Idiopathic Intracranial hypertension in a patient with a history of migraine: a case report

Introduction: Idiopathic intracranial hypertension (IIH) is marked by elevated intracranial pressure without a known cause, often affecting women of childbearing age and linked to obesity. Diagnosing IIH can be tricky, especially in patients with chronic headaches like migraines. This report discusses a case of IIH in a long-term migraine sufferer, stressing the importance of early detection and effective treatment. Case Report: A 44-year-old woman with migraines since menarche sought medical help in August 2021 due to more frequent and intense headaches, occurring three times a week with light and sound sensitivity and nausea. An MRI in September 2021 showed rare anomalies. Initially treated with topiramate and nortriptyline, her headaches decreased to twice a month by May 2022. However, in November 2022, an ophthalmologist found bilateral papilledema, and she reported retroocular pain and transient visual obscurations. A lumbar puncture confirmed IIH with an opening pressure of 32.5 cmH2O, and she was prescribed acetazolamide. Despite some headache relief, she experienced nausea and visual distortions. Adjustments in her medication and a five-kilogram weight loss improved her symptoms, though issues in the left eye's visual field persisted. Comment:This case highlights the challenges of managing IIH in migraine patients. New headache patterns and visual symptoms were key to suspecting IIH, confirmed by lumbar puncture. Acetazolamide effectively reduced her intracranial pressure, while nortriptyline helped manage sleep issues. Weight loss significantly improved symptoms, emphasizing the need for a multidisciplinary approach between neurologists and ophthalmologists are for optimal care.(AU)

Craniectomía descompresiva como alternativa terapéutica en la hipertensión intracraneal pediátrica incontrolable por traumatismo craneoencefálico grave / Decompressive craniectomy as a therapeutic alternative in uncontrollable intracranial hypertension in pediatric severe head injury

Introducción: El traumatismo craneoencefálico grave presenta una elevada incidencia en pacientes pediátricos. Es una importante causa de muerte y discapacidad. Sus causas más comunes en este grupo etario son los accidentes domésticos y de tránsito, caídas, violencia y actividades deportivas. Se realizó una revisión bibliográfica en julio y agosto de 2023 con un total de 38 bibliografías en idioma español, inglés y portugués en las bases de datos de SciElo, Elsevier, Pubmed y el motor de búsqueda Google Académico. Se consideró como criterio de selección aquella literatura publicada con mayor actualidad en concordancia con lo novedoso de esta enfermedad. Objetivo: Describir la craniectomía descompresiva como una alternativa a la hipertensión intracraneal pediátrica producida por traumatismo craneoencefálico grave. Desarrollo: Ante un traumatismo craneoencefálico grave, la presión intracraneal aumenta, lo que causa hipertensión intracraneal. Cuando esta hipertensión no se logra controlar, se convierte en refractaria, se requieren otros tratamientos más agresivos como la craniectomía descompresiva. Este procedimiento es invasivo, consiste en remover parte del cráneo para disminuir la presión dentro de la cavidad craneana. Conclusiones: Es necesario continuar los estudios de craniectomía descompresiva en el manejo de la hipertensión craneal pediátrica en la población infanto-juvenil, pues los estudios enfocados en ellos no abundan; estos constituyen una intervención de rescate. A pesar de los adelantos científicos, logros terapéuticos alcanzados y conocimientos de la hipertensión craneal pediátrica, se considera la craniectomía descompresiva como una elección terapéutica óptima, con una justa predicción y no brindarla cuando las opciones reales de éxito sean insuficientes(AU)

Introduction: Severe head trauma has a high incidence in pediatric patients. It is a major cause of death and disability. Its most common causes in this age group are domestic and traffic accidents, falls, violence and sports activities. A bibliographic review was carried out in July and August 2023 with a total of 38 bibliographies in Spanish, English and Portuguese from the SciElo, Elsevier, Pubmed databases and the Google Scholar search engine. The most recent published literature in accordance with the novelty of this disease was considered as a selection criterion. Objective: To describe decompressive craniectomy as an alternative to pediatric intracranial hypertension caused by severe head trauma. Development: In the event of severe head trauma, intracranial pressure increases, causing intracranial hypertension. When this hypertension cannot be controlled, it becomes refractory, other more aggressive treatments such as decompressive craniectomy are required. This procedure is invasive, it consists of removing part of the skull to reduce the pressure inside the cranial cavity. Conclusions: It is necessary to continue studies of decompressive craniectomy in the management of pediatric cranial hypertension in the child and adolescent population, since studies focused on them are not abundant; these constitute a rescue intervention. Despite scientific advances, therapeutic achievements and knowledge of pediatric cranial hypertension, decompressive craniectomy is considered an optimal therapeutic choice, with fair prediction and not provided when the real options for success are insufficient(AU)

Correlation between Optical Coherence Tomography Ganglion Cell Layer Analysis and Visual Field in Cases of Benign Intracranial Hypertension

Background: Benign intracranial hypertension (BIH) is a condition in which there is excessive cerebral spinal fluid (CSF) pressure in the subarachnoid space that surrounds the brain and spinal cord (intracranial pressure (ICP)) owing to an unexplained cause. It affects 1:100,000 persons yearly with a 20 times greater prevalence in young, obese girls. We wanted to correlate between optical coherence tomography ganglion cell layer analyses and visual field in patients of benign intracranial hypertension. Methods: This cross-sectional clinical study that was carried out on 30 patients (60 eyes) who all had a recently diagnosed papilledema due to first episode of IIH. Goal of the study, and applied tests was done before obtaining an informed consent. Personal history, past medical and ocular history, possible risk factors for IIH were taken. Full ophthalmological examination including best corrected visual acuity (BCVA), intraocular pressure (IOP), color perception, pupillary reflexes, slit lamp bio microscopy examination including assessment of papilledema grade, blood pressure check and body mass index (BMI). All patients underwent automated perimetry in dim light to evaluate their visual field using SITA fast Standard 30-2 protocol by Humphrey Field Analyzer (Humphrey Field Analyzer I Carl Zeiss AG – Oberkochen – Germany). Results: Average RNFL thickness had significant positive correlation with rim area (r=0.654, P<0.001) and disc area (r=0.665, P<0.001). Average RNFL thickness had no correlation with VA, IOP and average CD. Average GCL complex had significant negative correlation with rim area (r= -0.283, P=0.028) and disc area (r= -0.328, P=0.01). Average GCL complex had no correlation with VA, IOP and average CD. Minimum GCL complex had significant negative correlation with rim area (r= -0.272, P=0.036) and disc area (r= -0.315, P=0.014). Minimum GCL complex had no correlation with VA, IOP and average CD. Papilledema grading had significant positive correlation with average RNFL thickness (r=0.461, P<0.001). Papilledema grading had no correlation with average GCL complex, minimum GCL complex, VFI, MD and PSD. Conclusions: There is a strong structure-function link between visual field indices and OCT parameters such as RNFL and GCC.

Idiopathic Intracranial Hypertension In Background Of Empty Sella Syndrome

Background:Empty sella syndrome is a rare disorder characterized by enlargement or malformation of a structure in the skull known as the sella turcica. Most individuals with empty sella syndrome do not have any associated symptoms, but the finding raises concerns about hormone deficiencies. Empty sella syndrome may occur as a primary disorder (idiopathic) or as a secondary disorder in which it occurs due to an underlying condition or disorder such as a treated pituitary tumor, head trauma, or a condition known as idiopathic intracranial hypertension (also called pseudotumor cerebri) during which elevated intracranial pressure causes empty sella syndrome. Here we present a case of 25 year married female having symptoms and signs of raised ICP and decreased secondary sexual characters with blood investigations showing hypothyroidism. Her MRI Brain showed features of raised intracranial pressure (ICP) suggestive of Idiopathic Intracranial Hypertension with partially empty sella. Patient was diagnosed as Idiopathic Intracranial Hypertension with partial empty Sella with hypothyroidism and hypogonadotrophic normogonadism secondary to raised ICP. Patient was treated with IV Mannitol, thyroxine was started according to weight and other supportive treatment. Patient consciousness improved and got better. Patient was discharged with follow up on oral acetazolamide, thyroxine and hormone replacement therapy.

Application value of ultrasonic measurement of optic nerve sheath diameter and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococcal meningitis / 重庆医学

Objective To explore the application value of ultrasonic measurement of optic nerve sheath diameter(ONSD)and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococ-cal meningitis.Methods A total of 27 patients with cryptococcal meningitis diagnosed by Chongqing Public Health Medical Center from February to July,2022 were included.All patients were examined with ultrasound measurement of ONSD and ultrasound measurement of cerebral blood flow of intracranial middle cerebral ar-tery(MCA),including peak systolic velocity(PSV),end diastolic velocity(EDV),peak systolic velocity/end diastolic velocity(S/D)and resistance index(RI),and then lumbar puncture was performed and intracranial pressure(ICP)was recorded.The ICP≥200 mmH2O was defined as the ICP increased group,ICP＜200 mmH2O was defined as the ICP normal group,and 17 AIDS patients without complications were selected as the control group.The baseline data,ONSD and MCA cerebral blood flow parameters of the three groups were compared,and the statistically significant indexes were correlated with ICP,and the receiver operating charac-teristic(ROC)curve of the subjects was drawn to analyze the diagnostic efficacy of ONSD value in predicting intracranial hypertension caused by AIDS cryptococcal meningitis.Results There were no significant differ-ences in gender,age,systolic blood pressure or diastolic blood pressure among the ICP increased group,the ICP normal group and the control group(P＞0.05).There were no significant differences in PSV,EDV,S/D and RI among the three groups of MCA(P＞0.05),but there was significant difference in ONSD among the three groups(P＜0.05).There was a positive correlation between ICP and ONSD in the patients with AIDS cryptococcal meningitis(P＜0.01,r=0.736).The ROC curve analysis showed that when the ONSD cutoff value was 3.965 mm,it predicted the highest efficacy of intracranial high pressure in the patients with AIDS cryptococcal meningitis.The area under the ROC curve was 0.90(95％CI:0.714-1.000,P=0.001),the sensitivity was 90％,and the specificity was 100％.Conclusion Ultrasonic measurement of ONSD can effec-tively predict ICP in patients with AIDS cryptococcal meningitis and guide clinical decompression measures in time,which is worthy of clinical application.

The influence of hemodialysis on intracranial pressure waveform in patients with chronic kidney disease: an observational study

ABSTRACT BACKGROUND: Among the complications related to chronic kidney disease (CKD), those of a neurological nature stand out, and for a better quality of life for patients, the diagnosis and treatment of these complications is fundamental. OBJECTIVES: This study aimed to assess the effect of hemodialysis on intracranial pressure waveform (ICPw) in patients with chronic kidney disease undergoing hemodialysis and those who are not yet undergoing substitutive therapy. DESIGN AND SETTING: An observational study was conducted in two stages at a kidney replacement therapy center in Brazil. The first was a longitudinal study and the second was a cross-sectional study. METHODS: Forty-two patients on hemodialysis were included in the first stage of the study. In the second stage, 226 participants were included. Of these, 186 were individuals with chronic kidney disease (who were not undergoing substitutive therapy), and 40 did not have the disease (control group). The participants' intracranial compliance was assessed using the non-invasive Brain4care method, and the results were compared between the groups. RESULTS: There was a significant difference between the hemodialysis and non-hemodialysis groups, with the former having better ICPw conditions. CONCLUSIONS: Hemodialysis influenced the improvement in ICPw, probably due to the decrease in the patients' extra-and intracellular volumes. Furthermore, ICPw monitoring can be a new parameter to consider when defining the moment to start substitutive therapy.

Endovascular Treatment of Idiopathic Intracranial Hypertension Secondary to Venous Stenosis / Tratamento endovascular da Hipertensão Intracraniana Idiopática Secundária à Estenose Venosa

Introduction Idiopathic intracranial hypertension (IIH) is a condition characterized by signs and symptoms of elevated intracranial pressure (ICP). Although the role of venous sinus stenosis in the pathophysiology of IIH is controversial, venous angioplasty with stenting has been proven to decrease cerebral venous pressure and intracranial pressure. This study aims to identify and quantify the clinical improvement obtained by patients with IIH, refractory to prior pharmacological treatment, undergoing endovascular venous angioplasty in a neuroendovascular reference service. Methods A retrospective analytical study of 25 cases of IIH with transverse sinus stenosis operated on in a reference service using the endovascular method, in which clinical data from medical records and information about the procedure were analyzed. Results Of the 25 patients, 22 were women, and the mean age was 42 years. All patients were refractory to prior clinical treatment. At the clinical presentation, all had headaches. There were no complications or failures from the procedures performed. In the 30-day evaluation, there was a significant decrease in all the symptoms reported. Conclusion Venous sinus stenting is safe and effective in patients with IIH with transverse sinus stenosis refractory to clinical treatment, with substantial symptomatic improvement and good evolution in the postoperative follow-up period.

Introdução A hipertensão intracraniana idiopática (HII) é uma condição caracterizada por sinais e sintomas de pressão intracraniana elevada (PIC). Embora o papel da estenose dos seios venosos na fisiopatologia da HII seja controverso, a angioplastia venosa com colocação de stent tem se mostrado eficaz na redução da pressão venosa cerebral e da pressão intracraniana. Este estudo visa identificar e quantificar a melhoria clínica obtida por pacientes com HII, refratários ao tratamento farmacológico prévio, submetidos à angioplastia venosa endovascular em um serviço de referência neuroendovascular. Métodos Um estudo analítico retrospectivo de 25 casos de HII com estenose do seio transverso operados em um serviço de referência utilizando o método endovascular, no qual foram analisados dados clínicos dos prontuários médicos e informações sobre o procedimento. Resultados: Dos 25 pacientes, 22 eram mulheres, com idade média de 42 anos. Todos os pacientes eram refratários ao tratamento clínico prévio. Na apresentação clínica, todos tinham cefaleia. Não houve complicações ou falhas nos procedimentos realizados. Na avaliação de 30 dias, houve uma diminuição significativa em todos os sintomas relatados. Conclusão A colocação de stent nos seios venosos mostrou-se segura e eficaz em pacientes com HII com estenose do seio transverso refratários ao tratamento clínico, com melhoria sintomática substancial e boa evolução no período de acompanhamento pós-operatório.

Monitoração da pressão intracraniana em cães e gatos: o que sabemos? / Intracranial pressure monitoring: what do we know? / Monitoreo de la presión intracraneal en perros y gatos: ¿qué sabemos?

Monitorar a pressão intracraniana (PIC) permite otimizar o tratamento de pacientes com diversas afecções, já que a hipertensão intracraniana (HIC) pode causar isquemia. A aferição da PIC pode ser realizada de maneira invasiva, que é o método mais acurado, mas requer a introdução de um sensor no ventrículo ou parênquima, o que pode causar hemorragia e infecção. Existem ainda diversos métodos não invasivos, que aliados aos parâmetros clínicos, podem ser utilizados como alternativa para avaliar a PIC. O uso de cateter ventricular, epidural e microtransdutores são descritos na veterinária como métodos invasivos, porém, nenhum deles é considerado padrão ouro em pequenos animais, mas presume-se que o uso de microtransdutores intraparenquimatosos seja o mais preciso. Dentre os métodos não invasivos, a mensuração do diâmetro da bainha do nervo óptico (DBNO), ressonância magnética, ultrassonografia (US) com doppler transcraniano e elasticidade óssea intracraniana foram relatados. Em gatos, o DBNO foi mensurado por US transpalpebral em animais saudáveis e com HIC presumida e mostrou ser um método viável. A monitoração da PIC não é rotineiramente usada na medicina veterinária, mas poderia guiar e otimizar o tratamento em diversas afecções, portanto, o objetivo desta revisão narrativa é descrever os métodos de monitoração da PIC em cães e gatos.(AU)

Monitoring intracranial pressure (ICP) allows for the optimization of treatment in patients with various conditions, as intracranial hypertension (ICH) can lead to ischemia. ICP measurement can be conducted invasively, which is the most accurate method, but it requires the introduction of a sensor into the ventricle or parenchyma, posing risks of hemorrhage and infection. Additionally, there are various non-invasive methods that, when combined with clinical parameters, can serve as alternatives for assessing ICP. The use of ventricular catheters, epidural catheters, and microtransducers is described in veterinary medicine as invasive methods; however, none are considered the gold standard in small animals, although the use of intraparenchymal microtransducers is presumed to be the most precise. Among non-invasive methods, measurement of the optic nerve sheath diameter (ONSD), magnetic resonance imaging, transcranial Doppler ultrasound, and intracranial bone elasticity have been reported. In cats, ONSD has been measured via transpalpebral ultrasound in healthy animals and those with presumed ICH, proving to be a viable method. While ICP monitoring is not routinely employed in veterinary medicine, it could guide and optimize treatment for various conditions. Therefore, the aim of this narrative review is to describe the methods of ICP monitoring in dogs and cats.(AU)

Monitorear la presión intracraneal (PIC) permite optimizar el tratamiento de pacientes con diversas afecciones, ya que la hipertensión intracraneal (HIC) puede causar isquemia. La medición de la PIC puede realizarse de manera invasiva, que es el método más preciso, pero requiere la introducción de un sensor en el ventrículo o parénquima, lo que puede causar hemorragia e infección. Existen también diversos métodos no invasivos que, combinados con parámetros clínicos, pueden utilizarse como alternativa para evaluar la PIC. El uso de catéteres ventriculares, epidurales y microtransductores se describe en la medicina veterinaria como métodos invasivos; sin embargo, ninguno de ellos se considera el estándar de oro en pequeños animales, aunque se presume que el uso de microtransductores intraparenquimatosos sea el más preciso. Entre los métodos no invasivos, se han reportado la medición del diámetro de la vaina del nervio óptico (DVNO), la resonancia magnética, la ecografía (US) con doppler transcraneal y la elasticidad ósea intracraneal. En gatos, se ha medido el DVNO por ecografía transpalpebral en animales sanos y con HIC presumida, demostrando ser un método viable. La monitorización de la PIC no se utiliza de manera rutinaria en la medicina veterinaria, pero podría guiar y optimizar el tratamiento en diversas afecciones. Por lo tanto, el objetivo de esta revisión narrativa es describir los métodos de monitorización de la PIC en perros y gatos.(AU)

Decompressive Craniectomy in Extensive Ischemic Stroke. An Experience in a Single Institution / Craniectomia descompressiva no acidente vascular cerebral isquêmico extenso. Uma experiência em uma única instituição

Introduction Decompressive craniectomy (DC) is a valuable treatment for reducing early lethality in malignant intracranial hypertension (IH); however, it has been shown that the decision to implement DC in patients with extensive ischemic stroke should not be based solely on the detection of IH with the use of intracranial pressure (ICP) devices. Objective To establish the usefulness of DC in patients with extensive ischemic stroke who came to the emergency room during the period between May 2018 and March 2019. Methods This was an analytical, prospective, and longitudinal study whose population corresponded to all patients with a diagnosis of extensive ischemic stroke. Results The sample consisted of 5 patients, of which 3 were female and 2 males, the average age was 62.2 years old (minimum 49 years old, maximum 77 years old). Of all the patients who underwent DC, it was found that 80% of the patients did not present an increase in intracranial pressure. Decompressive craniectomy was not performed in a case that responded adequately to medical treatment. The mean values of ICP were 25 mmHg with a minimum value of 20 mmHg and a maximum value of 25 mmHg; in patients with a moderate value, the ICP averages were < 20 mmHg. The mortality was of 40% (RANKIN of 6 points). Conclusions Decompressive craniectomy is useful in extensive ischemic stroke. The decision to implement DC in patients with extensive stroke rests on clinicoradiological parameters. The monitoring of the IPC was not particularly useful in the early detection of the neurological deterioration of the patients studied.

Fundamento A craniectomia descompressiva (CD) é um tratamento valioso para reduzir a letalidade precoce na hipertensão intracraniana (HI) maligna; no entanto, foi demonstrado que a decisão de implementar a CD em pacientes com acidente vascular cerebral (AVC) isquêmico extenso não deve ser baseada apenas na detecção de HI com o uso de dispositivos de pressão intracraniana (PIC). Objetivo Estabelecer a utilidade da CD em pacientes com AVC isquêmico extenso que chegaram ao pronto-socorro no período entre maio de 2018 e março de 2019. Métodos Foi realizado um estudo analítico, prospectivo e longitudinal cuja população correspondeu a todos os pacientes com diagnóstico de AVC isquêmico extenso. Resultados A amostra foi composta por 5 pacientes, sendo 3 do sexo feminino e 2 do sexo masculino, com média de idade de 62,2 anos (mínimo 49 anos, máximo 77 anos). De todos os pacientes que realizaram CD, verificou-se que 80% dos pacientes não apresentaram aumento da pressão intracraniana. Não foi realizada uma CD que tenha respondido adequadamente ao tratamento médico. Os valores médios de pressão intracraniana foram de 25 mmHg, com o valor mínimo de 20 mmHg e o valor máximo de 25 mmHg; em pacientes com escala moderada, as médias de PIC foram < 20 mm Hg. A mortalidade foi de 40% (RANKIN de 6 pontos). Conclusões A DC é útil no AVC isquêmico extenso. A decisão de implementar uma CD em pacientes com AVC extenso depende de parâmetros clínico-radiológicos. O monitoramento do PCI não foi muito útil na detecção precoce da deterioração neurológica dos pacientes estudados.

Optic nerve sheath diameter as a non-invasive indicator of intracranial hypertension in traumatic brain injury: correlation with CT head and prognostic implications

Background: Ultrasound guided measurement of optic nerve sheath diameter (ONSD) is an emerging non invasive bedside tool that is being used to detect raised intracranial pressure (ICP) in patients with traumatic brain injury(TBI). Early detection of raised ICP can guide in the timely management of such patients with raised ICP due to TBI. Methods: A prospective, observational, open labelled study planned with a 30 patients of TBI of both genders, aged between 18 to 70 years. ONSD readings were taken 3 times a day for three days from the time of admission with portable SonoSite ultrasound machine. Data was expressed as mean ±standard deviation. Values were compared using T test and P value was calculated. Results: Highest reading recorded in patients with GCS <8 was 6.26±0.73 in comparison to 5.38±0.56 (p=0.001) in patients with GCS >8. Highest reading of ONSD correlating with a positive CT finding at admission was 6.22±.81 and was 5.46±.57 (p=0.006) in patients with negative findings on CT. ROC curve with average cut off of 6 mm correlated with positive CT findings with sensitivity of 80%, specificity of 70% and negative predictive value of 87% was found. Conclusions: Ultrasound-guided ONSD monitoring shows promise for diagnosing intracranial hypertension in traumatic brain injury. Correlations with CT, GCS, and outcomes emphasize its clinical relevance, warranting further validatio.

Optic nerve sheath fenestration: A second lease at sight

Purpose: To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods: Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results: Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was ?1.9789 ± 1.46270, which improved to ?0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from ?1.3378 ± 1.50107 to ?1.0667 ± 1.33813 (p < 0.05). Conclusion: Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.

The use of noninvasive measurements of intracranial pressure in patients with traumatic brain injury: a narrative review / Avaliação não invasiva da pressão intracraniana em pacientes com traumatismo cranioencefálico: uma revisão narrativa

Abstract Background The most frequent cause of death in neurosurgical patients is due to the increase in intracranial pressure (ICP); consequently, adequate monitoring of this parameter is extremely important. Objectives In this study, we aimed to analyze the accuracy of noninvasive measurement methods for intracranial hypertension (IH) in patients with traumatic brain injury (TBI). Methods The data were obtained from the PubMed database, using the following terms: intracranial pressure, noninvasive, monitoring, assessment, and measurement. The selected articles date from 1980 to 2021, all of which were observational studies or clinical trials, in English and specifying ICP measurement in TBI. At the end of the selection, 21 articles were included in this review. Results The optic nerve sheath diameter (ONSD), pupillometry, transcranial doppler (TCD), multimodal combination, brain compliance using ICP waveform (ICPW), HeadSense, and Visual flash evoked pressure (FVEP) were analyzed. Pupillometry was not found to correlate with ICP, while HeadSense monitor and the FVEP method appear to have good correlation, but sensitivity and specificity data are not available. The ONSD and TCD methods showed good-to-moderate accuracy on invasive ICP values and potential to detect IH in most studies. Furthermore, multimodal combination may reduce the error possibility related to each technique. Finally, ICPW showed good accuracy to ICP values, but this analysis included TBI and non-TBI patients in the same sample. Conclusions Noninvasive ICP monitoring methods may be used in the near future to guide TBI patients' management.

Resumo Antecedentes A causa mais frequente de morte em pacientes neurocirúrgicos é devido ao aumento da pressão intracraniana (PIC); consequentemente, o monitoramento adequado desse parâmetro é de extrema importância. Objetivos Avaliar na literatura científica os principais métodos não invasivos de medida da PIC em pacientes com traumatismo cranioencefálico (TCE). Métodos Os dados foram obtidos na base de dados PubMed, utilizando os seguintes termos: pressão intracraniana, não invasivo, monitoramento, avaliação e medida, resultando em 147 artigos. Os artigos selecionados datam de 1980 a 2021, sendo todos estudos observacionais ou ensaios clínicos, em inglês e especificando a medida da pressão intracraniana em traumatismo cranioencefálico. Ao final da seleção, 21 artigos foram incluídos nesta revisão. Resultados Foram analisados os seguintes métodos: diâmetro da bainha do nervo óptico (ONSD), pupilometria, doppler transcraniano (TCD), combinação multimodal, complacência cerebral por meio da análise de ondas intracerebrais (ICPW), HeadSense e visual evocado por flashes de luz (FVEP). A pupilometria não se correlacionou com os valores de PIC, enquanto que o monitor HeadSense e o método FVEP parecem ter uma boa correlação, mas os dados de sensibilidade e especificidade desses métodos não estão disponíveis. Os métodos ONSD e TCD mostraram acurácia de boa a moderada quanto aos valores de IPCi, além de bom potencial para detectar hipertensão intracraniana. Ademais, a combinação multimodal pode reduzir a possibilidade de erro relacionado a cada técnica. Por fim, o ICPW apresentou boa acurácia quanto aos valores de ICPi, mas, no estudo analisado, foram incluídos pacientes com e sem TCE em uma mesma amostra. Conclusões Métodos não invasivos de medição da PIC podem atuar no futuro no manejo de pacientes com TCE como uma potencial ferramenta de triagem para TCE grave e para a detecção de hipertensão intracraniana.

CLINICAL PROFILE IN PATIENTS WITH CEREBRAL VENOUS SINUS THROMBOSIS IN TERTIARY CARE HOSPITAL: A CROSS SECTIONAL STUDY

CVST often creates challenges regarding diagnosis among physicians, due to the nonspeci?c symptoms and countless presentation and absence of uniform symptoms. This study aims to understand current knowledge about CSVT including its pathogenesis, etiogenesis, clinical profile, diagnosis, and treatment. A Methods: descriptive cross-sectional study was conducted in the department of neurology at tertiary care hospital, Mumbai between January, 2021 and June 2022. This study was approved by institutional ethics committee. All patients who were more than 18 years with diagnosis of cerebral venous sinus thrombosis, admitted to critical care unit of neurology department were included in this study and those with bleeding disorder and prior anticoagulation therapy, already diagnosed with CVST were excluded. CVST was 3 times more common in females than in m Results: ales and the age group of 21 to 30 years was more common affected. Headache was the most common symptom seen and papilledema was the most common sign. In females puerperium was the main cause of CVST. Superior sagittal sinus and right transverse sinus were the most common sinuses involved as seen on Computed tomography(CT)venography/Magnetic resonance venography(MRV)and common finding was venous infarct. The mortality rate was 16%. Patients with Isolated intracranial hypertension syndrome(ICH) had good outcome. Variables like age ?35 years, GCS score of <8 and coma at presentation were associated with poor prognosis. CVST has a wide range of cli Conclusion nical presentation. The prognosis is good in CVST but early diagnosis with treatment and care is required in patients with poor prognostic factors.

Efectos cerebrales del oxígeno y el dióxido de carbono en el síndrome de dificultad respiratoria aguda / Cerebral Effects of Oxygen and Carbon Dioxide in Acute Respiratory Distress Syndrome

Introducción: El síndrome de dificultad respiratoria aguda producido por la COVID-19 provoca alteraciones en el intercambio de oxígeno y la excreción de dióxido de carbono con consecuencias neurológicas. Objetivo: Describir las implicaciones del oxígeno y el dióxido de carbono sobre la dinámica cerebral durante el tratamiento ventilatorio del síndrome de dificultad respiratoria aguda en el accidente cerebrovascular. Métodos: Se realizó una búsqueda en bases referenciales como: PubMed/Medline, SciELO, Google Académico y BVS Cuba. Los términos incluidos fueron brain-lung crosstalk, ARDS, mechanical ventilation, COVID-19 related stroke, ARDS related stroke y su traducción al español. Fueron referenciados libros de neurointensivismo y ventilación mecánica artificial. El período de búsqueda incluyó los últimos 20 años. Se seleccionaron 46 bibliografías que cumplieron con los criterios de selección. Resultados: Se ha descrito que los niveles de oxígeno y dióxido de carbono participan en la neurorregulación vascular en pacientes con daño cerebral. Algunas alteraciones alusivas son la vasodilatación cerebral refleja o efectos vasoconstrictores con reducción de la presión de perfusión cerebral. Como consecuencia aumenta la presión intracraneal y aparecen afectaciones neurocognitivas, isquemia cerebral tardía o herniación del tronco encefálico. Conclusiones: El control de la oxigenación y la excreción de dióxido de carbono resultaron cruciales para mantener la homeostasis neuronal, evita la disminución de la presión de perfusión cerebral y el aumento de la presión intracraneal. Se sugiere evitar la hipoxemia e hiperoxemia, limitar o eludir la hipercapnia y usar hiperventilación hipocápnica solo en condiciones de herniación del tallo encefálico(AU)

Introduction: The acute respiratory distress syndrome produced by COVID-19 causes alterations in the exchange of oxygen and the excretion of carbon dioxide with neurological consequences. Objective: To describe the implications of oxygen and carbon dioxide on brain dynamics during ventilatory treatment of acute respiratory distress syndrome in stroke. Methods: A search was carried out in referential bases such as PubMed/Medline, SciELO, Google Scholar and VHL Cuba. The terms included were brain-lung crosstalk, ARDS, mechanical ventilation, COVID-19 related stroke, ARDS related stroke and their translation into Spanish. Books on neurointensive care and artificial mechanical ventilation were referenced. The search period included the last 20 years. Forty six bibliographies that met the selection criteria were selected. Results: Oxygen and carbon dioxide levels have been described to participate in vascular neuroregulation in patients with brain damage. Some allusive alterations are reflex cerebral vasodilatation or vasoconstrictor effects with reduced cerebral perfusion pressure. As a consequence, intracranial pressure increases and neurocognitive impairments, delayed cerebral ischemia or brainstem herniation appear. Conclusions: The control of oxygenation and the excretion of carbon dioxide were crucial to maintain neuronal homeostasis, avoiding the decrease in cerebral perfusion pressure and the increase in intracranial pressure. It is suggested to avoid hypoxemia and hyperoxemia, limit or avoid hypercapnia, and use hypocapnic hyperventilation only in conditions of brainstem herniation(AU)

Identifying the risk factors for intracranial herniation in patients with cerebral venous thrombosis / Identificação dos fatores de risco para herniação intracranial em pacientes com trombose venosa cerebral

Abstract Background Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important. Objective This study aims to determine the risk factors for intracranial herniation in patients with CVST. Methods A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study. Results Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 ± 13.23 and 44.13 ± 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages. Conclusion This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy.

Resumo Antecedentes A trombose do seio venoso cerebral (CVST) não é tão bem compreendida como um acidente vascular cerebral isquémico de origem arterial. Embora o prognóstico de CVST seja geralmente bom lesões parenquimatosas podem ocorrer em alguns pacientes e o desenvolvimento de herniação intracraniana pode resultar em morte. Por esse motivo é importante reconhecer os fatores de risco para hérnia intracraniana e determinar com precisão os pacientes que devem ser submetidos à craniectomia descompressiva. Objetivo Este estudo tem como objetivo determinar os fatores de risco para herniação intracraniana em pacientes com CVST. Métodos Um total de 177 pacientes diagnosticados com CVST entre 2015 e 2021 em nosso centro terciário foram retrospectivamente incluídos neste estudo. Resultados Dos 177 pacientes 124 eram do sexo feminino e 53 do masculino com média de idade de 40 65 ± 13 23 e 44 13 ± 17 09 respectivamente. Destes 18 pacientes desenvolveram hérnia intracraniana. Uma relação estatística significativa foi observada entre trombose do seio sagital superior trombose do seio reto escore de colateral venosa infarto venoso não hemorrágico presença de malignidade pequena hemorragia justacortical e trombose da veia cortical. Os resultados da análise de regressão logística binária mostraram que as variáveis mais significativas foram o escore colateral venoso de 0 malignidade e pequenas hemorragias justacorticais. Conclusão Este estudo identificou pequenas hemorragias justacorticais a presença de malignidade e um escore colateral venoso de 0 como fatores de risco independentes para herniação intracraniana em pacientes CVST. Com base nesses resultados recomendamos uma observação clínica rigorosa dos pacientes CVST pois eles podem ser candidatos à craniectomia descompressiva.

Síndrome de hipertensión intracraneana como manifestación inhabitual del síndrome de Sjögren. Caso clínico / Intracranial hypertension syndrome as an unusual manifestation of Sjögren's syndrome. Report of one case

Neurological manifestations such as polyneuropathy are reported in 8-49% of cases with Sjögren's Syndrome (SjS), but central nervous system involvement is seldom described. We report a 46-year-old woman with a history of SjS with distal renal tubular acidosis and autoimmune thyroiditis. She consulted in the emergency room for a five-days history of holocranial headache and explosive vomiting. Fundoscopy showed bilateral papilledema. Brain computed tomography (CT) without contrast showed diffuse encephalic edema, with effacement ofsulci and restriction ofperitruncal cisterns. Brain AngioCT ruled out thrombosis, and brain magnetic resonance (MRI) was without structural alterations or hydrocephalus. Lumbar puncture had increased cerebrospinal fluid output pressure but without cytochemical alterations, and negative gram, cultures and filmarray. The diagnosis of Intracranial Hypertension Syndrome (ICHTS) ofprobable autoimmune etiology in the context of SjS was proposed, and management with high-dose corticosteroids was initiated with favorable clinical and imaging response.

Summary of the best evidence for intracranial hypertension care in adults with severe brain injury / 中国实用护理杂志

Objective:To summarize the best evidence of intracranial hypertension nursing for adult patients with severe brain injury, and to provide reference for clinical nursing practice.Methods:According to the evidence-based methodology, a systematic search of Chinese and English literature on intracranial hypertension nursing of adult patients with severe brain injury was conducted in domestic and foreign databases such as CNKI, Wanfang, PubMed, Cochrane Library and Cinahl Plus and so on, as well as related guide websites and professional association websites from the establishment of database to August 2022. Two researchers independently evaluated literature quality and screened evidence, and then the project team summarized and concluded the evidence.Results:A total of 6 009 articles were obtained through preliminary search, and 33 articles were included after screening, including 13 guidelines, 1 systematic review, 17 expert consensus, 1 evidence summary, and 1 meta-analysis. In total, 33 pieces of best evidence were obtained from 8 dimensions, including intracranial pressure related threshold, assessment and monitoring, respiratory care, circulation care, analgesic and sedative care, temperature care, nutrition care and cerebrospinal fluid care.Conclusions:This study summarizes the evidence-based basis of intracranial hypertension nursing in adult patients with severe brain injury, which provides a basis for the standardized construction of clinical nursing strategies and empirical research.

Recognition and progress of idiopathic intracranial hypertension / 中国医师杂志

Idiopathic intracranial hypertension (IIH) is a syndrome of unexplained increased intracranial pressure with normal cerebrospinal fluid and without organic brain lesions. The etiology and pathogenesis of IIH remain unclear, and IIH patients may develop irreversible visual impairment. At present, there are no guidelines and expert consensus on diagnosis and treatment of IIH in China. This review aims to introduce the pathogenesis, diagnosis and treatment of IIH, in order to help clinicians improve their understanding of the disease and to identify, diagnose and treat IIH as early as possible, and improve the prognosis of patients.

Research progress in the pathogenesis, diagnosis and treatment for posttraumatic acute diffuse brain swelling / 中华创伤杂志

Posttraumatic acute diffuse brain swelling (PADBS) is a relatively common severe traumatic brain injury (TBI). Since it can lead to acute intracranial hypertension in a short time, the illness can be acute and critical, with a high disability and fatality rate. The pathogenesis of PADBS is still unclear, with the current theory consisting of acute cerebral vasodilation, cerebral edema and intracranial venous circulation disorder. For PADBS, there is still a lack of unified diagnostic criteria, and the indications and timing of decompression craniectomy remain controversial. The authors review the research progress in the pathogenesis, diagnosis and treatment of PADBS, hoping to provide some new ideas for its treatment.

Mechanism of action of oxidative stress in severe traumatic brain injury and its complications: recent progress / 中华创伤杂志

Severe traumatic brain injury (sTBI) is characterized by critical condition, high lethality and poor prognosis. Its development and progression will lead to the damage and death of a large number of nerve cells, eventually causing a series of serious complications. The current treatments of sTBI and its complications are not optimistic due to problems such as unclear mechanism of action, challenges in treatment, and lack of effective prevention strategies. In recent years, more research evidences have shown that oxidative stress plays an important role in the development and progression of sTBI and its related complications. Therefore, it is of great significance to clarify the relationship of oxidative stress with sTBI and its complications and to understand the way of oxidative stress participating in the development and progression of sTBI. However, relevant researches are scattered and there lacks comprehensive and systematic summaries of oxidative stress participating in sTBI and its related complications. To this end, the authors reviewed the progress of the mechanism by which oxidative stress involves in sTBI and its complications, hoping to provide references for the research, treatment and prevention of sTBI.