A review of ocular manifestations in intracranial hypotension

2007 ◽  
Vol 23 (5) ◽  
pp. E8 ◽  
Author(s):  
Gabriel Zada ◽  
Thomas C. Solomon ◽  
Steven L. Giannotta
Keyword(s):  
Visual Acuity ◽  
Cranial Nerve ◽  
Intracranial Hypotension ◽  
Visual Fields ◽  
Abducens Nerve ◽  
Visual Deficits ◽  
Ocular Manifestations ◽  
Cranial Nerve Dysfunction ◽  
Blood Patch ◽  
Nerve Paresis

Object Intracranial hypotension (ICH) can present with a wide variety of visual symptoms and findings. Deficits in visual acuity and visual fields as well as ophthalmoplegia due to cranial nerve dysfunction have been frequently described. The aim of this review was to identify the most commonly reported ocular manifestations associated with ICH. Methods The authors conducted a review of the literature to date to identify all studies of patients with ICH and ocular manifestations. Results The most commonly encountered cranial nerve deficit resulting from ICH (> 80% of reported cases) is an abducens nerve paresis, which may occur unilaterally or bilaterally. Although less common, oculomotor and trochlear nerve palsies have been reported as well. The optic nerve complex is frequently involved in ICH and may manifest as deficits in visual acuity and field cuts. Visual deficits and ophthalmoplegia improved following appropriate management in 97% of reported cases. Conclusions Intracranial hypotension can present with a wide spectrum of visual deficits, the causes of which are multifactorial. Cranial nerve paresis, especially of the abducens nerve, is frequently reported. The majority of symptoms and cranial nerve deficits reviewed respond favorably to conservative management, epidural blood patch administration, or in a minority of cases, surgical intervention.

scholarly journals Abducens nerve paresis in spontaneous intracranial hypotension syndrome.

2005 ◽  
Vol 83 (2) ◽  
pp. 269-270 ◽  
Author(s):  
Matthias Grueb ◽  
Dorothea Besch ◽  
Joerg Mielke ◽  
Eva Reinthal ◽  
Volker Herzau
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Abducens Nerve ◽  
Intracranial Hypotension Syndrome ◽  
Nerve Paresis

Case Series of Rapid Surgical Interventions in Fulminant Intracranial Hypertension

2021 ◽  
pp. 088307382110267
Author(s):  
Jillian Ploof ◽  
Shawn C. Aylward ◽  
Catherine O. Jordan ◽  
Annie I. Drapeau
Keyword(s):  
Cerebrospinal Fluid ◽  
Visual Acuity ◽  
Intracranial Hypertension ◽  
Cranial Nerve ◽  
Visual Fields ◽  
Case Series ◽  
Cerebrospinal Fluid Shunt ◽  
Surgical Interventions ◽  
Lumbar Drain ◽  
Cranial Nerve Palsies

Aims: Examine ophthalmologic outcomes and complications of lumbar drain and cerebrospinal fluid shunts in pediatric fulminant intracranial hypertension. Methods: Patients under 21 years of age with a diagnosis of fulminant intracranial hypertension with temporary lumbar drain only, shunt after lumbar drain, and shunt only were included. Parameters investigated include lumbar drain data, medication freedom, time to resolution of papilledema, improvement in cranial nerve palsy, afferent pupillary defects, visual fields, visual acuity, and complications of each intervention. Results: Four patients had temporary lumbar drain, 2 temporary lumbar drain and cerebrospinal fluid shunt, and 3 shunt only. All achieved medication freedom and resolution of papilledema and cranial nerve palsies (if present). Most had resolution of preprocedure afferent pupillary defects. Minor residual visual field deficits occurred in 67%, and all had visual acuity improvement. One patient’s lumbar drain dislodged, and one patient had 2 cerebrospinal fluid shunt revisions. Conclusion: Temporary lumbar drain with medical therapy may be a viable first approach to fulminant intracranial hypertension.

scholarly journals Intracranial Hypotension Leading to Intracranial Hypertension with Ocular Manifestations

2021 ◽  
Vol 20 (3) ◽  
pp. 114-118
Author(s):  
Jiyoung Lee ◽  
Yeon Woong Chung
Keyword(s):  
Visual Acuity ◽  
Intracranial Hypertension ◽  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Nerve Palsy ◽  
Blind Spot ◽  
Ocular Manifestations ◽  
History Of ◽  
The Brain ◽  
Binocular Diplopia

Purpose: To report a case of a 29-year-old binocular-diplopia patient diagnosed with intracranial hypertension, caused by a subdural hematoma due to intracranial hypotension.Case summary: A 29-year-old male hypertensive patient, diagnosed 2 months previously with idiopathic intracranial hypotension, presented to an ophthalmologist with a 4-day history of binocular diplopia. Visual acuity was 1.0/0.63 (1.0) without relative afferent pupillary defects. There was bilateral papilledema, right 6th cranial nerve palsy, and blind spot enlargement in visual field examinations, suggestive of intracranial hypertension. Computer tomography of the brain identified a 2- to 3-week-old subdural hematoma, a complication of intracranial hypotension, which may have led to intracranial hypertension.Conclusion: While persistent headaches in intracranial hypertension patients progress to intracranial hypotension due to lowered cerebrospinal fluid pressures, this is the first report of intracranial hypotension progressing to intracranial hypertension.

scholarly journals Spontaneous spinal cerebrospinal fluid leaks: a review

2000 ◽  
Vol 9 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Wouter I. Schievink
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Traumatic Event ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Neck Stiffness ◽  
Arm Pain ◽  
Cranial Nerve Dysfunction ◽  
Blood Patch

Spontaneous intracranial hypotension has become a well-recognized clinical entity, but it remains an uncommonly, and probably underdiagnosed, cause of headache; its estimated prevalence is only one in 50,000 individuals. The clinical spectrum of spontaneous intracranial hypotension is quite variable and includes headache, neck stiffness, cranial nerve dysfunction, radicular arm pain, and symptoms of diencephalic or hindbrain herniation. Leakage of the spinal cerebrospinal fluid (CSF) is the most common cause of spontaneous intracranial hypotension. A combination of an underlying weakness of the spinal meninges and a more or less trivial traumatic event is often found to cause this event in these patients. Typical magnetic resonance imaging findings include diffuse pachymeningeal enhancement, sub-dural fluid collections, and downward displacement of the brain, sometimes mimicking a Chiari I malformation. Opening pressure is often, but not always, low, and examination of CSF may reveal pleocytosis, an elevated protein count, and xanthochromia. The use of myelography computerized tomography scanning is the most reliable method for the accurate localization of the CSF leak. Most CSF leaks are found at the cervicothoracic junction or in the thoracic spine. The initial treatment of choice is a lumbar epidural blood patch, regardless of the location of the CSF leak. If the epidural blood patch fails, the blood patch procedure can be repeated at the lumbar level, or a blood patch can be directed at the exact site of the leak. Surgical repair of the CSF leak is safe and generally successful, although a distinct structural cause of the leak often is not found.

scholarly journals Palsy of the Contralateral Abducens Nerve after Aneurysm Surgery and Temporal Meningioma in the Presence of Petroclival Meningioma: A Case Report

2018 ◽  
Vol 37 (02) ◽  
pp. 148-150
Author(s):  
Pedro Moreira ◽  
Anderson Souza ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Case Report ◽  
Intracranial Aneurysm ◽  
Cranial Nerve ◽  
Intracranial Hypotension ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Aneurysm Surgery ◽  
Sixth Cranial Nerve ◽  
Petroclival Meningioma ◽  
Meningioma Surgery

AbstractThe sixth abducens nerve is subject to injury after rare complications of intracranial hypotension caused by procedures such as dural punctures and spinal surgeries. The purpose of this case report is to discuss the mechanism of nerve palsy in these situations. Therefore, we describe a case of onset of contralateral sixth cranial nerve palsy after intracranial aneurysm and temporal meningioma surgery. Moreover, in this case there is a singularity due to the presence of the petroclival meningioma that amplified the unfolding of the lesion.

scholarly journals Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gha-Hyun Lee ◽  
Jiyoung Kim ◽  
Hyun-Woo Kim ◽  
Jae Wook Cho
Keyword(s):  
Intracranial Hypotension ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Brain Mri ◽  
Spontaneous Intracranial Hypotension ◽  
Vein Of Galen ◽  
Mri Findings ◽  
Post Dural Puncture Headache ◽  
Straight Sinus ◽  
Blood Patch

Abstract Background Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment. Methods We retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus). Results A total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02). Conclusions Patients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.

Sign in / Sign up

Export Citation Format

Share Document