scholarly journals Imaging of Intracranial Pressure Disorders

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 341-354 ◽  
Author(s):  
John Holbrook ◽  
Amit M. Saindane
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Neurological Disorders ◽  
Intracranial Hypotension ◽  
Idiopathic Intracranial Hypertension ◽  
Spontaneous Intracranial Hypotension ◽  
Imaging Findings ◽  
Venous Outflow

Abstract Intracranial pressure (ICP) is the pressure inside the bony calvarium and can be affected by a variety of processes, such as intracranial masses and edema, obstruction or leakage of cerebrospinal fluid, and obstruction of venous outflow. This review focuses on the imaging of 2 important but less well understood ICP disorders: idiopathic intracranial hypertension and spontaneous intracranial hypotension. Both of these ICP disorders have salient imaging findings that are important to recognize to help prevent their misdiagnosis from other common neurological disorders.

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.

Idiopathic intracranial hypertension without intracranial hypertension

2020 ◽  
pp. 10.1212/CPJ.0000000000001022
Author(s):  
Mattia Sansone ◽  
Michelangelo De Angelis ◽  
Leonilda Bilo ◽  
Vincenzo Bonavita ◽  
Roberto De Simone
Keyword(s):  
Physical Activity ◽  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Valsalva Manoeuvre ◽  
Dural Sinus ◽  
Daily Fluctuation ◽  
Csf Pressure ◽  
Postural Changes

The intracranial pressure (ICP) show large daily fluctuation, mainly due to postural changes and physical activity (e.g. it goes up to 470 mmH2O under Valsalva manoeuvre1). Consequently, the dural sinus must be sufficiently rigid in order to avoid its collapse during cerebrospinal fluid (CSF) pressure peaks. Hereby, we describe a patient with collapsible dural sinus associated with an intracranial hypertension syndrome without a detectable raised ICP, suggesting that a number of crucial assumptions on idiopathic intracranial hypertension with (IIH) or without papilledema (IIHWOP) might be discussed.

scholarly journals Cerebral Blood Flow in Low Intracranial Pressure Headaches—What Is Known?

2019 ◽  
Vol 10 (1) ◽  
pp. 2
Author(s):  
Magdalena Nowaczewska ◽  
Henryk Kaźmierczak
Keyword(s):  
Blood Flow ◽  
Cerebrospinal Fluid ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Intracranial Hypotension ◽  
Csf Pressure ◽  
Cerebral Vasodilatation ◽  
The Relationship ◽  
The Brain

Headaches attributed to low cerebrospinal fluid (CSF) pressure are described as orthostatic headaches caused by spontaneous or secondary low CSF pressure or CSF leakages. Regardless of the cause, CFS leaks may lead to intracranial hypotension (IH) and influence cerebral blood flow (CBF). When CSF volume decreases, a compensative increase in intracranial blood volume and cerebral vasodilatation occurs. Sinking of the brain and traction on pain-sensitive structures are thought to be the causes of orthostatic headaches. Although there are many studies concerning CBF during intracranial hypertension, little is known about CBF characteristics during low intracranial pressure. The aim of this review is to examine the relationship between CBF, CSF, and intracranial pressure in headaches assigned to low CSF pressure.

scholarly journals Cranial cerebrospinal fluid leak and intracranial hypotension syndrome – a case report

2021 ◽  
Vol 14 (4) ◽  
pp. 587-590
Author(s):  
Razvan Alexandru Radu ◽  
◽  
◽  
Elena Oana Terecoasa ◽  
Andreea Nicoleta Marinescu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Imaging ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Imaging Findings ◽  
Temporal Bone Fracture ◽  
Intracranial Hypotension Syndrome ◽  
Dural Leak ◽  
Fluid Leak

Spontaneous intracranial hypotension is a rare clinical entity caused in most cases by a cerebrospinal fluid leak occurring at the level of the spinal cord. Cranial dural leaks have been previously reported as a cause of orthostatic headaches but, as opposed to spinal dural leaks, were not associated with other findings characteristic of spontaneous intracranial hypotension. We present the case of a male admitted for severe orthostatic headache. The patient had a history of intermittent postural headaches, dizziness, and symptoms consistent with post-nasal drip, which appeared several years after head trauma. Brain imaging showed signs consistent with intracranial hypotension: bilateral hygromas, subarachnoid hemorrhage, superficial siderosis, diffuse contrast enhancement of the pachymeninges, and superior sagittal sinus engorgement. No spinal leak could be identified by magnetic resonance imaging, and the patient had a rapid remission of symptoms with conservative management. Further work-up identified an old temporal bone fracture which created a route of egress between the posterior fossa and the mastoid cells. Otorhinolaryngology examination showed pulsatile bloody discharge and liquorrhea at the level of the left pharyngeal opening of the Eustachian tube. The orthostatic character of the headache, as well as the brain imaging findings, were consistent with intracranial hypotension syndrome caused by a cranial dural leak. Clinical signs and imaging findings consistent with the diagnosis of apparently “spontaneous” intracranial hypotension should prompt the search for a cranial dural leak if a spinal leak is not identified.

Idiopathic intracranial hypertension – a wider spectrum than headaches and blurred vision

2021 ◽  
pp. 197140092110344
Author(s):  
H Urbach ◽  
IE Duman ◽  
DM Altenmüller ◽  
C Fung ◽  
N Lützen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Temporal Lobe Epilepsy ◽  
Intracranial Hypertension ◽  
Temporal Lobe ◽  
Intracranial Hypotension ◽  
Idiopathic Intracranial Hypertension ◽  
Spontaneous Intracranial Hypotension ◽  
Resonance Imaging ◽  
Imaging Signs

Background The purpose of this study was to analyse less known clinical scenarios associated with idiopathic intracranial hypertension. Methods The study involved analysis of magnetic resonance imaging signs of idiopathic intracranial hypertension in patients with spontaneous rhinoliquorrhoea ( n = 7), in patients with temporal lobe epilepsy and surgically treated antero-inferior temporal lobe meningo-encephaloceles (n = 15), and in patients who developed clinical signs of idiopathic intracranial hypertension following the treatment of spontaneous intracranial hypotension ( n = 7). Results Three of six patients with spontaneous rhinoliquorrhoea and six of 15 operated patients with temporal lobe epilepsy due to temporal lobe meningo-encephaloceles showed magnetic resonance imaging signs of idiopathic intracranial hypertension and had a body mass index >30 kg/m2. Rebound high pressure headaches and sings of idiopathic intracranial hypertension occurred in seven of 44 surgically treated spontaneous intracranial hypotension patients. Conclusions Magnetic resonance imaging findings should guide the clinician to consider (idiopathic) intracranial hypertension when patients develop spontaneous rhinoliquorrhoea, temporal lobe epilepsy secondary to temporal lobe meningoencephaloceles or high pressure headaches in spontaneous intracranial hypotension. Whether idiopathic intracranial hypertension must be regarded as a differential diagnosis or as a cause, or whether there are common pathophysiological pathways that lead to signs of idiopathic intracranial hypertension in this wider spectrum of disease is the focus of further study.

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