scholarly journals Addison’s Disease, Idiopathic Intracranial Hypertension and Empty Sella - In a 40-Year-Old Woman

2012 ◽  
Vol 30 (1) ◽  
pp. 53-55
Author(s):  
MAJ Chowdhury ◽  
U Salma ◽  
QMU Ahmed ◽  
M Fariduddin ◽  
A Alam ◽  
...  
Keyword(s):  
Physical Examination ◽  
Intracranial Hypertension ◽  
Optic Atrophy ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Radiological Investigation ◽  
Menstrual History ◽  
History Of ◽  
Background History ◽  
Medical University

A 40-year-old woman having normal menstrual history got  admitted into Bangabandhu Sheikh Mujib Medical  University (BSMMU) because of vomiting for previous two  months, with a background history of irregular steroid  intake for her bodyache for about six years. She was gaining  weight and gradually losing vision in her right eye and  noticed increased body pigmentation. Physical examination  revealed BMI 29 kg/m2, generalized pigmentation more  marked in palmar crease and oral mucosa, secondary optic  atrophy in right eye and papilloedema in left eye. After  biochemical and radiological investigation she was  diagnosed as a case of Addison’s disease with idiopathic  intracranial hypertension (IIH) with empty sella   DOI: http://dx.doi.org/10.3329/jbcps.v30i1.11368   J Bangladesh Coll Phys Surg 2012; 30: 53-55  

A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

2021 ◽  
Author(s):  
Christopher S. Hong ◽  
Adam J. Kundishora ◽  
Aladine A. Elsamadicy ◽  
Eugenia M. Vining ◽  
R. Peter Manes ◽  
...  
Keyword(s):  
Literature Review ◽  
Intracranial Hypertension ◽  
Skull Base ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Csf Leak ◽  
Presenting Symptoms ◽  
History Of ◽  
Sinus Stenosis ◽  
Csf Leaks

Abstract Background Spontaneous cerebrospinal fluid (CSF) leaks represent a unique clinical presentation of idiopathic intracranial hypertension (IIH), lacking classical features of IIH, including severe headaches, papilledema, and markedly elevated opening pressures. Methods Following a single-institution retrospective review of patients undergoing spontaneous CSF leak repair, we performed a literature review of spontaneous CSF leak in patients previously undiagnosed with IIH, querying PubMed. Results Our literature review yielded 26 studies, comprising 716 patients. Average age was 51 years with 80.8% female predominance, and average body mass index was 35.5. Presenting symptoms included headaches (32.5%), visual disturbances (4.2%), and a history of meningitis (15.3%). Papilledema occurred in 14.1%. An empty sella was present in 77.7%. Slit ventricles and venous sinus stenosis comprised 7.7 and 31.8%, respectively. CSF leak most commonly originated from the sphenoid sinus (41.1%), cribriform plate (25.4%), and ethmoid skull base (20.4%). Preoperative opening pressures were normal at 22.4 cm H2O and elevated postoperatively to 30.8 cm H2O. 19.1% of patients underwent shunt placement. CSF leak recurred after repair in 10.5% of patients, 78.6% involving the initial site. A total of 85.7% of these patients were managed with repeat surgical intervention, and 23.2% underwent a shunting procedure. Conclusion Spontaneous CSF leaks represent a distinct variant of IIH, distinguished by decreased prevalence of headaches, lack of visual deficits, and normal opening pressures. Delayed measurement of opening pressure after leak repair may be helpful to diagnose IIH. Permanent CSF diversion may be indicated in patients exhibiting significantly elevated opening pressures postoperatively, refractory symptoms of IIH, or recurrent CSF leak.

Fulminant Idiopathic Intracranial Hypertension and Venous Stasis Retinopathy Resulting in Severe Bilateral Visual Impairment

2017 ◽  
Vol 27 (2) ◽  
pp. e25-e27 ◽  
Author(s):  
Alexander Voldman ◽  
Breanna Durbin ◽  
John Nguyen ◽  
Brian Ellis ◽  
Monique Leys
Keyword(s):  
Optic Nerve ◽  
Magnetic Resonance ◽  
Intracranial Hypertension ◽  
Optic Atrophy ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Stasis ◽  
Fundus Examination ◽  
History Of ◽  
Venous Stasis Retinopathy ◽  
Central Retinal Vein

Purpose To report a complicated case of fulminant idiopathic intracranial hypertension and concomitant venous stasis retinopathy leading to postpapilledema optic atrophy. Methods Case report. Results A 34-year-old morbidly obese woman with a history of idiopathic intracranial hypertension (IIH) presented with a 1-month history of bilateral vision loss, diplopia, and left eye pain after being lost to follow-up for 6 years. Fundus examination revealed florid papilledema with venous tortuosity bilaterally. Brain and orbit magnetic resonance imaging showed bilateral globe flattening, intraocular optic nerve swelling in both eyes, and no abnormality on magnetic resonance venography. After additional workup including lumbar puncture with an opening pressure of 55 cm H2O, a diagnosis of IIH was confirmed. Medical treatment with oral carbonic anhydrase inhibitors was initiated, followed by same-day bilateral optic nerve sheath decompression and ventriculoperitoneal shunt placement the following week. Fundus examination 2 months later revealed a persistent blood and thunder fundus suggestive of bilateral central retinal vein occlusions. Over the course of 6 months, both eyes displayed postpapilledema optic atrophy with light perception and hand motion vision in the right and left eyes, respectively. On Goldmann perimetry, the patient had vague limited isolated responses in both eyes to the largest target. Conclusions Fulminant IIH can present with profoundly blinding complications recalcitrant to aggressive medical and surgical intervention. Central retinal vein occlusion is an uncommon blinding complication of IIH.

scholarly journals Acquired Tracheo-Esophageal Fistula : A Rare Case Report of the Neglected Denture

2018 ◽  
Vol 5 ◽  
Author(s):  
Sharir Asrul Bin Asnawi ◽  
Mohamad Bin Doi ◽  
Abdul Rahman Hikmet Shaker ◽  
Mawaddah Binti Azman
Keyword(s):  
Foreign Body ◽  
Endoscopic Examination ◽  
Esophageal Fistula ◽  
Medical Assessment ◽  
Radiological Investigation ◽  
Rare Case Report ◽  
Patient Will ◽  
Ingested Foreign Body ◽  
History Of ◽  
Background History

Introduction: Dentures are common accidental ingested foreign body (FB) especially among elderly. It is frequent to have foreign body impacted at esophagus in adults however it is very unsual to have Tracheo-esophageal fistula (TEF) caused by denture. The diagnosis of TEF is challenging due to two reasons. Firstly, most of the dental prosthesis is radiolucent and not visible in routine radiological investigation. Secondly, patient with history of swallowed dentures prosthesis may be asymptomatic initially and develops symptoms over time. In contrary, prolonged history of FB in esophagus with TEF has higher risk to develop serious complication such as pneumonia and lung abscess.Case Presentation: We report a case of 62 year old gentleman with background history of hypertension and temporal lobe epilepsy presented with history of choking on taking solid and liquid associated with significant weight loss past 2 months. He had lost his denture for almost 1 year during sleep. Endoscopic examination of the larynx showed normal anatomy but pooling of saliva. CT thorax showed foreign body within a tracheoesophgeal fistula. OGDS showed denture within a well formed tracheoesophageal fistula. He had acquired TEF secondary to the dentures. Conclusion: Symptomatic elderly who lose their denture during sleep should not be neglected. They need immediate medical assessment thus will reduce further debilitating complication. Failing to identify and treat this condition urgently, patient will suffer acquired trachea-oesophageal fistula on which the treatment is challenging and the morbidity and mortality is high.

scholarly journals CSF fistula in a woman with a history of idiopathic intracranial hypertension

2010 ◽  
Vol 25 (8) ◽  
pp. 515-516
Author(s):  
L.A. Rodríguez de Antonio ◽  
A. Tallón Barranco ◽  
E. Díez-Tejedor
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Csf Fistula ◽  
History Of

scholarly journals Idiopathic Hypertrophic Pachymeningitis: A Case Report from Bangladesh

2018 ◽  
Vol 3 (2) ◽  
pp. 110-112
Author(s):  
Meera Momtaz Sabeka ◽  
Md Nazrul Islam
Keyword(s):  
Case Report ◽  
Physical Examination ◽  
Optic Atrophy ◽  
Severe Headache ◽  
Imaging Studies ◽  
Hypertrophic Pachymeningitis ◽  
History Of ◽  
Diagnostic Clue ◽  
Work Up ◽  
Rule Out

A 52 years old lady presented with sudden severe headache with the history of similar intense headache twenty years back which ended up with left sided blindness. Her physical examination was unremarkable except optic atrophy of the left eye. Investigation included biochemical work up, imaging studies and CSF study. The MRI of brain with contrast gave the key diagnostic clue with characteristic findings of hypertrophic pachymeningitis. Other investigations helped to rule out possible etiologies and the diagnosis idiopathic hypertrophic pachymeningitis was finally made. The patient has been treated with steroid and enjoyed improvement in her yearlong symptoms.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 110-112

Hemifacial Spasm as a Rare Clinical Presentation of Idiopathic Intracranial Hypertension: Case Report and Literature Review

2020 ◽  
Vol 129 (8) ◽  
pp. 829-832 ◽  
Author(s):  
Charles B. Poff ◽  
Noga Lipschitz ◽  
Gavriel D. Kohlberg ◽  
Joseph T. Breen ◽  
Ravi N. Samy
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Intracranial Hypertension ◽  
Hemifacial Spasm ◽  
Idiopathic Intracranial Hypertension ◽  
Case Reports ◽  
English Literature ◽  
Anterior Inferior Cerebellar Artery ◽  
First Report ◽  
History Of

Objectives: To report a rare case of idiopathic intracranial hypertension (IIH) presenting with hemifacial spasm (HFS) and review the current literature. Methods: Case report and literature review. The patient’s medical record was reviewed for demographic and clinical data. For literature review, all case reports or other publications published in English literature were identified using PUBMED. Results: A 43-year-old obese female presented with a 2-year history of left HFS. Electroencephalography and head computed tomography were unremarkable. Magnetic resonance imaging demonstrated bilateral anterior inferior cerebellar artery vascular loops involving the internal auditory canals as well as IIH-associated findings. A lumbar puncture was performed and revealed an elevated opening pressure of 26 cm H20 cerebrospinal fluid. Acetazolamide treatment was then initiated, resulting in complete resolution of the HFS. Conclusion: HFS may be a rare presenting manifestation of IIH, and treatment of IIH may result in improvement of HFS symptoms. This is the first report of IIH presenting with HFS in the absence of headache or visual change. As a result, this is the first report of HFS as a presenting manifestation of IIH in Otolaryngology literature.

Imaging Features of Idiopathic Intracranial Hypertension in Children

2016 ◽  
Vol 32 (1) ◽  
pp. 120-126 ◽  
Author(s):  
Alexander J. P. W. Hartmann ◽  
Bruno P. Soares ◽  
Beau B. Bruce ◽  
Amit M. Saindane ◽  
Nancy J. Newman ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Optic Nerve Head ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Imaging Features ◽  
Mri Findings ◽  
Sinus Stenosis ◽  
Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI) signs of elevated intracranial pressure and idiopathic intracranial hypertension have been well characterized in adults but not in children. The MRIs of 50 children with idiopathic intracranial hypertension and 46 adults with idiopathic intracranial hypertension were reviewed for optic nerve head protrusion, optic nerve head enhancement, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, empty or partially empty sella, tonsillar herniation, enlargement of Meckel’s cave meningoceles, and transverse venous sinus stenosis(TSS). Compared to adolescents (11-17 years, n = 40) and adults (>17 years, n = 46), prepubescent children (<11 years, n = 10) had lower frequencies of scleral flattening (50% vs 89% and 85%, P = .02), increased perioptic cerebrospinal fluid (60% vs 84% and 89%, P = .08), optic nerve tortuosity (20% vs 46% and 59%, P = .07), empty or partially empty sella (56% vs 78% and 93%, P = .007), and TSS (67% vs 93% and 96%, P = .04). Children with idiopathic intracranial hypertension have similar MRI findings as adults, but they are less frequent in prepubescent children.

scholarly journals Idiopathic intracranial hypertension as a cause of severe intractable headache in a patient with Systemic Lupus Erythematosus: A case report from Eastern Nepal

2018 ◽  
Vol 7 (2) ◽  
pp. 40-42
Author(s):  
Bhupendra Shah ◽  
Mathew Ibrahim Amprayil ◽  
Rahul Taparia ◽  
Shailesh Mani Pokhrel
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Intracranial Hypertension ◽  
Lupus Erythematosus ◽  
Idiopathic Intracranial Hypertension ◽  
Female Gender ◽  
Systemic Lupus ◽  
Hypervitaminosis A ◽  
Neuropsychiatric Manifestation ◽  
History Of

Correction: Unfortunately, several authors on this paper were omitted. Therefore, on 15th April 2019 the following authors were added to the paper: Mathew Ibrahim Amprayil, Rahul Taparia and Shailesh Mani Pokhrel. The editorial board apologises for this error. The common risk factors for Idiopathic intracranial hypertension are obesity, female gender, hypervitaminosis A, and steroid withdrawal. Even though Idiopathic intracranial hypertension is considered as a neuropsychiatric manifestation of Systemic lupus erythematosus, it is often missed by the physician as a cause of a headache in a patient with Systemic lupus erythematosus. We report a case of 21-year-old female who presented in our outpatient department with a history of a severe intractable progressive headache for a duration of four weeks and blurring of vision for five days who was later diagnosed as a case of idiopathic intracranial hypertension with Systemic lupus erythematosus. She recovered dramatically with the institution of steroid and acetazolamide therapy.

scholarly journals Idiopathic intracranial hypertension associated with mild traumatic brain injury in a pediatric patient – Case report

2013 ◽  
Vol 32 (03) ◽  
pp. 204-206
Author(s):  
Carlos Umberto Pereira ◽  
Stephanie Chagas Feitosa ◽  
Alyne Andrade Lima
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Symptomatic Treatment ◽  
Good Prognosis ◽  
Patient Case ◽  
Blurred Vision ◽  
General Picture ◽  
Cranial Ct ◽  
Accidental Fall ◽  
History Of

AbstractMild head injury has been described as rare cause of idiopathic intracranial hypertension (IIH). In the presence of IIH, initial treatment is clinical and surgical treatment, such as lumboperitoneal shunt. Most cases have a good prognosis. The patient have 9-year-old male, went to the emergency room with a history of accidental fall, presenting headache, vomiting and blurred vision. Physical examination showed good overall condition. Neurological examination: normal. Fundoscopy: incipient bilateral papilledema. Normal cranial CT. The general picture suggested by exclusion of other causes IIH diagnosis. He underwent symptomatic treatment with acetazolamide, painkillers and rest. Discharged from the hospital on the eighth hospital day with no complaints being referred for outpatient treatment.

scholarly journals RARE-13. PRIMARY EMPTY SELLA SYNDROME AND PSEUDO-TUMOR CEREBERI: CORRELATION OF ASSOCIATION AND SURGICAL PLAN

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i43-i43
Author(s):  
Mohamed Arnaout
Keyword(s):  
Cerebrospinal Fluid ◽  
Natural History ◽  
Idiopathic Intracranial Hypertension ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Common Presentation ◽  
History Of ◽  
The Relationship ◽  
Primary Empty Sella

Abstract Introduction Management of primary empty sella syndrome (ESS) is generally remaining a neurosurgical challenge due to lack of a well standardized approach. Pseudo-tumor cereberi (Benign or idiopathic intracranial hypertension) is commonly associated condition. In this study, we have demonstrated the relationship and surgical plan and outcome of such cases. Patients and Methods: We retrospectively studied 24 patients with primary empty sella syndrome (ESS) for two years who were diagnosed radiologically as ESS. Fundus and other ophthalmological examinations were done. Lumbar puncture and cerebrospinal fluid (CSF) manometer were evaluated in those with papilledema. All patients’ data were collected and analyzed. Results Basically, 24 patients (18 females and 6 males) were radiologically diagnosed as EES. 13 females and only one male were having symptoms of BIH. 17 patients (70.83%) had headache as the first presentation. Second most common presentation in our study was visual in 14 patients (58.3%). Two patients (8.3%) had pituitary hypersecretion namely; growth and prolactin hormones. In those (58.3%) confirmed to have BIH Theco-peritoneal shunts were inserted. Incidental cases (29.17%) without symptoms were followed up. Conclusion Although (ESS) is a well-known radiological hallmark for BIH, in our study not all patients had BIH. Interestingly, pituitary hyperfunction may be the first presentation in some rare cases. Generally, natural history of that entity was benign. Frequent follow-up by neurosurgeons and increased awareness of associations are advised. We believe a more prospective large number cohort is important to outline the natural history.

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