scholarly journals Two Episodes of Ventriculoperitoneal Shunt Migration in a Patient with Idiopathic Intracranial Hypertension

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
V. Balakrishnan ◽  
R. Jeanmonod
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Symptom Control ◽  
Subsequent Development ◽  
Distal Portion ◽  
Obese Patients ◽  
Medical Provider ◽  
And Migration ◽  
High Index Of Suspicion ◽  
Shunt Migration

Introduction. Ventriculoperitoneal shunts are often placed as treatment for refractory idiopathic intracranial hypertension. Dislodgement and migration of the distal portion of the shunt are more common in obese patients and can be difficult to detect. We report the case of a woman with two separate episodes of shunt migration into her abdominal wall.Case Presentation. We report a case of a 37-year-old female with history of obesity eventually diagnosed with idiopathic intracranial hypertension (IIH) as the cause. She failed outpatient therapy and, through neurosurgery, had a VP shunt placed for symptom control. She had subsequent development of worsened symptoms that were found to be due to shunt migration. This happened not once but twice to the same patient.Conclusion. Shunt dislodgement, migration, and subsequent failure are common in obese patients who have shunts placed for IIH. The medical provider should maintain a high index of suspicion for shunt malfunction in these patients, particularly because clinical evaluation may be challenging due to habitus.

TM3-1 Idiopathic intracranial hypertension: consensus guidelines on investigation and management

2019 ◽  
Vol 90 (3) ◽  
pp. e15.1-e15
Author(s):  
SP Mollan ◽  
B Davis ◽  
NC Silver ◽  
S Shaw ◽  
C Malucci ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Subsequent Development ◽  
Underlying Disease ◽  
List Type ◽  
Patient Representatives ◽  
Primary Care Doctors ◽  
Consensus Guidance ◽  
Wide Group ◽  
The Uk

ObjectivesThe aim was to capture interdisciplinary expertise from a large group of clinicians, reflecting practice from across the UK and further, to inform subsequent development of a national consensus guidance for optimal management of Idiopathic Intracranial Hypertension.DesignConsensus guideline critically reviewed by the Association of British Neurologists, British Association for the Study of Headache, the Society of British Neurological Surgeons and the Royal College of Ophthalmologists.SubjectsAn initial UK survey of attitudes and practice in IIH was sent to a wide group of physicians and surgeons.MethodsBetween September 2015 and October 2017 a specialist interest group including neurology, neurosurgery, neuro-radiology, ophthalmology, nursing, primary care doctors, and patient representatives met. A comprehensive systematic literature review was performed to assemble the foundations of the statements.ResultsOver twenty questions were constructed: One based on the diagnostic principles for optimal investigation of papilloedema and twenty-one for the management of IIH. 3 main principles were identified:to treat the underlying disease;to protect the vision andto minimise the headache morbidity.Statements presented provide insight to uncertainties in IIH where research opportunities exist.ConclusionsIn collaboration with many different specialists, professions and patient representatives we have developed guidance statements for the investigation and management of adult IIH.

Plasma ghrelin levels are normal in obese patients with idiopathic intracranial hypertension (pseudotumor cerebri)

2004 ◽  
Vol 138 (1) ◽  
pp. 109-113 ◽  
Author(s):  
Prem S. Subramanian ◽  
Nitza Goldenberg-Cohen ◽  
Salil Shukla ◽  
Lawrence J. Cheskin ◽  
Neil R. Miller
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Pseudotumor Cerebri ◽  
Obese Patients

Predictors for venous sinus stent retreatment in patients with idiopathic intracranial hypertension

2016 ◽  
Vol 9 (12) ◽  
pp. 1228-1232 ◽  
Author(s):  
Amgad El Mekabaty ◽  
Nancy A Obuchowski ◽  
Mark G Luciano ◽  
Seby John ◽  
Charlotte Y Chung ◽  
...  
Keyword(s):  
African Americans ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Revision Rate ◽  
Normal Weight ◽  
Venous Sinus ◽  
Practical Significance ◽  
Dural Sinus ◽  
Obese Patients ◽  
Class Iii

BackgroundVenous sinus stenting for dural sinus stenoses is an emerging alternative to cerebrospinal fluid diversion in cases of medically refractory idiopathic intracranial hypertension. Juxta-stent ‘re-stenoses’ have been reported and managed alternatively with ventricular shunting or stent revision. Identification of factors that might predispose patients to recurrent narrowing may help to select or exclude patients with idiopathic intracranial hypertension for venous sinus stenting.MethodsWe retrospectively reviewed a prospectively maintained database spanning December 2011 to May 2015 of all patients with idiopathic intracranial hypertension who were screened for possible venous sinus stenting, including only patients who received a stent, noting symptomatic improvements, changes in opening lumbar puncture pressure, demographic characteristics, and any subsequent intervention after stent placement. Fisher's exact test and logistic regression were used to test each of seven potential predictors for retreatment.ResultsThere were eight revisions in 31 patients (25.8%). Among Caucasians, 8.0% required a revision compared with 100% of African-Americans (p<0.001). The c-index for race was 0.857. Body mass index (BMI) was also a significant predictor of revision (p=0.031): among class III obese patients the revision rate was 46.2% compared with 16.7% among class I and II obese patients and 0% among overweight to normal weight patients.ConclusionsBMI was a significant predictor of revision, suggesting that higher BMI may have a higher risk of revision. The small number of African-Americans in the study makes interpretation of the practical significance of the revision rate in these patients uncertain. None of the other studied factors was statistically significant.

scholarly journals IDIOPATHIC INTRACRANIAL HYPERTENSION IN UNIVERSITY HOSPITAL IN SAUDI ARABIA, RETROSPECTIVE STUDY

2021 ◽  
Vol 9 (08) ◽  
pp. 300-305
Author(s):  
Faisal Al-Abass ◽  
◽  
Kawther Hadhiah ◽  
Abdullah Al-Fajri ◽  
Hanan AlHabib. ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Retrospective Study ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
University Hospital ◽  
Hormonal Contraceptives ◽  
Common Symptom ◽  
Blurred Vision ◽  
High Index Of Suspicion ◽  
The University

Background: Idiopathic intracranial hypertension (IIH) is one of headache syndromes that is female predominate and associated with increase intracranial pressure without obvious etiology, it has variable clinical presentation, and it needs high index of suspicion to reach diagnosis even with presence of well-established diagnostic criteria. Visual symptoms, which range from visual obscuration to blindness significantly,affect the outcome of this disease. Unfortunately, there is limited literature about IHH in Middle East and in Saudi Arabia in particular. In this retrospective study, we try to shed the light on pseudo-tumor cerebri in university hospital in Saudi Arabia. Methodology: This is a retrospective study conducted among 105 patients with IIH admitted to the university hospital in Saudi Arabia. Data on age, gender, as well as about symptoms, obesity, medication and surgeries, and CT/MRI results was collected. Results: The mean age of patients was 37.72 years old with standard deviation of 13.48 where 96.2 % of patients were females. Headache is the more common symptom presented by 96.2 % of patients followed with blurred vision and papilledema (85.7 %) and over weight (77.1 %). Considering medications taken by patients because of IIH, we found that main medications was Diamox which prescribed to 96.2 % with mean dose of 942.3 mg. Regarding surgical intervention, 4.8 % had a surgery of VP-shunt and 1.9 % had optic nerve fenestration Conclusion: We concluded that IIH incidence is higher among young women with higher body weight and associated with the use of hormonal contraceptives. The main symptoms of IIH are headache with papilledema and visual disturbances. Acetazolamide is the most common prescribed medication for IIH patients while 6.6 % of patients need surgical procedures.

Bariatric surgery for the treatment of idiopathic intracranial hypertension

2011 ◽  
Vol 114 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Jared Fridley ◽  
Rod Foroozan ◽  
Vadim Sherman ◽  
Mary L. Brandt ◽  
Daniel Yoshor
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Visual Field ◽  
Intracranial Hypertension ◽  
Body Mass ◽  
Idiopathic Intracranial Hypertension ◽  
Obese Patients ◽  
Symptom Resolution ◽  
Visual Field Deficits

Object The purpose of this study was to review the literature on the effectiveness of bariatric surgery for obese patients with idiopathic intracranial hypertension (IIH) with regard to both symptom resolution and resolution of visual deficits. Methods The published literature was reviewed using manual and electronic search techniques. Data from each relevant manuscript were gathered, analyzed, and compared. These included demographic data, pre- and postoperative symptoms, pre- and postoperative visual field deficits, bariatric procedure type, absolute weight loss, changes in body mass index, and changes in CSF opening pressure. Results Eleven relevant publications (including 6 individual case reports) were found, reporting on a total of 62 patients. The Roux-en-Y gastric bypass was the most common bariatric procedure performed. Fifty-six (92%) of 61 patients with recorded postoperative clinical history had resolution of their presenting IIH symptoms following bariatric surgery. Thirty-four (97%) of 35 patients who had undergone pre- and postoperative funduscopy were found to have resolution of papilledema postoperatively. Eleven (92%) of 12 patients who had undergone pre- and postoperative formal visual field testing had complete or nearly complete resolution of visual field deficits, and the remaining patient had stabilization of previously progressive vision loss. In 13 patients both pre- and postoperative CSF pressures were recorded, with an average postoperative pressure decrease of 254 mm H2O. Changes in weight loss and body mass index varied depending on the reported postoperative follow-up interval. Conclusions The published Class IV evidence suggests that bariatric surgery may be an effective treatment for IIH in obese patients, both in terms of symptom resolution and visual outcome. Prospective, controlled studies are necessary for better elucidation of its role.

Idiopathic Intracranial Hypertension With and Without Papilloedema in a Consecutive Series of Patients With Chronic Migraine

Cephalalgia ◽  
2008 ◽  
Vol 28 (6) ◽  
pp. 609-613 ◽  
Author(s):  
DSS Vieira ◽  
MR Masruha ◽  
AL Gonçalves ◽  
E Zukerman ◽  
CA Senne Soares ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Chronic Migraine ◽  
Idiopathic Intracranial Hypertension ◽  
International Headache Society ◽  
Consecutive Series ◽  
Obese Patients ◽  
Open Pressure ◽  
A Prospective Study ◽  
High Bmi ◽  
Rule Out

Chronic migraine (CM) has been associated with idiopathic intracranial hypertension without papilloedema (IIHWOP), a significant percentage of these cases occurring in obese patients with intractable headache. A prospective study from February 2005 to June 2006 was made of 62 CM patients who fulfilled International Headache Society diagnostic criteria and had cerebral magnetic resonance venography (MRV) and lumbar puncture (LP) done. Two patients were excluded, six (10%) with elevated cerebrospinal fluid (CSF) open pressure (OP), five with body mass index (BMI) > 25. None of the patients had papilloedema or abnormal MRV. BMI and CSF OP were significantly correlated ( r = 0.476, P < 0.001, Pearson's correlation test). Obesity (defined as BMI > 30) was a predictor of increase in intracranial pressure (defined as OP > 200 mmH2O) ( f = 17.26, 95% confidence interval 6.0, 8.6; P < 0.001). From our study we strongly recommend that not only intractable CM patients with high BMI, but also first diagnosed patients with BMI > 30 should be systematically evaluated by a LP to rule out IIHWOP.

scholarly journals Idiopathic intracranial hypertension: consensus guidelines on management

2018 ◽  
Vol 89 (10) ◽  
pp. 1088-1100 ◽  
Author(s):  
Susan P Mollan ◽  
Brendan Davies ◽  
Nick C Silver ◽  
Simon Shaw ◽  
Conor L Mallucci ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Subsequent Development ◽  
Underlying Disease ◽  
International Panel ◽  
Patient Representatives ◽  
Primary Care Doctors ◽  
Consensus Guidance ◽  
Wide Group ◽  
The Uk

The aim was to capture interdisciplinary expertise from a large group of clinicians, reflecting practice from across the UK and further, to inform subsequent development of a national consensus guidance for optimal management of idiopathic intracranial hypertension (IIH).MethodsBetween September 2015 and October 2017, a specialist interest group including neurology, neurosurgery, neuroradiology, ophthalmology, nursing, primary care doctors and patient representatives met. An initial UK survey of attitudes and practice in IIH was sent to a wide group of physicians and surgeons who investigate and manage IIH regularly. A comprehensive systematic literature review was performed to assemble the foundations of the statements. An international panel along with four national professional bodies, namely the Association of British Neurologists, British Association for the Study of Headache, the Society of British Neurological Surgeons and the Royal College of Ophthalmologists critically reviewed the statements.ResultsOver 20 questions were constructed: one based on the diagnostic principles for optimal investigation of papilloedema and 21 for the management of IIH. Three main principles were identified: (1) to treat the underlying disease; (2) to protect the vision; and (3) to minimise the headache morbidity. Statements presented provide insight to uncertainties in IIH where research opportunities exist.ConclusionsIn collaboration with many different specialists, professions and patient representatives, we have developed guidance statements for the investigation and management of adult IIH.

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