Benign intracranial hypertension associated with inhaled corticosteroids in a child with asthma

A 13-year-old male asthmatic presented to the general paediatric clinic with papilloedema identified following a check-up with his optician due to blurred vision. His asthma was well controlled on a moderate dose of inhaled corticosteroid and there had been no recent increase or decrease in the dose. A diagnosis of benign intracranial hypertension (BIH) was made based on a raised cerebrospinal fluid opening pressure, papilloedema, a normal neurological examination and normal neuroimaging. The only associated risk factor was his inhaled corticosteroids. He was commenced on acetazolamide and the inhaled corticosteroid dose was reduced, resulting in resolution of his papilloedema. This case serves to highlight that steroid side effects including BIH may occur at moderate doses of inhaled corticosteroids and that inhaled corticosteroid dose should be regularly reviewed and decreased to the lowest dose that maintains asthma control.

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“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-019-0064-5 ◽

2019 ◽

Vol 34 (1) ◽

Author(s):

Ali R. Hamdan ◽

Amr M. Tayel ◽

Eslam El Sayed El Khateeb ◽

Osama Elsoghiar

Keyword(s):

Cerebrospinal Fluid ◽

Visual Acuity ◽

Magnetic Resonance ◽

Visual Field ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

The Other ◽

Benign Intracranial Hypertension ◽

Fundus Examination ◽

Opening Pressure

Abstract Objective Assessment of visual field outcomes following the medical or surgical management of increased intracranial pressure in patients with idiopathic intracranial hypertension. Patient and methods Thirty-two patients diagnosed with idiopathic intracranial hypertension who met all the modified Dandy criteria were included in this study. Magnetic resonance brain imaging with contrast and magnetic resonance venography were performed to exclude the presence of secondary causes of intracranial hypertension. Following normal neuroimaging, a lumbar puncture was performed for all patients with papilledema to measure the cerebrospinal fluid opening pressure. The assessment of visual function, including visual acuity, fundus examination (dilated fundus examination to confirm the presence and the grade of papilledema and to exclude the other ocular causes of optic disc swelling), and formal visual field assessment by perimetry when visual acuity was more than 1/60 were performed by the ophthalmologist before and after medical or surgical treatment. Results Thirty-two patients were included, the majority of whom were females of childbearing age (29/32; 90.6%). All patients complained of headache. Visual assessment revealed the presence of blurry vision in all patients. Papilledema with different grades was observed in 31/32 (96.9%) patients, while the other patient (3.1%) showed optic atrophy; 30/32 (93.8%) patients had visual acuity ˃ 1/60. The average visual field was − 18 dB ± 9.97 SD in the right eye and − 19.47 dB ± 5.43 SD in the left eye. Twenty-nine patients received medical treatment in the form of acetazolamide, which succeeded in controlling idiopathic intracranial hypertension in 24/29 (82.7%) patients, while a theco-peritoneal shunt was inserted in 8/32 (25%) patients. After management, statistically significant improvements in cerebrospinal fluid opening pressure, presenting manifestation, visual acuity, and field were noticed. Conclusions Permanent visual loss is the most feared complication of idiopathic intracranial hypertension; therefore, early diagnosis and multidisciplinary treatment are necessary to improve visual acuity and visual field.

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Cerebrospinal Fluid Vasopressin and Oxytocin in Benign Intracranial Hypertension

Clinical Science ◽

10.1042/cs074067pb ◽

1988 ◽

Vol 74 (s18) ◽

pp. 67P-67P

Author(s):

JR Seckl ◽

SL Lightman

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypertension ◽

Benign Intracranial Hypertension

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Cerebrospinal fluid protein and opening pressure in idiopathic intracranial hypertension (pseudotumor cerebri)

Neurology ◽

10.1212/wnl.41.7.1040 ◽

1991 ◽

Vol 41 (7) ◽

pp. 1040-1040 ◽

Cited By ~ 16

Author(s):

P. K. Johnston ◽

J. J. Corbett ◽

C. E. Maxner

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Pseudotumor Cerebri ◽

Opening Pressure ◽

Cerebrospinal Fluid Protein

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Significance of Empty Sella in Cerebrospinal Fluid Leaks

Otolaryngology ◽

10.1067/mhn.2003.43 ◽

2003 ◽

Vol 128 (1) ◽

pp. 32-38 ◽

Cited By ~ 79

Author(s):

Rodney J. Schlosser ◽

William E. Bolger

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypertension ◽

Sella Turcica ◽

Radiographic Finding ◽

Empty Sella ◽

Senior Author ◽

Csf Leak ◽

Benign Intracranial Hypertension ◽

Cerebrospinal Fluid Leaks ◽

Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

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Clinical treatment of Idiopathic Benign Intracranial Hypertension (IIH): case report

10.5327/1516-3180.020 ◽

2021 ◽

Author(s):

Lorrana Alves Medeiros ◽

Carla Cristina Lopes Barbosa Tiveron

Keyword(s):

Case Report ◽

Intracranial Hypertension ◽

Severe Headache ◽

Secondary Headache ◽

Benign Intracranial Hypertension ◽

Review Of Literature ◽

Opening Pressure ◽

Factors Associated ◽

Expansive Process ◽

Visual Disturbances

Introduction: Headache is one of the most common complaints in medicine, being divided into primary or secondary. Idiopathic Benign Intracranial Hypertension (IBIH) is one of the causes of secondary headache, where there is an increase in intracranial pressure in the absence of an expansive process. Goals: To present the management of IBIH refractory to conventional treatment. Methodology: Clinical evaluation of the patient, review of her medical record and review of literature related to the topic. Case report: RMC, female, 55 years old, short stature, BMI 48, presented in 2018 repetitive pictures of severe headache, without improvement factors, associated with visual disturbances that evolved to amausore, sporadic loss of balance and slowing pupillary reflexes, mood disorders and easy cry. Magnetic resonance and fundscopy were inconclusive, and CSF puncture found an opening pressure of 20 cm of water. After CSF puncture, the patient showed instantaneous vision improvement, and therapy with Acetazolamide was introduced, which controlled and kept her ophthalmological symptoms stable. Angina conditions were only resolved with the introduction of Lamotrigine. RESULTS: The most commonly prescribed medication for IBIH, Acetazolamide, controlled the reported patient’s ophthalmological condition, but not the pain episodes. When this medication alone cannot control the condition, the association of other medications or surgical conduct is indicated. The association of Acetazolamide with Lamotrigine was extremely important to solve the patient’s pain episodes, making her clinical management positive. Conclusion: The combination of Lamotrigine and Acetazolamide has been shown to be an excellent form of outpatient treatment for IBIH.

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BENIGN INTRACRANIAL HYPERTENSION IN CHILDREN

PEDIATRICS ◽

10.1542/peds.39.2.227 ◽

1967 ◽

Vol 39 (2) ◽

pp. 227-237

Author(s):

Arthur Rose ◽

Donald D. Matson

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypertension ◽

Otitis Media ◽

Viral Infections ◽

Corticosteroid Treatment ◽

Clinical Syndrome ◽

Benign Intracranial Hypertension ◽

Upper Respiratory Tract ◽

Initial Manifestation ◽

Tract Infections

The clinical features of 23 cases of benign intracranial hypertension occurring in childhood have been reviewed. Eight cases followed minor bacterial or viral infections, four cases occurred in association with head or neck injury, four cases occurred with otitis media, and one case followed sudden cessation of corticosteroid treatment. There were no apparent associated clinical factors in the remaining six cases. Benign intracranial hypertension thus emerges as a clinical syndrome of varied etiology, generally with a short course, good prognosis, little tendency to recurrence, and only rarely requiring surgical intervention. Clinical evidence suggests that, in addition to otitis media, cerebral venous thrombosis may, in certain circumstances, follow head injury, trauma to the jugular vein, and thrombosis in the pterygoid venous plexus. Therefore, it is suggested that complete visualization of the venous cerebral circulation should be attempted in the investigation of patients with benign intracranial hypertension. In view of the occurrence of the syndrome following gastroenteritis, upper respiratory tract infections, and chickenpox, diagnostic virological studies, including culture of cerebrospinal fluid, are of special interest. Other precipitating causes of this clinical syndrome are discussed. The occurrence of benign intracranial hypertension as an initial manifestation of two well defined endocrine abnormalities is described. It is possible in the future that systematic endocrine study of patients, particularly pre-pubertal females, will reveal other hormonal defects. It appears probable that transient generalized cerebral edema of any type may be responsible for the occurrence of this syndrome. The elucidation of its pathophysiology will probably have to wait more accurate and safe methods of clinical measurement of intra- and extra-cellular fluid shifts within the brain, as well as more reliable understanding of cerebrospinal fluid and cerebral blood flow alterations.

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Benign intracranial hypertension with spinal and radicular pain

Journal of Neurosurgery ◽

10.3171/jns.1982.57.6.0833 ◽

1982 ◽

Vol 57 (6) ◽

pp. 833-836 ◽

Cited By ~ 28

Author(s):

Marco Bortoluzzi ◽

Leonardo Di Lauro ◽

Giovanni Marini

Keyword(s):

Cerebrospinal Fluid ◽

Serum Albumin ◽

Intracranial Hypertension ◽

Spinal Pain ◽

Radicular Pain ◽

Benign Intracranial Hypertension ◽

Csf Flow ◽

Content Type ◽

Csf Absorption ◽

Fine Print

✓ A case of benign intracranial hypertension with polyradiculopathy and spinal pain is reported. Radioactive iodinated serum albumin (RISA) cisternography demonstrated the absence of cerebrospinal fluid (CSF) flow into the intracranial cisterns, and gave evidence of CSF absorption through the spinal arachnoid villi.

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