GLP-1 reduces cerebrospinal fluid secretion and intracranial pressure: a novel treatment for idiopathic intracranial hypertension?

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.

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Papilledema

Neuro-Ophthalmology ◽

10.1093/med/9780190603953.003.0008 ◽

2019 ◽

pp. 41-46

Author(s):

Matthew J. Thurtell ◽

Robert L. Tomsak

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Fluid Secretion ◽

Management Approach ◽

Fluid Absorption ◽

Increased Intracranial Pressure ◽

Absorption Increase ◽

Cerebrospinal Fluid Absorption ◽

Symptoms And Signs ◽

Cerebrospinal Fluid Secretion

Papilledema is the cardinal clinical sign of increased intracranial pressure. In this chapter, we begin by reviewing the symptoms and signs of increased intracranial pressure. We next review potential causes of increased intracranial pressure, which include intracranial masses, obstruction of the ventricular system, obstruction of cerebral venous outflow, decrease in cerebrospinal fluid absorption, increase in cerebrospinal fluid secretion, cerebral edema, medications, and idiopathic intracranial hypertension. We then review the approach to the diagnostic evaluation of increased intracranial pressure, including the recommended neuroimaging studies and cerebrospinal fluid evaluation. Lastly, we discuss the basic management approach for the patient with symptoms and signs of increased intracranial pressure.

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Radiographic Signs of Elevated Intracranial Pressure in Idiopathic Cerebrospinal Fluid Leaks: A Possible Presentation of Idiopathic Intracranial Hypertension

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3026 ◽

2007 ◽

Vol 21 (3) ◽

pp. 257-261 ◽

Cited By ~ 40

Author(s):

Ross I. Silver ◽

Gul Moonis ◽

Rodney J. Schlosser ◽

William E. Bolger ◽

Laurie A. Loevner

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Elevated Intracranial Pressure ◽

Cerebrospinal Fluid Leaks

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Acetazolamide modulates intracranial pressure directly by its action on the cerebrospinal fluid secretion apparatus

10.1101/2022.01.11.475854 ◽

2022 ◽

Author(s):

Dagne Barbuskaite ◽

Eva Kjer Oernbo ◽

Jonathan Henry Wardman ◽

Trine Lisberg Toft-Bertelsen ◽

Eller Conti ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Ex Vivo ◽

Direct Action ◽

Fluid Secretion ◽

Carbonic Anhydrases ◽

Patient Groups ◽

Systemic Side Effects ◽

Cerebrospinal Fluid Secretion

Elevated intracranial pressure (ICP) is observed in many neurological pathologies, e.g. hydrocephalus and stroke. This condition is routinely relieved with neurosurgical approaches, since effective and targeted pharmacological tools are still lacking. The carbonic anhydrase inhibitor, acetazolamide (AZE), may be employed to treat elevated ICP. However, its effectiveness is questioned, its location of action unresolved, and its tolerability low. Here, we employed in vivo and ex vivo approaches to reveal the efficacy and mode of action of AZE in the rat brain. The drug effectively reduced the ICP, irrespective of the mode of drug administration and level of anaesthesia. The effect occurred via a direct action on the choroid plexus and an associated decrease in cerebrospinal fluid secretion, and not indirectly via the systemic action of AZE on renal and vascular processes. Upon a single administration, the reduced ICP endured for approximately 10 h post-AZE delivery with no long-term changes of brain water content or choroidal transporter expression. However, a persistent reduction of ICP was secured with repeated AZE administrations throughout the day. Future specific targeting of choroidal carbonic anhydrases may limit the systemic side effects, and therefore enhance the treatment tolerability and effectiveness in select patient groups experiencing elevated ICP.

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Cerebrospinal Fluid Corticosteroid Levels and Cortisol Metabolism in Patients with Idiopathic Intracranial Hypertension: A Link between 11β-HSD1 and Intracranial Pressure Regulation?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2010-0729 ◽

2010 ◽

Vol 95 (12) ◽

pp. 5348-5356 ◽

Cited By ~ 46

Author(s):

Alexandra J. Sinclair ◽

Elizabeth A. Walker ◽

Michael A. Burdon ◽

Andre P. van Beek ◽

Ido P. Kema ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Pressure Regulation ◽

Cortisol Metabolism

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Update on Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

Neurology International Open ◽

10.1055/s-0043-113034 ◽

2017 ◽

Vol 01 (03) ◽

pp. E224-E231 ◽

Cited By ~ 1

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.

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Imaging of Intracranial Pressure Disorders

Neurosurgery ◽

10.1227/neu.0000000000001362 ◽

2017 ◽

Vol 80 (3) ◽

pp. 341-354 ◽

Cited By ~ 14

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.

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More than meets the eye: Papilledema from syphilis posing as idiopathic intracranial hypertension

International Journal of STD & AIDS ◽

10.1177/0956462420943017 ◽

2020 ◽

Vol 31 (11) ◽

pp. 1117-1119

Author(s):

Sharon Chi ◽

Amy Weintrob

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Pseudotumor Cerebri ◽

Elevated Intracranial Pressure ◽

Fluid Production

Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a diagnosis of exclusion. Elevated intracranial pressure (ICP) can result from a variety of inflammatory and structural causes affecting cerebrospinal fluid production and absorption. First described in 1935, syphilis is a well-established cause of elevated ICP, referred to as syphilitic hydrocephalus. We report a case of a 49-year-old man presenting with vision changes and headache who was treated for IIH without resolution of symptoms, and eventually diagnosed with syphilitic hydrocephalus. Syphilis should be considered as a cause of elevated ICP prior to a diagnosis of IIH.

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