Management of Idiopathic Intracranial Hypertension during the COVID19 Pandemic

2020 ◽  
Vol 15 ◽  
Author(s):  
Ayman G. Elnahry ◽  
Gehad A. Elnahry
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Fundus Photography ◽  
Young Females ◽  
Optic Nerve Sheath Fenestration ◽  
Threatening Condition ◽  
Coronavirus Infection

Background: In the current coronavirus disease 2019 (COVID-19) pandemic, health systems are struggling to prioritize care for affected patients, however, physicians globally are also attempting to maintain care for other lessthreatening medical conditions that may lead to permanent disabilities if untreated. Idiopathic intracranial hypertension (IIH) is a relatively common condition affecting young females that could lead to permanent blindness if not properly treated. In this article, we provide some insight and recommendations regarding the management of IIH during the pandemic. Methods: The diagnosis, follow-up, and treatment methods of IIH during the COVID-19 pandemic period are reviewed. COVID-19 as a mimic of IIH is also discussed. Results: Diagnosis and follow-up of papilledema due to IIH during the COVID-19 pandemic can be facilitated by nonmydriatic fundus photography and optical coherence tomography. COVID-19 may mimic IIH by presenting as cerebral venous sinus thrombosis, papillophlebitis, or meningoencephalitis, so a high index of suspicious is required in these cases. When surgical treatment is indicated, optic nerve sheath fenestration may be the primary procedure of choice during the pandemic period. Conclusion: IIH is a serious vision threatening condition that could lead to permanent blindness and disability at a relatively young age if left untreated. It could be the first presentation of a COVID-19 infection. Certain precautions during the diagnosis and management of this condition could be taken that may allow appropriate care to be delivered to these patients while minimizing the risk of coronavirus infection.

Venous sinus stenting in patients without idiopathic intracranial hypertension

2016 ◽  
Vol 9 (5) ◽  
pp. 512-515 ◽  
Author(s):  
Michael R Levitt ◽  
Felipe C Albuquerque ◽  
Bradley A Gross ◽  
Karam Moon ◽  
Ashutosh P Jadhav ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Venous Sinus ◽  
Congenital Hydrocephalus ◽  
Pulsatile Tinnitus ◽  
Venous Sinus Thrombosis ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

BackgroundVenous sinus stenting is an effective treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis.ObjectiveTo determine the usefulness of venous sinus stenting in the treatment of patients with symptomatic venous sinus stenosis without a diagnosis of IIH.MethodsWe performed a retrospective review of a prospective multicenter database of patients undergoing venous sinus stenting between January 2008 and February 2016. Patients with acute dural venous sinus thrombosis, arteriovenous fistula or arteriovenous malformation, or IIH were excluded. Clinical, radiological, and ophthalmological information was recorded.ResultsNine patients met the inclusion criteria and underwent venous sinus stenting for symptomatic dural venous sinus stenosis. Reasons for treatment included isolated unilateral pulsatile tinnitus (n=1), congenital hydrocephalus (n=2), unilateral pulsatile tinnitus following prior venous sinus thrombosis (n=1), acquired hydrocephalus following dural sinus thrombosis (n=2), meningitis (n=2) and tumor invasion into the dural venous sinus (n=1). Six patients underwent lumbar puncture or shunt tap, and all of these patients had elevated intracranial pressure. All stenoses were located in the transverse sinus, transverse–sigmoid junction and/or jugular bulb, and all were treated with self-expanding bare-metal stents. At follow-up, clinical symptoms had resolved in all but two patients, both of whom had congenital hydrocephalus and pre-existing shunts. There was no significant in-stent stenosis, and patients with ophthalmological follow-up demonstrated improvement of papilledema.ConclusionsDural venous sinus stenting may be an effective treatment for patients with symptomatic venous sinus stenosis without IIH in carefully selected cases, but may not be effective in resolving the symptoms of congenital hydrocephalus.

scholarly journals Eye-Neck Integrated Ultrasound in Idiopathic Intracranial Hypertension and Cerebral Venous Sinus Thrombosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Li Liu ◽  
Yingqi Xing ◽  
Ying Chen ◽  
Xiaorui Ji ◽  
Jiaojiao Ge ◽  
...  
Keyword(s):  
Blood Flow ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Hemodynamic Characteristics ◽  
The Mean ◽  
Increased Icp

Background: The clinical presentation of cerebral venous sinus thrombosis (CVST) overlaps with that of idiopathic intracranial hypertension (IIH), but no screening tool exists. We investigated the role of eye-neck integrated ultrasound in the diagnosis and differentiation of IIH and CVST.Methods: Twenty IIH patients, 30 CVST patients, and 40 healthy controls were retrospectively analyzed. The ultrasonographic optic nerve sheath diameter (ONSD) and hemodynamic characteristics of the internal jugular veins (IJVs) were recorded. The cerebrospinal fluid opening pressure was measured after ultrasonic examination.Results: The ONSD was significantly larger in IIH patients than in controls (4.71 ± 0.41 vs. 3.93 ± 0.24 mm, p < 0.001). The ONSD cut-off for IIH diagnosis was 4.25 mm (AUC = 0.978; 95% CI: 0.95–1.0, p < 0.001, sensitivity: 90%, specificity: 93%). In the CVST group, 22 (73.3%) patients had elevated intracranial pressure (ICP); the mean ONSD was significantly higher in patients with increased ICP than in those without (4.43 ± 0.33 vs. 3.95 ± 0.17 mm, p < 0.001). The mean blood flow volume (BFV) was significantly reduced in CVST patients (425.17 ± 349.83 mL/min) compared to that in controls (680.37 ± 233.03 mL/min, p < 0.001) and IIH patients (617.67 ± 282.96 mL/min, p = 0.008). The optimal BFV cut-off for predicting CVST was 527.28 mL/min (AUC = 0.804, 95% CI: 0.68–0.93, p < 0.001, sensitivity: 80%, specificity: 78%). The velocity of the unilateral IJVs-J3 segment decreased or remained constant during deep inspiration (abnormal respiratory modulate blood flow test, ARMT) in 32.5% of controls, with no bilateral ARMT. The prevalence of bilateral ARMT was 25% in IIH patients (χ2 = 12.9, p = 0.005) and 27% in CVST patients (χ2 = 17.6, p = 0.001).Conclusion: Eye-neck integrated ultrasound is an easily available bedside technique to assess ICP and hemodynamic characteristics of IJVs. ONSD measurement can identify patients with increased ICP, and reduced IJV BFV may aid the differentiation of CVST and IIH.

THUR 090 Idiopathic intracranial hypertension – towards a streamlined pathway

2018 ◽  
Vol 89 (10) ◽  
pp. A9.4-A10
Author(s):  
Vijay Vivek ◽  
Grant Laura ◽  
Nagar Anindyt ◽  
Bahra Anish
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Primary Headache ◽  
Headache Disorder ◽  
Cerebral Venous Sinus Thrombosis ◽  
Primary Headache Disorder ◽  
Patient Pathways ◽  
Evidence Based Treatments

Recent studies have yielded the first evidence-based treatments for idiopathic intracranial hypertension (IIH) and shed light on many aspects of this condition, providing an opportunity to streamline the assessment and management of patients with IIH.This study highlighted the inefficiency of most patient pathways, especially when via outpatients, with resulting delays in diagnosis and /or management. Of note, 37% of patients did not have venography. Up to a third of patients with cerebral venous sinus thrombosis present with isolated signs of elevated intracranial pressure, thus clinically mimicking IIH and emphasising the importance of venography acutely.Acetazolamide was appropriately commenced but rarely titrated to the maximum dose of 4 g/day as supported by the IIHTT. Over 40% of our cohort had a diagnosable co-morbid primary headache disorder which persisted and required additional headache-specific medication in almost half of these. This is in keeping with studies showing that headache is unrelated to raised intracranial pressure in IIH patients, and headache-specific management is a key aspect to the management of IIH patients.In summary, this study highlights significant delays and missed investigations when not performed acutely, emphasising the importance of implementing a clear and visible pathway for the assessment and management of IIH patients.

Occurrence of Cerebral Venous Sinus Thrombosis in Patients with Presumed Idiopathic Intracranial Hypertension

Ophthalmology ◽  
2006 ◽  
Vol 113 (12) ◽  
pp. 2281-2284 ◽  
Author(s):  
Albert Lin ◽  
Rod Foroozan ◽  
Helen V. Danesh-Meyer ◽  
Gabriella De Salvo ◽  
Peter J. Savino ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis

scholarly journals Chronic intracranial hypertension after cerebral venous and sinus thrombosis – frequency and risk factors

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Christina Geisbüsch ◽  
Christian Herweh ◽  
Christoph Gumbinger ◽  
Peter A. Ringleb ◽  
Markus A. Möhlenbruch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Cohort Analysis ◽  
Venous Drainage ◽  
Cerebral Venous Sinus Thrombosis ◽  
Retrospective Cohort Analysis ◽  
Radiological Data ◽  
Recurrent Sinus

Abstract Background Cerebral venous sinus thrombosis (CVST) can infrequently lead to chronical intracranial hypertension (IH) due to the altered venous drainage. The aim of this study was to ascertain the risk of IH after CVST and to stratify underlying risk factors. Methods We performed a retrospective cohort analysis of all cases treated for acute CVST at our department between 2013 and 2019. IH was diagnosed at follow-up according to the modified Dandy criteria. CVST-patients with and without IH were descriptively compared conforming to available clinical and radiological data as well as outcomes. Results Our study included 102 patients with acute CVST. In 70 cases complete follow-up data was available (68.6%). Seven of these patients developed symptomatic intracranial hypertension (10%; N = 7, n = 70) within a median follow-up of 6 months. Four of these patients (57.1% (N = 4, n = 7) vs. 3.2% (N = 2, n = 63); p < 0.001) presented recurrent sinus thrombosis in the further course. There were no significant differences between patients with or without IH concerning gender, age, risk factors, occluded vessels and treatment for their CVST. However the presence of visual deterioration at initial admission was higher in patients who developed IH afterwards (57.1% (N = 4, n = 7) vs. 20.6% (N = 13, n = 63); p = 0.03). Patients with chronic IH after CVST showed significantly less likely recanalization of the occluded vessel on follow-up MRI (no recanalization in 28.6% (N = 2, n = 7) vs. 4.8% (N = 3, n = 63); p = 0.02). All patients with IH had a good outcome (mRS 0–2) at discharge and follow-up. Conclusion IH occurred in around 10% after CVST. Insufficient recanalization status may facilitate IH. Patients with visual disturbances seem to develop more likely IH afterwards. Patients who present IH after CVST may develop recurrent cerebral venous thrombosis.

scholarly journals Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-up Study on Visual Outcome and Prognostic Markers

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 778
Author(s):  
Snorre Malm Hagen ◽  
Marianne Wegener ◽  
Peter Bjerre Toft ◽  
Kåre Fugleholm ◽  
Rigmor Højland Jensen ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Optic Nerve Head ◽  
Idiopathic Intracranial Hypertension ◽  
Visual Outcome ◽  
Optic Nerve Sheath ◽  
Optic Nerve Sheath Fenestration ◽  
Head Elevation ◽  
Nerve Sheath

Loss of vision is a feared consequence of idiopathic intracranial hypertension (IIH). Optic nerve sheath fenestration (ONSF) may be an effective surgical approach to protect visual function in medically refractory IIH. In this study, we evaluate the impact of unilateral superomedial transconjunctival ONSF on bilateral visual outcome using a comprehensive follow-up program. A retrospective chart review of IIH patients who underwent unilateral ONSF between January 2016 and March 2021 was conducted. Patients fulfilling the revised Friedman criteria for IIH and who had exclusively received ONSF as a surgical treatment were included. Main outcomes were visual acuity (VA); perimetric mean deviation (PMD); papilledema grade; and optic nerve head elevation (maxONHE) 1 week, 2 weeks, and 1, 3, and 6 months after surgery. VA (p < 0.05), PMD (p < 0.05), papilledema grade (p < 0.01), and maxOHNE (p < 0.001) were improved after 6 months on both the operated and non-operated eye. Prolonged surgical delay impedes PMD improvement (r = −0.78, p < 0.01), and an increasing opening pressure initiates a greater ganglion cell loss (r = −0.79, p < 0.01). In this small case series, we demonstrate that unilateral superonasal transconjunctival ONSF is a safe procedure with an effect on both eyes. Optic nerve head elevation and PMD are feasible biomarkers for assessing early treatment efficacy after ONSF.

Abstract 167: Efficacy of Endovascular Treatment for Idiopathic Intracranial Hypertension: Cerebral Venous Sinus Stenosis Treated by Stenting

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jian Chen ◽  
Liqun Jiao ◽  
Wenbo Zhao ◽  
Yuchuan Ding ◽  
Hongqi Zhang ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Clinical Symptoms ◽  
Sinus Thrombosis ◽  
Venous Sinus ◽  
Surgical Approaches ◽  
Stenosis Rate ◽  
Sinus Stenosis

Objective: To explore the diagnosis of cerebral venous sinus stenosis (CVSS) in idiopathic intracranial hypertension (IIH), and to evaluate the efficacy and risk of venous sinus stenting treatment for CVSS. Methods: 40 patients with refractory IIH complicated with CVSS underwent examination with magnetic resonance venography (MRV), digital subtraction angiography (DSA) and direct retrograde cerebral venography and manometry to confirm morphologic features of IlH and measure venous pressure.The CSF pressure on lumbar puncture ranged from 250 to 500 mmH 2 O with normal composition. All patients had headache, and funduscopic examination demonstrated papilledema for all patients. 28 patients who showed severe stenosis of venous sinuses with the pressure gradient across the stenosis >100 mmH 2 O were treated with venous sinus stenting and were followed-up for more than 12 months.Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome during the follow-up period. Results: Sinus stenting angioplasty was successful in all 28 patients.In all patients venous sinus stenosis was improved after stenting procedure (the residual stenosis rate<20%) and intrasinus pressure was reduced (the pressure gradient vanished or<20 mmH 2 O ).The clinical symptoms in all the patients were improved or disappeared at discharge and intracranial pressures were normalized within 3 months after the procedure.During the follow-up period of (16.3±11) months (range 12 to 36 months),no patient had recurrence of IIH.In all cases, DSA or MRV was performed at 12-month follow-up and demonstrated the absence of sinus thrombosis or in-stent stenosis. Conclusions: Patients with refractory IIH should be assessed for CVSS. MRV or DSA was recommended for these patients as a routine work-up.Cerebral venography and manometry are helpful to evaluate the relation between venous outflow obstruction and intracranial hypertension.If severe CVSS is presented in patients who experienced medical treatment failure, endovascular stent placement could be an alternative to classic surgical approaches. Additional randomized and controlled clinical research is deserved.

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