scholarly journals Intracranial pressure in patients with the empty sella syndrome without benign intracranial hypertension.

1982 ◽  
Vol 45 (3) ◽  
pp. 209-216 ◽  
Author(s):  
A H Kaye ◽  
B M Tress ◽  
D Brownbill ◽  
J King
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Empty Sella ◽  
Benign Intracranial Hypertension ◽  
Empty Sella Syndrome

scholarly journals Benign Intracranial Hypertension: A Diagnostic Dilemma

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Gary Y. Shaw ◽  
Stephanie K. Million
Keyword(s):  
Intracranial Hypertension ◽  
Signs And Symptoms ◽  
Pseudotumor Cerebri ◽  
Empty Sella ◽  
Definitive Diagnosis ◽  
Benign Intracranial Hypertension ◽  
Imaging Studies ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Empty Sella Syndrome

Benign intracranial hypertension (BIH) (also known as pseudotumor cerebri and empty sella syndrome) remains a diagnostic challenge to most physicians. The modified Dandy criteria consist of, the classic findings of headache, pulsatile tinnitus, papilledema, and elevated cerebrospinal fluid (CSF) pressure, however, these are rarely collectively present in any one patient. Furthermore, these findings can wax and wane over time. Due to the nature of this disease, both signs and symptoms may be intermittent, making definitive diagnosis difficult. Newer imaging studies, particularly the magnetic resonance venogram (MRV) along with a constellation of correlative findings and associated diseases have given new impetus in the diagnosis, treatment, and pathophysiology of this disease. This has led the authors to offer modifications to the classic Dandy criteria. This report presents three representative cases of BIH highlighting many of the newer advances in both diagnosis and treatment of this perplexing disorder.

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
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.

scholarly journals Intracranial hypertension and empty Sella from adrenal adenoma and excessive and prolonged steroid usage: a case report

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Naiqian Zhao ◽  
Weixia Yang ◽  
Xiaoyan Li ◽  
Li Wang ◽  
Ying Feng
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Low Dose ◽  
Adrenal Adenoma ◽  
Empty Sella ◽  
Elevated Intracranial Pressure ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Free Cortisol

Abstract Background There is only one documented case of intracranial hypertension (IH) and empty sella from cortisol-producing adrenal adenoma so far. And IH and empty sella caused by long-term exogenous hypercortisolism has never been reported before. The purpose of this case report is to alert clinicians to glucocorticoid-induced IH. Case presentation We present retrospectively a 50-year-old woman with cortisol-secreting adrenal adenoma, who progressed to intractable intracranial hypertension and a markedly expanded empty sella due to improper treatment. In 2011, the patient presented with hypertension, lack of cortisol circadian rhythm, low ACTH, a left adrenal adenoma and a partial empty sella, but did not receive low-dose dexamethasone suppression test (LDDST) and 24-h urinary cortisol. In 2014, she exhibited truncal obesity, raised cortisol, LDDST non-suppression, high urinary free cortisol and low ACTH, proving her cortisol-producing adrenal adenoma. She was simultaneously diagnosed with unexplained IH because of papilledema and elevated intracranial pressure, and her partial empty sella changed to a complete empty sella. In 2015, she underwent adrenal adenoma resection. From 2015 to 2018, she kept taking dexamethasone at least 2 mg daily without her doctors’ consent. During this period, she developed transient cerebrospinal fluid rhinorrhea, and her empty sella further worsened. After switching to low dose hydrocortisone, her papilledema disappeared completely, but optic atrophy has become irreversible. Conclusions The patient seems to be just an extreme case, but it may reveal and illustrate a general phenomenon: Both cortisol-producing adrenal adenoma and long-term exogenous hypercortisolism could cause varying degrees of elevated intracranial pressure and empty sella. Clinicians should remain vigilant for this phenomenon in patients with cortisol-producing adrenal adenoma or excessive and prolonged steroid usage and give them corresponding examinations to identify this complication.

Spontaneous Nasal Cerebrospinal Fluid Leaks and Empty Sella Syndrome: A Clinical Association

2003 ◽  
Vol 17 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Skull Base ◽  
Sella Turcica ◽  
Empty Sella ◽  
Radiographic Appearance ◽  
Radiographic Findings ◽  
Empty Sella Syndrome ◽  
Csf Pressure ◽  
Csf Leaks

Background Spontaneous, idiopathic nasal meningoencephaloceles are herniations of arachnoid/dura and cerebrospinal fluid (CSF) through anatomically fragile sites within the skull base. Empty sella syndrome occurs when intracranial contents herniate through the sellar diaphragm filling the sella turcica with CSF and giving the radiographic appearance of an absent pituitary gland. The objective of this study was to examine the association between spontaneous encephaloceles/CSF leaks and empty sella syndrome because of their similar clinical features and potential common pathophysiology. Methods Retrospective. Results Sixteen patients were treated for spontaneous encephaloceles between 1996 and 2001. All 16 patients had associated CSF leaks. Five patients had multiple simultaneous encephaloceles. Fifteen patients with imaging of the sella turcica had empty (10 patients) or partially empty (5 patients) sellas. One patient did not have complete imaging of the sella. Three patients had lumbar punctures with measurement of CSF pressure during computed tomography cisternograms because of multiple skull base defects. Mean CSF pressure was 28.3 cm of water (range, 19–34 cm; normal, 0–15 cm). Thirteen of 16 patients (81%) were obese women (mean body mass index, 35.9 kg/m2; normal, <25 kg/m2). Mean follow-up was 14.2 months with 100% success in closure of the defects after one procedure. Conclusion Spontaneous meningoencephaloceles and CSF leaks are strongly associated with radiographic findings of an empty sella and suggest a common pathophysiology. The underlying condition probably represents a form of intracranial hypertension that exerts hydrostatic pressure at anatomically weakened sites within the skull base. Otolaryngologists should be familiar with this disease entity and the implications intracranial hypertension has on patient management.

The diagnostic value of cranial MRI findings in idiopathic intracranial hypertension: evaluating radiological parameters associated with intracranial pressure

2021 ◽  
pp. 028418512110388
Author(s):  
Tuncer Taşcioğlu
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Control Group ◽  
Mri Findings ◽  
Delay In Diagnosis ◽  
Radiological Parameters ◽  
Cranial Mri

Background Idiopathic intracranial hypertension (IIH) is a disease that can result in blindness if there is a delay in diagnosis. Although it is stated that cranial imaging should be normal among the diagnostic criteria, we know that some radiological parameters can be used for the pre-diagnosis of IIH. Purpose To determine the predictive value of radiological parameters for the diagnosis of IIH with cranial magnetic resonance imaging (MRI). Material and Methods The study included a group of 19 patients with IIH (“IIH Group”), a group of 34 patients with hyperintensity around the optic nerve in cranial MRI (“Radiological Increased Intracranial Pressure Group”), and a “Control Group” consisting of 45 healthy individuals. All patients were evaluated using cranial MRI with respect to the presence/absence of empty sella, flattening of the posterior globe, hyperintensity around the optic nerve, optic nerve tortuosity, and optic nerve protrusion. In addition, optic nerve sheath diameter measurement was performed in all patients using cranial axial T2 sequence. Results It was found that optic nerve tortuosity ( P = 0.002), flattening of the posterior globe ( P = 0.013), and optic nerve protrusion ( P = 0.033) were the best parameters to distinguish patients with IIH and those with optic nerve subarachnoid space enlargement. A scoring system was developed according to these data. Conclusion In the presence of hyperintensity around the optic nerve, it may be possible to evaluate optic nerve tortuosity, flattening of the posterior globe, and optic nerve protrusion using cranial MRI in order to come upon a preliminary diagnosis of IIH.

Intracranial pressure following optic nerve decompression for benign intracranial hypertension

1981 ◽  
Vol 55 (3) ◽  
pp. 453-456 ◽  
Author(s):  
Andrew H. Kaye ◽  
J. E. K. Galbraith ◽  
John King
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Continuous Recording ◽  
Optic Nerve Sheath ◽  
Benign Intracranial Hypertension ◽  
Content Type ◽  
Nerve Sheath ◽  
Before And After ◽  
Fine Print

✓ The authors report the case of a patient with benign intracranial hypertension and severe papilledema, who underwent surgery for bilateral optic nerve sheath decompression. No change in the intracranial pressure (ICP) was seen during continuous recording performed before and after the operation. This case supports the contention that the decrease in papilledema and the visual improvements seen following this operation are more likely to be due to decrease in optic nerve sheath pressure than to a generalized decrease in ICP, as suggested by other authors.

Primary empty sella syndrome in a series of 142 patients

2005 ◽  
Vol 103 (5) ◽  
pp. 831-836 ◽  
Author(s):  
Giulio Maira ◽  
Carmelo Anile ◽  
Annunziato Mangiola
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Empty Sella ◽  
Csf Leak ◽  
Csf Shunt ◽  
Csf Dynamics ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Fine Print ◽  
Primary Empty Sella

Object. The primary empty sella syndrome (ESS) represents a heterogeneous clinical picture characterized by endocrine disturbances and signs of intracranial hypertension. An increase in intracranial pressure (ICP) is proposed to be one of the involved pathogenetic factors. Methods. The series included 142 patients who were observed during a period of 20 years. All patients underwent an ICP and cerebrospinal fluid (CSF) dynamics evaluation through the use of a lumbar constant-rate infusion test. Impairment of ICP and CSF dynamics was observed in 109 patients (76.8%). In 35 of the 36 patients affected by severe intracranial hypertension without rhinorrhea, improvement in adverse neurological symptoms was achieved after implanting a CSF shunt. Visual function, already seriously compromised before surgery, remained severely altered in one patient. In the group of 34 patients affected by rhinorrhea, CSF leakage was controlled using different surgical treatments: CSF shunt placement in 16 cases, surgical repair of the sellar floor in three, and both procedures in the remaining 13. Two patients refused any surgical treatment. Conclusions. The role of increased ICP in the pathogenesis and perpetuation of primary ESS has been confirmed. Adverse neurological signs and a CSF leak are correlated with an actual increase in ICP and are relieved after CSF shunt insertion. Cerebrospinal fluid rhinorrhea is more common than generally thought. Its resolution can be achieved using a careful diagnostic protocol and sometimes may require different surgical procedures.

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