Long-term intracranial pressure recording in the management of pseudotumor cerebri

Abstract

Long-term monitoring of intracranial pressure (ICP) was used as an aid for the management of four patients with pseudotumor cerebri. After the implantation of a small experimental pressure sensor in the skull, most of the subsequent (ICP measurements were made noninvasively by an external interrogator. During the initial study of the patient, baseline ICP recordings were made in the hospital before treatment. Pressure recordings on a 24-hour basis were continued during treatment, which, depending on the case, was with Diamox (acetazolamide), steroids, or the coperitoneal shunting. After discharge these patients returned weekly over 10 to 22 months for ICP measurement and for ophthalmological examination. Intracranial pressure before treatment showed irregular variations ranging from 100 to 500 mm H2O over a 24-hour period. The efficacy of treatments could be assessed in a few hours by the degree of ICP stabilization. Shunt malfunction was detected by a slow but continuous rise in pressure before full clinical signs were evident.

CSF pressure, papilledema grade, and response to acetazolamide in the Idiopathic Intracranial Hypertension Treatment Trial

“…CSFp can fluctuate widely over 24 h in IIH and in conditions with other causes of increased ICP [7,8], and it is possible that prolonged ICP recording would detect stronger associations. Given our data and the ability of ACZ to improve FPG grade and CSFp, having a high CSFp or high FPG is not an indication for early surgical intervention in IIH patients with mild vision loss.…”

“…To our knowledge, there are no prospective studies in patients with IIH and visual field loss which have examined the associations between elevated CSFp and IIH symptoms . We acknowledge that in individual patients CSF pressure varies substantially throughout the day [7,8], but our large cohort of prospectively collected data from the IIHTT provided an opportunity to examine the relationships between CSFp and the clinical features of IIH. We hypothesized that higher CSFp would be associated with higher FPG and worse IIH characteristics, as well as worse clinical outcome.…”

Experience with Telemetric Pressure Measurements in Shunt Systems

“…A variety of tele metric intracranial pressure-monitoring devices have been devised. These include either battery-or inductancepowered variable-frequency oscillators [2][3][4][5], radioactive sources [6], and passive resonant-circuit devices [7], Prob lems peculiar to telemetry, such as baseline drift, powersource decay, and in vivo calibration changes, have ham pered efforts to find a generally useful system. Recently Zervas et al [8] described a radiofrequency passive reson ant-circuit device that can be calibrated and zero baseline determined in vivo, thus overcoming a major problem.…”

Non-Operative Management of Benign Intracranial Hypertension Presenting with Complete Visual Loss and Deafness

“…Quincke was the fi rst to give a clear description of pseudotumour cerebri [1] . This was then called 'serous meningitis ' We describe a case of a rapidly deteriorating 14-yearold African girl who presented with headaches and visual and hearing loss secondary to BIH.…”