The relationship between obesity and idiopathic intracranial hypertension

Rowe, Fiona; Nj, Sarkies

doi:10.1038/sj.ijo.0800758

Cited by 94 publications

(69 citation statements)

References 22 publications

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“…21,33 Two recent pediatric case series of PC report obesity in 59% to 70% of patients. 34,35 Patient 1 in our case series is obese, with a body mass index of 26.6 kg/m 2 (95th percentile for age: 22.5 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor Cerebri in Children With Sickle Cell Disease: A Case Series

Henry¹,

Driscoll²,

Miller

et al. 2004

Pediatrics

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Headache is a frequent symptom in sickle cell disease (SCD) that usually is attributable to anemia or cerebrovascular disease. We report 3 pediatric patients with SCD (1 patient with SCD-SC and 2 patients with SCD-SS) who presented with headache and were diagnosed with pseudotumor cerebri (PC). All 3 patients had elevated opening pressures during a lumbar puncture with normal cerebrospinal fluid studies. Magnetic resonance imaging revealed no evidence of hydrocephalus or arteriopathy in all 3 cases. Magnetic resonance venograms performed in 2 of the patients at diagnosis revealed no evidence of cerebral sinus thrombosis. Each patient received a thorough ophthalmologic examination. A diagnostic funduscopic examination revealed bilateral papilledema without signs of retinopathy in all 3 patients. There were no clinically significant changes in visual acuity or abnormalities of color vision in any patient. Goldmann or Humphrey visual-field assessment was abnormal only in patient 1, who demonstrated bilaterally enlarged blind spots at diagnosis and later developed reduced sensitivity in the inferomedial quadrant of the left eye in an arcuate pattern (which later resolved). The diagnosis of PC was made in all 3 patients, and acetazolamide treatment was started. Two of the patients’ symptoms resolved completely with medical treatment, whereas the third patient’s symptoms improved. None of these patients had permanent visual-field deficits as a result of their syndrome. PC has been reported in several other types of anemia including SCD-SC, but these cases are the first reported in conjunction with pediatric SCD. Early recognition of the signs and symptoms of PC in patients with SCD who present with headache can expedite proper diagnosis and treatment and prevent long-term ophthalmologic sequelae.

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Section: Discussionmentioning

confidence: 99%

Pseudotumor Cerebri in Children With Sickle Cell Disease: A Case Series

Henry¹,

Driscoll²,

Miller

et al. 2004

Pediatrics

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“…We computed an OR between EE-norethindrone and Mirena ® as well as EE-norgestimate and Mirena ® . One of the potential confounding variables in this study is body mass index (BMI) as it is associated with both ICH and use of IUL [Rowe and Sarkies, 1999]. For example, clinicians may be more likely to prescribe IUL to women with higher BMI due to its slower systemic absorption and potentially lower propensity to cause weight gain.…”

Section: Methodsmentioning

confidence: 99%

Risk of intracranial hypertension with intrauterine levonorgestrel

Etminan

Luo

Gustafson

2015

Therapeutic Advances in Drug Safety

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Objectives: The objective of this study was to quantify the risk of intracranial hypertension (ICH) with the intrauterine levonorgestrel (IUL) device Mirena ® . Methods: We used the United States Food and Drug Administration's Adverse Events Reporting System (FAERS) database to quantify a reporting odds ratio (ROR) for ICH and Mirena ® . We also conducted a retrospective cohort study using the IMS LifeLink ® database, comparing the risk of two oral contraceptives ethinyl estradiol (EE) with Mirena ® . A Bayesian sensitivity analysis was performed to account for the effect of body mass index (BMI). Results:The reported odds ratios (ORs) for ICH and papilledema with Mirena ® were 1.78 (95% confidence interval [CI] 1.41-2.25) and 1.50 (95% CI 1.10-2.05), respectively. In the cohort study, the OR for ICH and EE-norgestimate and EE-norethindrone compared with Mirena ® were 1.29 (95% CI 0.83-2.00) and 0.31 (95% CI 0.04-2.29), respectively. The presence of a strong confounder BMI did not affect the estimated OR (OR = 1.31, 95% CI 0.73-2.41 for EEnorgestimate; OR = 0.18, 95% CI 0.01-1.27 for EE-norethindrone). Conclusion: We found a higher than expected number of reports of ICH with Mirena ® in the FAERS database. We also found a similar risk of ICH with Mirena ® compared with the oral contraceptive EE-norgestimate. The higher risk of ICH with EE-norethindrone, another oral contraceptive should be further investigated.

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confidence: 99%

Inflammatory and haemostatic markers in idiopathic intracranial hypertension

Hannerz

Antović

Blombäck

et al. 2011

Journal of Internal Medicine

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Many obese patients share with patients suffering from idiopathic intracranial hypertension (IIH) increased intracranial pressure [1] and weight increase [2,3]. Obese patients have been reported to display signs of low-grade inflammation [1,4] and haemostatic changes [5][6][7]. Such markers have not been much examined in IIH.This study investigated markers of inflammation and haemostasis in IIH patients with bilateral papilledema and healthy age-and sex-matched controls with body mass index (BMI) below 25. As normal values for cerebrospinal fluid pressure (Pcsf) are not distinct, (150 ± 50 mm water in nonobese and up to 250 mm water in obese [8]), only IIH patients with bilateral papilledema, i.e., with Pcsf above 350 mm water [9], were recruited for our study. As low-grade systemic inflammation in IIH may escape detection if normal values of inflammation markers were used for comparison to the findings in IIH patients, only a well-defined group of healthy, age-and sex-matched persons could be used as controls. The controls had to have BMI below 25, as some, but not all [10], overweight and obese patients display intracranial hypertension, signs of inflammation and haemostatic abnormalities and consequently could not be used for comparison [1,[5][6][7].The laboratory tests performed were considered to best reflect the presence of signs of inflammation and coagulopathies. Inflammation markers were fibrinogen, C-reactive protein (CRP) haptoglobin, orosomucoid, immunoglobulins G and M earlier found to be increased in overweight and obese patients [1,4]. Of the analysed haemostatic markers, von Willebrand factor antigen and plasminogen activator inhibitor (PAI-1) have been considered also to reflect inflammation. The other haemostatic markers studied were overall haemostatic potential (OHP), overall coagulation potential (OCP), overall fibrinolysis potential (OFP), thrombin-antithrombin complex, prothrombin fragment 1 + 2, fibrin-d-dimer, von Willebrand factor antigen, von Willebrand ristocetin cofactor, and the inhibitors protein C, protein S, and lupus anticoagulant. (OHP summarizes coagulation and fibrinolytic activations in one assay, OCP, if increased, indicates hypercoagulation, and OFP changes as to fibrinolysis.)For further markers of inflammation, six of the IIH patients and eight of the controls were investigated as to expression of tumour necrosis factor-a, interleukins 2, 6, 10, 23 (IL-2, IL-6, IL-10, IL-23) and Fox P3 in peripheral mononuclear (PBMC) and cerebrospinal fluid (csf) cells.

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The relationship between obesity and idiopathic intracranial hypertension

Cited by 94 publications

References 22 publications

Pseudotumor Cerebri in Children With Sickle Cell Disease: A Case Series

Pseudotumor Cerebri in Children With Sickle Cell Disease: A Case Series

Risk of intracranial hypertension with intrauterine levonorgestrel

Inflammatory and haemostatic markers in idiopathic intracranial hypertension

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