The Potentially Modifiable Risk Factor in Idiopathic Intracranial Hypertension: Body Weight

2021 ◽  
pp. 10.1212/CPJ.0000000000001063
Author(s):  
Susan P Mollan ◽  
Abd A Tahrani ◽  
Alexandra J Sinclair
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Risk Factor ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Treatment Strategy ◽  
Idiopathic Intracranial Hypertension ◽  
Potential Treatment ◽  
Distal Small Intestine

AbstractPurpose of review:Idiopathic intracranial hypertension (IIH) prevalence increased in conjunction with rising obesity rates. Here, we highlight the importance of weigh management in IIH, and introduce glucagon-like peptide 1 (GLP-1) receptor agonists (RA) as potential treatment strategy for IIH.Recent findings:Weight gain is a risk factor for IIH; and weight loss (via any treatment strategy) plays a key role in IIH management. GLP-1 is an incretin secreted by the distal small intestine in response to a meal. GLP-1 RA have been shown to improve glycaemic control (no. hypoglycaemia) and lower body weight in patients with and without type 2 diabetes. The choroid plexus has been found to express GLP-1 receptors and treatment with a GLP-1 RA significantly reduces cerebrospinal fluid secretion in vitro and intracranial pressure in rodents.Summary:New research evaluating the pathophysiology of IIH supports GLP-1 RA as a potential treatment for IIH via weight loss dependant and independent mechanism to directly reduce intracranial pressure.

scholarly journals How much weight loss is required to reduce intracranial pressure in idiopathic intracranial hypertension?

2021 ◽  
Vol 1 ◽  
pp. 100754
Author(s):  
S. Mollan ◽  
J.L. Mitchell ◽  
A. Yiagnou ◽  
R. Ottridge ◽  
Z. Alimajstorovic ◽  
...  
Keyword(s):  
Weight Loss ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension

scholarly journals Update on Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

2017 ◽  
Vol 01 (03) ◽  
pp. E224-E231 ◽  
Author(s):  
Jan Hoffmann ◽  
Arne May
Keyword(s):  
Cerebrospinal Fluid ◽  
Body Weight ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Controlled Trials ◽  
Venous Outflow ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Visual Disturbances

AbstractIdiopathic intracranial hypertension is characterized by an increase of intracranial pressure of unknown etiology. The clinical presentation is dominated by progressive visual disturbances, which are commonly the result of a papilledema, headache and cranial nerve palsies. Clinical studies have revealed over the past years that the syndrome may also be associated with olfactory disturbances, cognitive deficits and a pulsatile tinnitus.The underlying pathomechanism is probably based on a disturbance of venous outflow, which causes a reduced absorption of cerebrospinal fluid that results in an increase of cerebrospinal fluid pressure. It remains unclear if the venous outflow disturbance results from the overweight-induced increase of intrathoracic pressure, the presence of sinus vein stenoses or both conditions. Recently hormonal factors have also been discussed, but the mechanisms behind a potential influence on intracranial pressure remain unclear.Treatment of idiopathic intracranial hypertension relies mainly on an effective body weight reduction and medication with carboanhydrase inhibitors, which can reduce the production of cerebrospinal fluid and body weight. Results of the first randomized, placebo-controlled trial as well as a 12-month follow-up show that acetazolamide effectively reduces papilledema, visual disturbances and headache in idiopathic intracranial hypertension. In contrast, the evidence for the carboanhydrase inhibitors topiramate and furosemide still relies on open-label trials, because double-blind, placebo-controlled trials for their efficacy in idiopathic intracranial hypertension do not exist. In addition to the treatment with carboanhydrase inhibitors, increasing evidence suggests that the somatostatin analog octreotide may be effective in the treatment of idiopathic intracranial hypertension, but to date no randomized, double-blind, placebo-controlled trials exist to confirm this observation.

scholarly journals Evaluation of cerebrovascular hemodynamics in patients with idiopathic intracranial hypertension using transcranial Doppler

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Mahmoud M. Allam ◽  
Hatem A. Almasry ◽  
Sandra M. Ahmed ◽  
Youssuf G. Taha ◽  
Mohammed I. Oraby
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Transcranial Doppler ◽  
Idiopathic Intracranial Hypertension ◽  
Pulsatility Index ◽  
Research Work ◽  
Increased Intracranial Pressure ◽  
Significant Relation ◽  
Before And After

Abstract Background Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial pressure without a clear cause and can have serious visual effects. Previous research work suggests that transcranial Doppler measurements of pulsatility index correlate accurately with elevated intracranial pressure. Objective To assess the cerebrovascular hemodynamic changes in patients with IIH using transcranial Doppler before and after lumbar puncture and CSF withdrawal. Methods An interventional study conducted on 40 patients (31 females and 9 males) fulfilling the modified Dandy criteria for diagnosis of idiopathic intracranial hypertension, MRI brain, and MRV was done to the patients. Lumbar puncture was done for all included patients to measure intracranial pressure and CSF withdrawal. Transcranial Doppler was performed for all included before and after lumbar puncture and CSF withdrawal and the following parameters were measured: peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI), and pulsatility index (PI). Results Significant relation was found between grades of papilledema and PSV, RI, and PI (p value 0.012, 0.025, 0.016) but no significant relation was found between grades of papilledema and EDV (0.102). Significant changes occurred in parameters of TCD pre- and post-CSF withdrawal including PSV, EDV, and PI (p value 0.001, 0.015, 0.019) denoting a significant change in cerebral hemodynamics after CSF withdrawal which denotes a decrease in intracranial pressure. Conclusion Increased intracranial pressure significantly affects cerebral blood flow. A normalization of transcranial Doppler parameters occurs following lowering of intracranial pressure through lumbar puncture and CSF withdrawal.

1338 Bariatric Surgery as a Viable Treatment for Idiopathic Intracranial Hypertension: A Case Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Mahendran ◽  
P Ricart ◽  
M Wadley ◽  
A Perry ◽  
S Robinson
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Case Series ◽  
Radicular Pain ◽  
Csf Pressure ◽  
Disease Modifying Therapy ◽  
Effective Treatment Modality ◽  
Preventable Blindness

Abstract Introduction Idiopathic Intracranial Hypertension (IIH) is a significant cause of preventable blindness. Patients also suffer from debilitating headaches, pulsatile tinnitus, nausea, vomiting, photophobia, and radicular pain. If IIH continues to rise as predicted, treatment cost will increase to 462.7 million GBP annually by 2030. Weight loss is the only proven disease-modifying therapy for reversal of IIH. Bariatric surgery is an attractive treatment option due to superlative weight loss and reversal of related comorbidities. The case series aims to raise awareness of bariatric surgery as a safe and effective treatment modality for IIH. Method The case series consists of a retrospective analysis of four patients with a pre-operative diagnosis of IIH. They were referred to our department for bariatric surgery between January to December 2018. They were followed up for a total of two years. Results In our case series, all four patients were females with a mean age of 34 years. Mean BMI reduced from 47.3 kg/m2 before surgery to 30 kg/m2 with an EWL of 76.4% at the end of two years after surgery. They all showed significant improvement or resolution in their symptoms related to IIH, and none of them required further CSF pressure reducing procedures afterwards. Conclusions Bariatric surgery is a safe and effective method of treating IIH. It is superior compared to medical management and CSF pressure reducing procedures which have high rates of recurrence.

Intracranial hypertension and papilloedema as a complication to low antiretroviral therapy adherence in a man living with chronic HIV

2021 ◽  
Vol 14 (3) ◽  
pp. e237504
Author(s):  
Rosa Maja Møhring Gynthersen ◽  
Helene Mens ◽  
Marianne Wegener ◽  
Neval Ete Wareham
Keyword(s):  
Antiretroviral Therapy ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Ventricular Volume ◽  
Art Adherence ◽  
Hiv Viral Load ◽  
Blurred Vision ◽  
Antiretroviral Therapy Adherence ◽  
Acute Retroviral Syndrome

We describe a 61-year-old man living with HIV on antiretroviral therapy (ART), who presented with headache, dizziness and blurred vision. Latest CD4+ cell count 3 months prior to admission was 570×106 cells/mL and HIV viral load <20 copies/mL. The patient was diagnosed with cerebrospinal fluid (CSF) lymphocytic pleocytosis, raised intracranial pressure and papilloedema. Neuroimaging showed normal ventricular volume and no mass lesions, suggesting (1) neuroinfection (2) idiopathic intracranial hypertension or (3) retroviral rebound syndrome (RRS) as possible causes. Neuroinfection was ruled out and idiopathic intracranial hypertension seemed unlikely. Elevated plasma HIV RNA level was detected consistent with reduced ART adherence prior to admission. RRS is a virological rebound after ART interruption, which can mimic the acute retroviral syndrome of acute primary infection. To the best of our knowledge, we describe the second case of RRS presenting as CSF lymphocytic pleocytosis and elevated intracranial pressure after low ART adherence.

Diagnosis of idiopathic intracranial hypertension - the importance of excluding secondary causes: A systematic review

Cephalalgia ◽  
2021 ◽  
pp. 033310242110565
Author(s):  
Kubra Kilic ◽  
Johanne Juhl Korsbæk ◽  
Rigmor H Jensen ◽  
Vlasta Vukovic Cvetkovic
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Weight Status ◽  
Renal Diseases ◽  
Adult Group ◽  
Increased Intracranial Pressure ◽  
Pubmed Database ◽  
Index Weight ◽  
Secondary Causes

Background Idiopathic intracranial hypertension is characterized by increased intracranial pressure without any pathological findings on neuroimaging, except for signs of high intracranial pressure. Before diagnosing idiopathic intracranial hypertension secondary causes of increased intracranial pressure should be excluded. Objective to characterize the phenotype of patients with secondary intracranial hypertension and to identify possible risk factors for secondary intracranial hypertension. Methods We have systematically searched the PubMed database. The publications were analyzed according to the patient phenotype, age, gender, comorbidities, body mass index/weight status, and additional medication. The results are summarized in four categories: medication, infection, hormonal induced intracranial hypertension and miscellaneous groups of diseases related to sIH. Results We identified 105 eligible papers which included 272 cases. There were 49.6% pediatric cases. Among the adult group,70.9% were women. A total of 40.4% of all cases were obese or overweight, 27% among adults and 13.4% among pediatric cases. Increased BMI and recent weight gain, anemia, renal diseases and hypertension were the most frequent comorbidities related to sIH. Conclusion Among sIH patients, 40.4% were obese or overweight; two thirds were women. We recommend that even patients with a typical IIH phenotype should be screened for secondary causes.

Idiopathic intracranial hypertension

2020 ◽  
pp. 6054-6059
Author(s):  
Alexandra Sinclair
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Poor Quality ◽  
Raised Intracranial Pressure ◽  
Obese Women ◽  
Pseudotumour Cerebri ◽  
Chronic Headaches ◽  
Considerable Morbidity

Idiopathic intracranial hypertension (IIH) (also called pseudotumour cerebri and, previously, benign intracranial hypertension) is a syndrome of raised intracranial pressure in the absence of an intracranial mass lesion, enlargement of the cerebral ventricles, or venous sinus thrombosis. IIH affects predominantly obese women of childbearing age (>90%). The condition has considerable morbidity from permanent visual loss (up to 25% of cases) and chronic disabling headaches, which result in poor quality of life. Patients presenting acutely with papilloedema must be evaluated urgently for secondary causes of raised intracranial pressure (e.g. space occupying lesion and venous thrombosis). After this, the priority is to assess accurately the threat to vision. In most patients, the condition becomes chronic and the disease burden is mostly from chronic headaches, which need active management, alongside visual monitoring. This chapter does not cover paediatric IIH.

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