State of the venous system in patients with Pseudotumor cerebri

The article describes two clinical cases of idiopathic intracranial hypertension, the first manifestation of which was the development of retroorbital headache and the visual disorders. Leading in the clinical picture of the disease in both cases was the detection of stagnant optic nerve discs on the fundus. In both patients, the vascular system of the brain was examined using duplex scanning of the neck and brain vessels, MR angiography and MR venography, and in one case — SCT angiography, a lumbar puncture was performed with the study of cerebrospinal fluid (CSF). An increase in CSF pressure was found, accompanied by changes in the large venous vessels of the skull and brain. This suggests a significant role of venous outflow disorders in the development of Pseudotumor cerebri syndrome.

Download Full-text

Bilateral jugular foraminal stenosis in a patient with benign osteopetrosis associated with pseudotumor cerebri syndrome

Journal of Neurosurgery ◽

10.3171/2008.5.17581 ◽

2009 ◽

Vol 110 (4) ◽

pp. 804-807 ◽

Cited By ~ 7

Author(s):

Sayed Mohammad Haji Mirsadeghi ◽

Ali Tayebi Meybodi ◽

Farideh Nejat ◽

Hooshang Saberi

Keyword(s):

Disease Process ◽

Signs And Symptoms ◽

Pseudotumor Cerebri ◽

Underlying Disease ◽

Foraminal Stenosis ◽

Laboratory Studies ◽

Venous Outflow ◽

Shunt Insertion ◽

Pseudotumor Cerebri Syndrome ◽

The Brain

One of the prominent causes of pseudotumor cerebri (PTC) syndrome is increased impedance of the venous outflow tracts of the brain. Theoretically, this is a justified mechanism for raised intracranial pressure; yet, there had been few cases of such a scenario reported in the literature, and to the authors' knowledge no case of PTC due to benign osteopetrosis has been reported to date. The present case occurred in a 19-year-old woman with a constellation of signs and symptoms compatible with PTC syndrome, whose radiological and laboratory studies confirmed the diagnosis of osteopetrosis. Magnetic resonance venography demonstrated bilateral jugular foraminal stenosis regarding the underlying disease process. The patient did well after she underwent a lumboperitoneal shunt insertion procedure.

Download Full-text

Remission of Pseudotumor Cerebri Syndrome after Initiating Pregnancy and Menarche: The Puzzling Role of Female Sex Hormones

Journal of Pediatric Neurology ◽

10.1055/s-0035-1555148 ◽

2015 ◽

Vol 13 (01) ◽

pp. 022-025 ◽

Cited By ~ 1

Author(s):

Anna Romeo ◽

Rosa Morabito ◽

Dominique De Vivo ◽

Emanuele David ◽

Daniela Impollonia ◽

...

Keyword(s):

Sex Hormones ◽

Pseudotumor Cerebri ◽

Female Sex ◽

Female Sex Hormones ◽

Pseudotumor Cerebri Syndrome

Download Full-text

Pseudotumor cerebri induced by topical application of steroid: a case report

Journal of International Medical Research ◽

10.1177/0300060519857852 ◽

2019 ◽

Vol 47 (7) ◽

pp. 3435-3437 ◽

Cited By ~ 1

Author(s):

Yousef Mohammad ◽

Bandar N. Aljafen ◽

Mohammed S. Alnafisah ◽

Fawaz A. Al-Hussain

Keyword(s):

Case Report ◽

Magnetic Resonance ◽

Topical Steroid ◽

Pseudotumor Cerebri ◽

First Case ◽

Pseudotumor Cerebri Syndrome ◽

Neurology Clinic ◽

Neuro Imaging ◽

The Brain ◽

Tomography Scan

A 19-year-old man visited the neurology clinic for evaluation of a headache and pulsating tinnitus that he had experienced for 2 months. A neurological examination was normal, except for bilateral disc swelling. His medical history was notable for recently diagnosed psoriasis for which he had been applying topical hydrocortisone 2.5% three to four times a day. Neuro-imaging with a computed tomography scan and magnetic resonance imaging/magnetic resonance venography of the brain was normal, except for tortuosity of the optic nerves and dilatation of the optic nerve sheaths. Pseudotumor cerebri syndrome was suspected. Unfortunately, the patient refused a spinal tap to measure the cerebrospinal fluid opening pressure. Excessive application of topical steroid was believed to be the cause of the patient’s pseudotumor cerebri syndrome. The patient’s headache and disc swelling improved after treatment with acetazolamide and cessation of topical hydrocortisone. This is the first case report of a topical steroid associated with pseudotumor cerebri syndrome.

Download Full-text

Pseudotumor cerebri syndrome in a child with Alagille syndrome: intracranial pressure dynamics and treatment outcome after ventriculoperitoneal shunting

Child s Nervous System ◽

10.1007/s00381-021-05043-9 ◽

2021 ◽

Author(s):

Manolis Polemikos ◽

Elvis J. Hermann ◽

Hans E. Heissler ◽

Hans Hartmann ◽

Joachim K. Krauss

Keyword(s):

Intracranial Pressure ◽

Vascular System ◽

Pseudotumor Cerebri ◽

Alagille Syndrome ◽

Ventricular Catheter ◽

Ophthalmological Examination ◽

Multisystem Disease ◽

Ventriculoperitoneal Shunting ◽

Pseudotumor Cerebri Syndrome ◽

History Of

AbstractAlagille syndrome (AS) is a rare multisystem disease of the liver, heart, eyes, face, skeleton, kidneys, and vascular system. The occurrence of pseudotumor cerebri syndrome (PTCS) in patients with AS has been reported only exceptionally. Owning to its rarity and a mostly atypical presentation, the diagnosis and natural history of affected patients remain uncertain. We report an atypical case of PTCS in a 4-year-old boy with a known history of AS who presented with bilateral papilledema (PE) on a routine ophthalmological examination. Visual findings deteriorated after treatment with acetazolamide. Continuous intracranial pressure (ICP) monitoring was then utilized to investigate ICP dynamics. Successful treatment with resolution of PE was achieved after ventriculoperitoneal shunting but relapsed due to growth-related dislocation of the ventricular catheter. This report brings new insights into the ICP dynamics and the resulting treatment in this possibly underdiagnosed subgroup of PTCS patients. It also demonstrates that ventriculoperitoneal shunting can provide long-term improvement of symptoms for more than 10 years.

Download Full-text

Role of MR Venography in Planning Venous Outflow Reconstruction in Living Donor Liver Transplant

Transplantation Journal ◽

10.1097/00007890-201211271-00076 ◽

2012 ◽

Vol 94 (10S) ◽

pp. 41

Author(s):

M. Ghazaly ◽

M. T. Badawy ◽

H. E.-D. Soliman ◽

M. El-Gendy ◽

T. Ibrahim ◽

...

Keyword(s):

Liver Transplant ◽

Living Donor ◽

Mr Venography ◽

Donor Liver ◽

Venous Outflow ◽

Living Donor Liver Transplant ◽

Donor Liver Transplant

Download Full-text

Prostanoids attenuate pial arteriolar dilation induced by cortical spreading depression in rabbits

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1991.261.4.r828 ◽

1991 ◽

Vol 261 (4) ◽

pp. R828-R834 ◽

Cited By ~ 2

Author(s):

M. Shibata ◽

C. W. Leffler ◽

D. W. Busija

Keyword(s):

Cerebrospinal Fluid ◽

Cortical Spreading Depression ◽

Spreading Depression ◽

Brain Vessels ◽

Cranial Window ◽

Baseline Levels ◽

Fluid Levels ◽

The Brain ◽

Arteriolar Diameter

The role of prostanoids in mediating cerebrovascular responses to cortical spreading depression (CSD) was examined in anesthetized rabbits. CSD was elicited by KCl microinjection, and its propagation was monitored electrophysiologically. Pial arterial diameter was determined using a closed cranial window and intravital microscopy, and regional cerebral blood flow (rCBF) was determined using laser flowmetry. Levels of peri-arachnoid cerebrospinal fluid prostanoids were determined by radioimmunoassay. CSF increased pial arteriolar diameter 62% and rCBF 354% over the baseline levels. Locations of propagating CSD, dilating pial arteriole, and increased rCBF were always closely associated spatiotemporally. Cerebrospinal fluid prostanoid levels increased during single CSD-induced arteriolar dilation, and they were further augmented during multiple CSDs. Indomethacin enhanced both CSD-induced vasodilation (88%) and rCBF increase (580%), but it decreased the cerebrospinal fluid levels of prostanoids below the baseline levels and prevented their increase during CSD-induced vasodilation. These results indicate that prostanoids are synthesized from neurons or glial cells and/or the brain vessels and, as the net result, counteract pial arteriolar dilation and rCBF increase during CSD. In addition, they support the hypothesis that the vasodilation is caused primarily by neurogenic factors associated with CSD.

Download Full-text

Role of imaging in pseudotumor cerebri syndrome

Radiología (English Edition) ◽

10.1016/j.rxeng.2020.05.004 ◽

2020 ◽

Vol 62 (5) ◽

pp. 400-410

Author(s):

D. Veiga-Canuto ◽

J. Carreres-Polo

Keyword(s):

Pseudotumor Cerebri ◽

Pseudotumor Cerebri Syndrome

Download Full-text

The importance of the cortical subarachnoid space in understanding hydrocephalus

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/2/7/001 ◽

2008 ◽

Vol 2 (1) ◽

pp. 1-11 ◽

Cited By ~ 58

Author(s):

Harold L. Rekate ◽

Trimurti D. Nadkarni ◽

Donna Wallace

Keyword(s):

Subarachnoid Space ◽

Pseudotumor Cerebri ◽

Ventricular Volume ◽

Third Ventriculostomy ◽

Shunt Failure ◽

Csf Dynamics ◽

Starting Point ◽

Concentric Spheres ◽

The Brain

Object In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. Methods The magnitude of the contribution of the CSAS is explored using the solid geometry of concentric spheres. With this starting point, clinical conditions in which CSF dynamics are not easily understood are explored regarding the potential role of the CSAS. Overall, problems of CSF dynamics are easily understood. Insights may be gained when the results of a pathological process or its treatment vary from what has been expected. Results Acute changes in ventricular volume at the time that hydrocephalus develops, the failure of shunts, and the changes in ventricular volume with shunt repair may occur very rapidly. Changes in the volume of water in the brain, especially in the brain substance itself, are unlikely to occur at this rapid rate and may be interpreted as a simple redistribution of the CSF between the ventricle and CSAS with no initial change in the actual volume of brain parenchyma. Problems such as pseudotumor cerebri, shunt failure with nonresponsive ventricles, and negative-pressure hydrocephalus can be explained by assessing the ability of ventricular CSF to flow to the CSAS and the ability of this fluid to exit this compartment. Ventricular enlargement at the time of shunt failure implies a failure of flow between the ventricles and CSAS, implying that all patients who show this phenomenon are potential candidates for ETV. Conclusions The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.

Download Full-text