be screened on earth and in-flight.

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“…Idiopathic intracranial hypertension (IIH) classically presents in obese females of childbearing age [1][2][3]. It manifests as headache associated with vomiting, pulsatile tinnitus, transient visual loss with papilledema, and diplopia due to cranial nerve IV palsy [1][2][3][4][5]. It occurs due to disruption in cerebral spinal fluid (CSF) equilibrium, either inadequate reabsorption of CSF or overproduction, with the etiology of the underlying mismatch not yet known [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…It manifests as headache associated with vomiting, pulsatile tinnitus, transient visual loss with papilledema, and diplopia due to cranial nerve IV palsy [1][2][3][4][5]. It occurs due to disruption in cerebral spinal fluid (CSF) equilibrium, either inadequate reabsorption of CSF or overproduction, with the etiology of the underlying mismatch not yet known [1][2][3][4][5]. The increasing CSF leads to increased intracranial pressure, according to the Monro-Kellie hypothesis, which damages vulnerable structures, particularly the optic nerve fiber layer [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Intracranial Hypertension and Multiple Sclerosis Overlap

Stoutin¹,

Fan²

2021

Cureus

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Idiopathic intracranial hypertension (IIH) and multiple sclerosis (MS) occur with a higher incidence in women of childbearing age and may be associated with other clinical entities. Both disease processes alter cerebrospinal fluid (CSF) dynamics and may present similarly with headache and visual changes. We report a case of a 33-year-old morbidly obese woman who developed progressive worsening blurry vision and unilateral temporal headache. She was found to have papilledema which prompted workup for intracranial hypertension. Her imaging and CSF findings were suggestive of a demyelinating process such as MS in addition to IIH.

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Dural sinus collapsibility, idiopathic intracranial hypertension, and the pathogenesis of chronic migraine

Cited by 37 publications

References 123 publications

The incidence of obesity, venous sinus stenosis and cerebral hyperaemia in children referred for MRI to rule out idiopathic intracranial hypertension at a tertiary referral hospital: a 10 year review

The incidence of obesity, venous sinus stenosis and cerebral hyperaemia in children referred for MRI to rule out idiopathic intracranial hypertension at a tertiary referral hospital: a 10 year review

Biofluid modeling of the coupled eye-brain system and insights into simulated microgravity conditions

Idiopathic Intracranial Hypertension and Multiple Sclerosis Overlap

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