scholarly journals Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia

2021 ◽  
Vol 3 (1) ◽  
pp. e000145
Author(s):  
Natasha Krishnadas ◽  
Bruce Taylor
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Local Health ◽  
Childbearing Age ◽  
Tertiary Referral Centre ◽  
Health Service Provision ◽  
Prevalence Studies ◽  
Local Health Service ◽  
Australian Bureau Of Statistics ◽  
New Diagnosis

IntroductionAnecdotally, the incidence of idiopathic intracranial hypertension (IIH) is increasing, linked to an increase in the obesity rate in Australian society. However, formal incidence and prevalence studies are rare. We therefore sought to determine the incidence and clinical features of IIH in Southern Tasmania, Australia.MethodNeurology discharge summaries and lumbar puncture referrals from the single tertiary referral centre in this region were screened for an IIH diagnosis. All regional neurologists were surveyed to capture patients diagnosed through private neurology clinics. A retrospective review of medical records was conducted to confirm the diagnosis and determine whether patients met the Modified Dandy Criteria (MDC). Patients were included if they were above the age of 18 years and received a new diagnosis of IIH between June 2016 and June 2018. Population statistics were obtained from the Australian Bureau of Statistics.ResultsIIH incidence was 5.4/100 000. All patients were females, aged between 18 and 45 years. Headache was the most commonly reported symptom, with high rates of pre-existing or concurrent migraine diagnoses. Weight loss and commencement of oral acetazolamide were the most common treatment approaches. Four patients were medically refractory and required surgical intervention.ConclusionThe incidence of IIH in Southern Tasmania is comparable with the incidence reported in subgroups of females of childbearing age in recent prior studies. The demographic, diagnostic and therapeutic data presented can inform future local health service provision and serve as a baseline for ongoing assessment of change in incidence and treatment of IIH at a community level.

scholarly journals A Case of Pulsatile Tinnitus Related to Idiopathic Intracranial Hypertension

2020 ◽  
Vol 63 (9) ◽  
pp. 422-426
Author(s):  
Jong-Won Bae ◽  
Kyu-Yup Lee ◽  
Myung Hoon Yoo ◽  
Da Jung Jung
Keyword(s):  
Intracranial Hypertension ◽  
Young Women ◽  
Idiopathic Intracranial Hypertension ◽  
Obese Woman ◽  
Pulsatile Tinnitus ◽  
Obese Women ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Early Symptom ◽  
Vascular Abnormalities

Idiopathic intracranial hypertension (IIH) is a disorder that commonly occurs in obese young women of childbearing age and is characterized by symptoms such as pulsatile tinnitus, dizziness, headache, nausea, vomiting, and visual loss without any structural or vascular abnormalities in the intracranial cavity. We recently experienced a case of a 33-year-old obese woman who presented with right-sided pulsatile tinnitus, which is an early symptom for IIH. The patient was successfully treated with weight reduction and carbonic anhydrase inhibitor (acetazolamide). Pulsatile tinnitus requires thorough diagnosis and examination because it can be cured if the anatomical or functional cause is identified and treated. When obese women of childbearing age present with pulsatile tinnitus at the otorhinolaryngology outpatient department, treatment for IIH should be initiated after appropriate examination and diagnosis as pulsatile tinnitus may be the only symptom for IIH.

Evidence for potential involvement of pro-inflammatory adipokines in the pathogenesis of idiopathic intracranial hypertension

Cephalalgia ◽  
2016 ◽  
Vol 37 (6) ◽  
pp. 525-531 ◽  
Author(s):  
Bedia Samancı ◽  
Yavuz Samancı ◽  
Erdem Tüzün ◽  
Güneş Altıokka-Uzun ◽  
Esme Ekizoğlu ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Oligoclonal Bands ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Healthy Controls ◽  
Childbearing Age ◽  
Serum Samples ◽  
Necrosis Factor Alpha ◽  
Tnf Α

Background Although specific role players are currently unknown, contribution of inflammatory mediators has been suggested in the pathophysiology of idiopathic intracranial hypertension (IIH), which is a disease more prevalent in obese female individuals of childbearing age. We aimed to investigate the levels of adipokines and cytokines to demonstrate possible markers for inflammation that participate in IIH pathophysiology and their association with clinical features of IIH. Methods IIH patients, diagnosed according to the revised criteria, and age-, gender- and body mass index (BMI)-matched healthy controls were enrolled in this study. Serum samples were evaluated for insulin-like growth factor 1, insulin, nesfatin, adiponectin, interleukin (IL)-1β, IL-6, IL-8, leptin, plasminogen activator inhibitor type-1, resistin, tumour necrosis factor-alpha (TNF-α) and monocyte chemotactic protein 1 via enzyme-linked immunosorbent assay or multiplex immunoassays. Results IL-1β level was significantly higher ( p = 0.012), and IL-8 and TNF-α levels were significantly lower in the IIH group ( p < 0.001 and p = 0.008, respectively) compared to the control group. There were no correlations between the cytokine/adipokine levels and age, BMI, disease duration, and cerebrospinal fluid oligoclonal bands. There were also no significant differences in cytokine and adipokine levels between IIH patients regarding visual impairment. However, statistically significant differences were found between IIH patients with relapse versus healthy controls regarding IL-1β ( p = 0.007), IL-8 ( p = 0.001) and TNF-α ( p = 0.017) levels. Other investigated cytokines and adipokines showed no significant alterations in IIH patients investigated in the remission period. Conclusion Altered serum levels of IL-1β, IL-8 and TNF-α seem to be associated with IIH pathogenesis, and these cytokines may be used as prognostic markers in IIH to predict relapse.

scholarly journals 080 The incidence, diagnosis and outcomes of idiopathic intracranial hypertension in the southern tasmanian catchment

2019 ◽  
Vol 90 (e7) ◽  
pp. A25.3-A26
Author(s):  
Natasha Krishnadas ◽  
Bruce Taylor
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Incidence Rates ◽  
Regional Studies ◽  
Opening Pressure ◽  
Exclusion Criteria ◽  
Human Ethics ◽  
Regional Population ◽  
Australian Bureau Of Statistics ◽  
The University

IntroductionThis study aimed to identify the incidence of idiopathic intracranial hypertension (IIH) in Southern Tasmania, Australia. Secondary aims were to elucidate demographics, current approaches to investigation, treatment and outcomes. To our knowledge, similar regional studies have not been performed.MethodsThe study was approved by the University of Tasmania Human Ethics Committee. Patients presented between June 2016-June 2018 to Royal Hobart Hospital, the single tertiary Neurology service in Tasmania. Cases were identified by screening lumbar punctures (LP) performed by Neurology services (inpatient, outpatient, Radiologically-assisted) and by surveying all regional Neurologists. Medical records were used to corroborate LP results and determine whether patients met Modified Dandy Criteria (MDC) (used to define IIH in current literature). Regional population statistics were obtained from the Australian Bureau of Statistics (ABS). Duplicate records were excluded. Exclusion criteria included age <18 at data collection, LP opening pressure <20cm of water or secondary causes for IIH.Results45 cases identified; 30 within the Greater Hobart region, population of 229,088 (June 2016-June 2017). Cumulative incidence was 6.55/100,000 (incidence rate 0.06/1000) with classification based on Neurologist diagnosis and 5.46/100,000 (0.05/1000) with classification according to MDC. 100% of the cohort were female. Mean age was 26.7 (range 17–45) and mean weight was 105.3kg (range 78–170). Headache was the most commonly reported symptom. 8.9% (4/45) of the total cohort were medically refractory (requiring VP/LP shunting). Ophthalmology services initiated 51% (23/45) of the referrals.ConclusionsOur incidence rates are higher than rates in previous studies for population subsets of young women.

Unilateral papilledema in idiopathic intracranial hypertension: A rare entity

2020 ◽  
pp. 112067212096904
Author(s):  
Mousumi Banerjee ◽  
Swati Phuljhele Aalok ◽  
Deepti Vibha
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Pseudotumor Cerebri ◽  
Clinical Syndrome ◽  
Unknown Etiology ◽  
Obese Women ◽  
Mechanical Compression ◽  
Childbearing Age ◽  
Diagnostic Challenge ◽  
Rare Presentation

Idiopathic Intracranial Hypertension (IIH), also known as pseudotumor cerebri is a clinical syndrome of unknown etiology, which typically affects young, obese women of childbearing age and is characterized by increased intracranial pressure and bilateral papilledema. Unilateral and highly asymmetrical papilledema is a rare presentation in IIH occurring in less than 4% of patients with definite IIH and can poses a diagnostic challenge for the treating physician as it usually raises the suspicion of localized ocular pathology. As per current consensus, papilledema results in stasis of axoplasmic transport due to mechanical compression, leading to secondary vascular changes of venous dilation and hemorrhage. Given this mechanism, the underlying reasons for unilateral and asymmetrical papilledema remain unclear.

Idiopathic intracranial hypertension

2010 ◽  
pp. 4972-4975
Author(s):  
N.F. Lawton
Keyword(s):  
Vitamin A ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Pressure ◽  
Visual Disturbance ◽  
Fluid Absorption ◽  
Childbearing Age ◽  
Hypervitaminosis A ◽  
Cerebrospinal Fluid Absorption ◽  
Cerebral Venous Pressure

Case History—A 40 yr old man presenting with headache and visual disturbance. Idiopathic intracranial hypertension is a syndrome of raised intracranial pressure in the absence of an intracranial mass lesion, enlargement of the cerebral ventricles due to hydrocephalus, or venous thrombosis in the dural sinuses. Impaired cerebrospinal fluid absorption and raised cerebral venous pressure have both been implicated. Obese females of childbearing age are predominantly affected. Rarely, provocative factors include tetracycline, vitamin A derivatives, hypervitaminosis A, and vitamin A excess....

Idiopathic Intracranial Hypertension

2019 ◽  
pp. 47-54
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Older Adults ◽  
Visual Field ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Clinical Signs ◽  
Field Testing ◽  
Obese Women ◽  
Childbearing Age

Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in obese women of childbearing age, although it can also occur in children, men, and older adults. Papilledema is usually present and can cause irreversible vision loss if left untreated. In this chapter, we begin by reviewing the symptoms of this condition, which include headache, transient visual obscurations, and pulse-synchronous tinnitus. We next review the clinical signs and common findings on formal visual field testing. We then discuss the diagnostic evaluation and review the diagnostic criteria for this condition. Lastly, we review the goals and management of this condition, which must be tailored depending on the severity of symptoms, papilledema, and vision loss.

scholarly journals Headaches and papilloedema in a pregnant woman with polycystic ovarian syndrome

2011 ◽  
Vol 4 (1) ◽  
pp. 28-29
Author(s):  
Adam Morton
Keyword(s):  
Pregnant Woman ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Polycystic Ovarian Syndrome ◽  
Rare Condition ◽  
Reproductive Age ◽  
Obese Women ◽  
Women Of Reproductive Age ◽  
New Diagnosis ◽  
Ovarian Syndrome

Idiopathic intracranial hypertension (IIH) is a rare condition, its highest incidence being in obese women of reproductive age. A woman with polycystic ovarian syndrome and IIH is presented, a new diagnosis during pregnancy resulting in a change in her management.

scholarly journals Management of Idiopathic Intracranial Hypertension: Experience of a North African Center

2020 ◽  
Vol 9 (02) ◽  
pp. 085-088
Author(s):  
Ibrahim Assoumane ◽  
Mahdia Touati ◽  
Harissou Adamou ◽  
Nadia Lagha ◽  
Ibrahim Baaré ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Young Women ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Postoperative Outcome ◽  
North African ◽  
Childbearing Age ◽  
Neurosurgical Department ◽  
The Mean ◽  
Space Occupation

Abstract Background The idiopathic intracranial hypertension (IIH) is characterized by elevation of intracranial pressure (ICP) in the absence of intracerebral space occupation or venous sinus thrombosis. It usually occurs in obese young women but is very rare in childhood. Materials and Methods We conducted a retrospective study in the neurosurgical department of Bab El Oued teaching hospital of Algiers over a period of 8 years from January 2008 to December 2015. We analyzed clinical data of 10 patients with IIH diagnosis, and the surgical technique consisted of an insertion of a lumbo-peritoneal shunt. Results In our study, 80% were women with sex ratio M/F of 0.25; the mean age was 32 years and 60% of our patients were obese. For most of our patients, the postoperative outcome was marked by the disappearance of the headache immediately, disappearance of strabismus and diplopia in the following week, followed by improvement of visual function. Conclusion The IIH is predominantly a disease of women in the childbearing age; surgical treatment is a good option for patients who resisted medication or did not tolerate it as well as for ICH fulminous in emergency cases.

scholarly journals Idiopathic Intracranial Hypertension: Current Neuroophthalmologic Points

2021 ◽  
Vol 18 (4) ◽  
pp. 791-800
Author(s):  
A. V. Petrayevsky ◽  
K. S. Trishkin ◽  
I. A. Gndoyan
Keyword(s):  
Drug Therapy ◽  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Brain Mri ◽  
Clinical Manifestations ◽  
Optic Nerve Sheath ◽  
Childbearing Age ◽  
Short Term Treatment ◽  
Nerve Sheath

Idiopathic intracranial hypertension (ICH) is a neuroophophthalmologic syndrome, the main ophthalmologic symptoms of which are vision loss and bilateral swelling of optic nerve disks (OD). The article provides a review covering various aspects of ICH. Epidemiology: ICH occurs mainly in women aged 20–45 years with body overweight. In this group of patients world incidence is 12–20 per 100 000 of population per year. In the total population it represents 0.5–2 cases per 100 000 of population per year. The eightfold gender predominance of women with ICH is observed. Etiology is not fully known until present time. The reliable connection between obesity in childbearing age women and menstrual cycle disorders as evidences of hormonal changes has been established. The probable mechanisms of increase of ICP are supposed: hyperproduction of and disturbances of its absorption, CSF mechanical pressure on the optic nerve sheath; restriction of venous outflow from the brain due to the pathology of venous sinuses; stimulating effect of abundant vitamin A in diet resulting in the fat tissue formation with the development of obesity; expression of the protein aquaporin, involved in the regulation of body mass and water metabolism in the subarachnoid space. Clinical manifestations. Ophthalmologic symptoms of ICH: transient visual impairment, sustained loss of visual acuity, photopsy, retrobulbar pain, diplopia. Non-ophthalmologic symptoms: headache, throbbing tinnitus, hearing loss, dizziness. Diagnostics. The valuable diagnostic data can be obtained by visual field investigation, ophthalmoscopic examination with revealing of bilateral OD-edema, OD and retinal optical coherent tomography, orbital ultrasound examination, brain MRI with venography. Treatment. Non-drug therapy: weight loss, lowcalorie diet with limited water and salt intake. Drug therapy: long-term oral use of carbonic anhydrase inhibitors (acetazolamide, topiramate). High doses of steroids (methylprednisone) are used for short-term treatment of patients with fulminant disease type before surgery. Surgery: bypass surgery, cerebral venous sinus stenting and fenestrations of the optic nerve sheath: bariatric surgery with reducing of stomach volume.

scholarly journals Incidence of idiopathic intracranial hypertension in Fife

2018 ◽  
Vol 64 (2) ◽  
pp. 62-66 ◽  
Author(s):  
Colin Goudie ◽  
Jennifer Burr ◽  
Andrew Blaikie
Keyword(s):  
Visual Impairment ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Clinical Syndrome ◽  
Common Symptom ◽  
Obesity Epidemic ◽  
Prevalence Of Obesity ◽  
One Year ◽  
High Level ◽  
New Diagnosis

Background and aims Idiopathic intracranial hypertension is a clinical syndrome of intracranial hypertension with normal cerebrospinal fluid in the absence of a mass lesion or hydrocephalus on brain imaging. Headache is the most common symptom of idiopathic intracranial hypertension, and about 10–15% of patients suffer from irreversible visual impairment. Previous estimates of the annual incidence of idiopathic intracranial hypertension vary worldwide from 0.03 to 2.2 per 100,000. The major risk factor implicated in idiopathic intracranial hypertension is body mass. Scotland has one of the worst records for obesity in the developed world, and the prevalence of obesity in Fife is higher than the Scottish average. Our aim was to record the incidence of idiopathic intracranial hypertension in NHS Fife over a one-year period. Methods and results Prospective study including every patient who was seen in the ophthalmology department in NHS Fife with a new diagnosis of idiopathic intracranial hypertension over a one-year period. Thirteen patients were seen with a new diagnosis of idiopathic intracranial hypertension from August 2013 to July 2014 giving an incidence of 3.56 per 100,000. Headache was the most common presenting symptom. Three patients were asymptomatic but were noted to have swollen optic discs during a routine sight test. One patient complained of visual symptoms. All patients were overweight. The mean BMI was 36 (range: 28–49). Conclusion The incidence of idiopathic intracranial hypertension in NHS Fife was significantly higher than previous estimates in the literature. This is probably due to a high level of obesity in Fife. Scotland is in the midst of an obesity epidemic and if this continues we may see increasing levels of idiopathic intracranial hypertension nationally with associated increasing incidence of visual impairment in young adults.

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