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 Post traumatic isolated ipsilateral oculomotor nerve palsy

2019 ◽  
pp. 188-190
Author(s):  
Praveen Kumar ◽  
Sharad Pandey ◽  
Kulwant Singh ◽  
Mukesh Sharma ◽  
Prarthana Saxena
Keyword(s):  
Subdural Hematoma ◽  
Nerve Palsy ◽  
Chronic Subdural Hematoma ◽  
Oculomotor Nerve Palsy ◽  
Rare Presentation ◽  
Third Nerve Palsy ◽  
Common Causes ◽  
History Of ◽  
Post Traumatic ◽  
Third Nerve

The common causes of isolated third nerve palsy are microvascular infarction, intracranial aneurysm, diabetes, hypertension and atherosclerosis. Here we are presenting a case of 26-year female presenting with a history of head injury two months back. She presented with ptosis on the left side. On computed tomography, a large left-sided chronic subdural hematoma with significant midline shift was found. Isolated ipsilateral third nerve palsy is a rare presentation with unilateral chronic subdural hematoma. Improvement in ptosis after surgery indicate a good neurological outcome.

scholarly journals Miller Fisher syndrome with early intracranial hypertension and delayed bilateral simultaneous facial nerve palsy: a case report

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051986749
Author(s):  
Yu-Ming Liu ◽  
Yan-Li Chen ◽  
Yan-Hua Deng ◽  
Yan-Ling Liang ◽  
Wei Li ◽  
...  
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Intracranial Hypertension ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Miller Fisher Syndrome ◽  
Ivig Treatment ◽  
Fisher Syndrome ◽  
Igm Antibodies ◽  
History Of

Miller Fisher syndrome (MFS), a variant of Guillain–Barré syndrome, is characterized by ataxia, areflexia and ophthalmoplegia. This case report describes a 40-year old male that presented with a 3-day history of unsteady walking and numbness on both hands, and a 2-day history of seeing double images and unclear articulation. Lumbar puncture revealed an opening pressure of 260 mm H2O. Plasma serology was positive for anti-ganglioside M1-immunoglobulin M (anti-GM1-IgM) antibodies and negative for anti-ganglioside Q1b (anti-GQ1b) antibodies. The patient was diagnosed with MFS based on the clinical course and neurophysiological findings. On the 4th day of treatment with intravenous immunoglobulin (IVIG), his ataxia and unsteady walking improved, but his bilateral eyeballs were fixed, and over the next few days he developed bilateral peripheral facial paralysis. After 5 days of IVIG treatment, methylprednisolone treatment was offered and the patient's symptoms gradually improved. Early intracranial hypertension and delayed facial nerve palsy may be atypical presentations of MFS. Anti-GM1-IgM antibodies may be the causative antibodies for MFS. If the IVIG therapy does not stop the progression of the disease, the addition of corticosteroid therapy may be effective. However, the relationship between IgM type, anti-GM1 antibody and MFS remains unclear and requires further research.

scholarly journals Child Neurology (Neurocritical Care/Neuro Trauma)

2015 ◽  
Vol 42 (S1) ◽  
pp. S24-S24
Author(s):  
JA Mailo ◽  
J Pugh ◽  
FD Jacob
Keyword(s):  
Bacterial Meningitis ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Neurological Deficits ◽  
Search Terms ◽  
History Of ◽  
Streptococcal Meningitis ◽  
The Brain ◽  
New Onset

Background: Focal neurological deficits occur in approximately 15% of children with bacterial meningitis. However, cranial nerve involvement such as facial-nerve palsy is uncommon in non-tuberculous bacterial meningitis. Methods: Case Report. Review of the literature was conducted on Pubmed for the search terms: facial nerve palsy and meningitis. Results: We present the case of a 4-year old right-handed girl who presented with a new onset unilateral facial nerve palsy preceded by 5-day history of fever and headaches. The patient had meningeal signs and was identified to have Streptococcal Meningitis. MRI of the brain showed a large previously undiagnosed intranasal encephalocele. The facial palsy resolved within 7 days of antibiotic treatment. Conclusions: Our case represents an unusual combination of facial nerve palsy in context of Streptococcal Meningitis secondary to intranasal encephalocele.

scholarly journals Cerebral Blood Flow in Low Intracranial Pressure Headaches—What Is Known?

2019 ◽  
Vol 10 (1) ◽  
pp. 2
Author(s):  
Magdalena Nowaczewska ◽  
Henryk Kaźmierczak
Keyword(s):  
Blood Flow ◽  
Cerebrospinal Fluid ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Intracranial Hypotension ◽  
Csf Pressure ◽  
Cerebral Vasodilatation ◽  
The Relationship ◽  
The Brain

Headaches attributed to low cerebrospinal fluid (CSF) pressure are described as orthostatic headaches caused by spontaneous or secondary low CSF pressure or CSF leakages. Regardless of the cause, CFS leaks may lead to intracranial hypotension (IH) and influence cerebral blood flow (CBF). When CSF volume decreases, a compensative increase in intracranial blood volume and cerebral vasodilatation occurs. Sinking of the brain and traction on pain-sensitive structures are thought to be the causes of orthostatic headaches. Although there are many studies concerning CBF during intracranial hypertension, little is known about CBF characteristics during low intracranial pressure. The aim of this review is to examine the relationship between CBF, CSF, and intracranial pressure in headaches assigned to low CSF pressure.

scholarly journals Pathological laughter in a patient with trigeminal neurinoma

2002 ◽  
Vol 60 (4) ◽  
pp. 1000-1002 ◽  
Author(s):  
André G. Machado ◽  
Paulo Henrique Aguiar ◽  
Raul Marino Jr
Keyword(s):  
Nerve Palsy ◽  
Large Tumor ◽  
Pathological Laughter ◽  
History Of ◽  
Significant Compression ◽  
One Year ◽  
The One ◽  
The Right ◽  
The Brain

We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up.

scholarly journals Bilateral Idiopathic Neuroretinitis

2020 ◽  
Vol 8 (C) ◽  
pp. 89-93
Author(s):  
Muhammad Hidayat
Keyword(s):  
Visual Acuity ◽  
Infectious Agent ◽  
Cat Scratch Disease ◽  
Methyl Prednisolone ◽  
Specific Infectious Agent ◽  
History Of ◽  
Macular Star ◽  
The Brain ◽  
Tomography Scan

BACKGROUND: Neuroretinitis is a clinical entity characterized by an acute loss of vision associated with disc edema and a star pattern of exudates in the macula. It can be divided into two, those with a specific infectious agent or idiopathic. Most infectious cases are due to cat-scratch disease caused by Bartonella species and other infectious agents. Case with a clear infectious is categorized as idiopathic. Most patients with idiopathic neuroretinitis recover excellent visual acuity with or without intervention. Although the presentation is most often unilateral, bilateral cases of neuroretinitis have been reported. CASE REPORT: A 20-year-old woman with a 2-weeks history of sudden progressive visual loss both eyes (visual acuity: RE 3/60; LE 20/200). The optic disc was edema and the hard exudate on the macular area. Two weeks follow-up, funduscopic shows a macular star and the optic disc’s edema was reduced. Perimetric test shows general depressed in both eyes. The blood tests and the brain computed tomography scan were normal. She received methyl prednisolone 48 mg for 2 weeks. Eight months follow-up, VA: RE 20/50, LE 20/40 with the pinhole 20/15 in both eyes. The funduscopic still showed edema and slight paling. There was an improvement in central visual acuity after steroid treatment but leave residual abnormal funduscopic. CONCLUSION: Neuroretinitis is generally self-limited. The visual acuity recovers excellent with the steroid, but the abnormal disc in this case related to a vaso-occlusive mechanism of prelamin arterioles with subsequent disc infraction.

scholarly journals Sinovenous Abnormalities in Patients of Idiopathic Intracranial Hypertension

2018 ◽  
Vol 26 ◽  
pp. 53-56
Author(s):  
M Pervez Amin ◽  
Pijush Kumar Kundu ◽  
M Munzur Alahi ◽  
Mukul Kumar Sarkar ◽  
M Ahmed Ali ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Transverse Sinus ◽  
College Hospital ◽  
Medical College ◽  
Significant Difference ◽  
History Of ◽  
History Of Use ◽  
The Brain

Idiopathic Intracranial Hypertension is a disease of unknown aetiology common in obese females and presents with headache, papilledema, raised CSF opening pressure, no abnormalities in CSF examination and no abnormality on CT scan or MRI of the Brain. Sinovenous abnormalities are commonly detected in patients of IIH by different neuroimaging techniques. But the exact role of these sinovenous abnormalities in the causation of the disease or whether they are an effect of the disease is not yet known. Nor has a ‘gold standard’ investigation been established yet for detection of the sinovenous abnormalities. This study was done to detect the presence of sinovenous abnormalities in IIH patients by performing a Magnetic Resonance Venography of the brain. All 33 patients of IIH who presented to Rajshahi Medical College Hospital during the study period from June 2009 to May 2010 were included in the study. There were 30 females and 3 males having a F:M ratio of 10:1. 91% of the patients were between 20 and 35 years of age and most of them were married housewives. 63.64% patients had history of use of oral contraceptives. Unusually 51.52% of the patients had a BMI less than 25 indicating that they were not even overweight (BMI 25 to 30). Only 6% of the patients had BMI > 30 indicating that they were obese. Headache and papilloedema were present in all patients but visual difficulties were present only in 54.54% of the patients. Abnormalities in MRV of the brain were detected in 27.27% (9/33) of the patients and transverse sinus hypoplasia was the commonest finding (88.89% - 8/9 patients). There was no statistically significant difference in the findings of MRV abnormalities between the males and females or among the patients having BMI less or more than 25TAJ 2013; 26: 53-56

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 Idiopathic Intracranial Hypertension: A Case Report

2021 ◽  
Vol 59 (234) ◽  
Author(s):  
Anupam Ghimire ◽  
Achal Raj Acharya ◽  
Anish Karn ◽  
Mukesh Kumar Jha
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Care Setting ◽  
Young Male ◽  
Signs And Symptoms ◽  
Ophthalmological Examination ◽  
History Of ◽  
Ideal Body ◽  
The Brain ◽  
The Ideal

Idiopathic Intracranial Hypertension (IIH) is a rare occurrence in young, physically fit male and a diagnosis of exclusion among most patients presenting with signs and symptoms of raised intracranial pressure. Here we describe a case of a young male in the ideal weight range with no previous exposure to offending chemicals presented with a history of headache, obscuration of vision, and photopsia. On examination, there were no positive neurological findings. Increased opening pressure was found on the lumbar puncture. Ophthalmological examination revealed bilateral papilledema. Humphrey’s Visual field test showed peripheral field loss. MRI scan of the brain and orbits were normal. The patient was diagnosed and managed in primary care setting after neurosurgical consultation. Though rare, we should suspect IIH in ideal body weighted male if the headache is persistent after other causes of headache have been ruled out.

scholarly journals Idiopathic Intracranial Hypertension Associated with Uncontrolled Use of WeightLoss Drugs

2018 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Intracranial Hypertension ◽  
Visual Fields ◽  
Blind Spot ◽  
Benign Intracranial Hypertension ◽  
Self Medication ◽  
Blurred Vision ◽  
Rnfl Thickness ◽  
Obese Female ◽  
History Of ◽  
Treatment Of Obesity

Purpose: We report a case of a patient with bilateral papilledema and Benign Intracranial Hypertension caused by uncontrolled use of drugs for self-treatment of obesity. Methods: A 36-year-old, mildly obese female with a 7-month history of visual changes with floaters, intermittent episodes of diplopia and blurred vision, intense, debilitating, daily headaches, pulsatile tinnitus, bilateral maxillary pressure and pain. Fundus examination revealed papilledema, visual field test detects blind spot enlargement, generalized constriction, and loss of the nasal visual fields, optical coherence tomography (OCT) - increased RNFL thickness in all four quadrants, Lumbar puncture- Increased Intracranial Pressure. Results: The diagnosis of IIH we made according modified Dandy criteria. Conclusion: To our knowledge, this is the first report in literature of BIH caused after self-medication of overweight. Patient during a year lose 40 kg, and she manage it by uncontrolled use of drugs for weight loss.

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