scholarly journals Diagnostic value of brain MR imaging and its correlation with clinical presentation and cognitive functions in idiopathic intracranial hypertension patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ali Ahmed Abou Elmaaty ◽  
Carmen Ali Zarad ◽  
Tamer Ibrahim Belal ◽  
Tamer Sabry Elserafy
Keyword(s):  
Cognitive Impairment ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Brain Magnetic Resonance Imaging ◽  
Education Level ◽  
Unknown Etiology ◽  
Control Subjects ◽  
Low Education

Abstract Background Idiopathic intracranial hypertension (IIH) is a neurological disorder of unknown etiology and ambiguous pathophysiology due to cerebrospinal fluid dysregulation. This study is designed to evaluate the role of brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in diagnosis of IIH, to clarify the nature and extent of cognitive deficits, and to detect if there is a correlation between radiology, clinical findings, and cognitive dysfunctions in those patients. Results The study included 34 patients and 34 age-, sex-, body mass index (BMI)-, and education-matched healthy control subjects. MR brain imaging and Montreal cognitive assessment (MoCA) test were used for both groups. MRI and MRV sensitivity for IIH diagnosis were 85.2% and 85.3% with 100% and 94.1% specificity respectively. 44.1% had cognitive impairment, memory was the most affected domain, followed by attention, abstraction, and orientation with statistically significantly lower total MoCA score (p < 0.005). Domain comparisons reveal a statistically significantly lower memory/delayed recall (p < 0.001) and abstract scores (p < 0.007) in IIH cases versus control subjects. In comparing patients with cognitive impairment (CI) versus those without CI, there were statistically significantly higher CI in low education level, presence of diplopia, hormonal contraceptive use, abnormal MRI brain, papilledema grades, BMI, and opening pressure. Conclusions Presence of more than or equal 3 MR imaging findings, bilateral transverse sinus stenosis, and less than or equal 4 combined conduit score increase the specificity and sensitivity of MRI and MRV for IIH diagnosis. IIH had detrimental effect on different cognitive domains especially when patient have low education level, diplopia, papilledema ≥ grade III, high OP ≥ 61.5 cm H2O, and BMI ≥ 34 Kg/m2 with abnormal MRI and MRV findings.

scholarly journals Empty Sella and Unilateral Sixth Nerve Palsy in a Pediatric Patient with Idiopathic Intracranial Hypertension

2021 ◽  
Vol 20 (4) ◽  
pp. 169-176
Author(s):  
Shin Hyeong Park ◽  
Woo Hyuk Lee ◽  
Tae Seen Kang ◽  
Hyun Kyung Cho ◽  
Yong Seop Han ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Nerve Palsy ◽  
Fluid Pressure ◽  
Brain Magnetic Resonance Imaging ◽  
Empty Sella ◽  
Resonance Imaging ◽  
The Right

Purpose: We report the case of a child with idiopathic intracranial hypertension who presented with binocular papillary edema and monocular sixth cranial nerve palsy accompanied by empty sella syndrome evident on brain magnetic resonance imaging.Case summary: A 9-year-old, normal-weight male patient visited the emergency room complaining of headache and diplopia 4 days in duration. The alternative prism cover test revealed esotropia of 16 prism diopters and a -1 right lateral gaze limitation. A fundus examination revealed papilledema and peripapillary hemorrhages in both eyes, and a visual field examination an enlarged, physiological blind spot in the right eye. Brain magnetic resonance imaging revealed elevated cerebrospinal fluid pressure, an empty sella, and posterior scleral flattening. We diagnosed and treated idiopathic intracranial hypertension. After 4 months, the papilledema and peripapillary hemorrhages of both eyes resolved, and the right lateral gaze limitation improved. The empty sella improved on brain magnetic resonance imaging, and we noted no recurrence 8 months after treatment.Conclusions: If a child with suspected idiopathic intracranial hypertension visits a hospital, but it is difficult to perform a lumbar puncture, brain magnetic resonance imaging should be scheduled. If abnormalities are found, these help to determine the course of disease.

Depression and Cognitive Impairment in Patients on Hemodialysis: A cross-sectional study

2020 ◽  
Vol 5 (15) ◽  
pp. 185-192
Author(s):  
Nor Jannah Nasution Raduan ◽  
Mohd Razali Salleh ◽  
Ghazali Ahmad ◽  
Zaleha Ismail
Keyword(s):  
Cognitive Impairment ◽  
Publishing House ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Education Level ◽  
Sectional Study ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Factors Associated ◽  
Low Education

Depression and cognitive impairment are the most common complications of patients on hemodialysis. The objective of this study is to identify contributing factors to depression and cognitive impairment in hemodialysis patients. This is a cross-sectional study involving 110 hemodialysis patients in Hospital Kuala Lumpur. The samples were recruited through universal sampling. Patients were assessed with the Beck Depression Inventory and Montreal Cognitive Assessment. This study found that 18.2% of patients had depression, and 48.2% had cognitive impairment. Factors associated with depression were unmarried status, low education level, and cognitive impairment. Factors associated with cognitive impairment were low education level, depression, and unemployment. Keywords: hemodialysis, depression, cognitive, ESRD eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5i15.2468.

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

2019 ◽  
Vol 34 (13) ◽  
pp. 806-814 ◽  
Author(s):  
Sama Boles ◽  
Claudia Martinez-Rios ◽  
Daniel Tibussek ◽  
Daniela Pohl
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
Treatment Guidelines ◽  
Fluid Pressure ◽  
Specific Treatment ◽  
Unknown Etiology ◽  
Age Group ◽  
Review Of The Literature

Idiopathic intracranial hypertension, or pseudotumor cerebri, is an increase in cerebrospinal fluid pressure of unknown etiology. It is mostly seen in adults, less frequently in adolescents, rarely in younger children. Only 5 infants meeting idiopathic intracranial hypertension criteria have been mentioned in the literature. We report a case of a previously healthy 9-month-old boy who presented with irritability, decreased appetite, and a bulging fontanelle. Computed tomography (CT) head imaging and cerebrospinal fluid studies revealed normal results. The patient’s symptoms transiently resolved after the initial lumbar puncture, but 11 days later, his fontanelle bulged again. A second lumbar puncture revealed an elevated opening pressure of 35 cmH2O and led to a diagnosis of idiopathic intracranial hypertension in accordance with the modified Dandy Criteria. Treatment with acetazolamide at a dose of 25 mg/kg/d was initiated and the patient remained symptom-free for 6 weeks, followed by another relapse. His acetazolamide dose was increased to 37 mg/kg/d, with no further relapses to date. A diagnosis of idiopathic intracranial hypertension is challenging in infants, because the patients cannot yet verbalize typical idiopathic intracranial hypertension–related symptoms such as positional headaches, diplopia, or pulsatile tinnitus. Furthermore, it is more difficult to assess papilledema in that age group. If undetected and untreated, idiopathic intracranial hypertension may result in permanent visual deficits. Little is known about idiopathic intracranial hypertension in infants, and age-specific treatment guidelines are lacking. We discuss this rare case of infantile idiopathic intracranial hypertension and provide a review of the literature, including an overview of disease characteristics and outcomes of idiopathic intracranial hypertension in this very young age group.

Magnetic Resonance Imaging Changes in Idiopathic Intracranial Hypertension in Children

2009 ◽  
Vol 25 (3) ◽  
pp. 294-299 ◽  
Author(s):  
Ming Jin Lim ◽  
Kuberan Pushparajah ◽  
Wajanat Jan ◽  
David Calver ◽  
Jean-Pierre Lin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Resonance Imaging ◽  
Hypertension In Children

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.

Posterior fossa volume in idiopathic intracranial hypertension: a magnetic resonance imaging–based study

2021 ◽  
pp. 028418512110665
Author(s):  
Emily N Milarachi ◽  
Saikrishna C Gourishetti ◽  
Jonathan Ciriello ◽  
David J Eisenman ◽  
Prashant Raghavan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intracranial Hypertension ◽  
Posterior Fossa ◽  
Idiopathic Intracranial Hypertension ◽  
Multivariate Logistic Regression Analysis ◽  
Intracranial Volume ◽  
Resonance Imaging ◽  
Cephalometric Measurements ◽  
Volumetric Measurements

Background The etiology of idiopathic intracranial hypertension (IIH) is uncertain. Studies suggest the fundamental cause of the Chiari 1 malformation, a congenitally hypoplastic posterior fossa, may explain the genesis of IIH in some patients. Purpose To assess the hypothesis that linear and volumetric measurements of the posterior fossa (PF) can be used as predictors of IIH. Material and Methods A retrospective analysis of magnetic resonance imaging (MRI) studies on 27 patients with IIH and 14 matched controls was performed. A volumetric sagittal magnetization prepared rapid acquisition gradient echo sequence was used to derive 10 linear cephalometric measurements. Total intracranial and bony posterior fossa volumes (PFVs) were derived by manual segmentation. The ratio of PFV to total intracranial volume was calculated. Results In total, 41 participants were included, all women. Participants with IIH had higher median body mass index (BMI). No significant differences in linear cephalometric measurements, total intracranial volumes, and PFVs between the groups were identified. Linear measurements were not predictive of volumetric measurements. However, on multivariate logistic regression analysis, the likelihood of IIH decreased significantly per unit increase in relative PFV (odds ratio [OR]=3.66 × 10−50; 95% confidence interval [CI]=1.39 × 10−108 to 1.22 × 10−5; P = 0.04). Conversely, the likelihood of IIH increased per unit BMI increase (OR=1.19; 95% CI=1.04–1.47; P = 0.02). Conclusion MRI-based volumetric measurements imply that PF alterations may be partly responsible for the development of IIH and Chiari 1 malformations. Symptoms of IIH may arise due to an interplay between these and metabolic, hormonal, or other factors.

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