Clinical, Demographic, and Radiological Characteristics of Patients Demonstrating Antibodies Against Myelin Oligodendrocyte Glycoprotein

Background: Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims: To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design: Multicenter, retrospective, observational study. Methods: Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayis University's Faculty of Medicine were included in the study. Results: Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion: For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

Clinical and demographic characteristics of late-onset multiple sclerosis: LOMS-TR study.

OBJECTIVES: Multiple sclerosis (MS), which is known as a young-adult age disease, is called late-onset MS (LOMS) when it occurs at the age of 50 and older. In our study, we aimed to analyse the clinical and demographic characteristics, comorbidities, diagnostic and treatment challenges and prognosis of LOMS. METHODS: In a retrospective analysis of 136 patients diagnosed with multiple sclerosis (MS) after the age of 50, based on the 2017 McDonald criteria, and who were under observation in eight distinct MS centers across Turkey; demographic information, clinical characteristics of the disease, oligoclonal band (OCB) status, initial and current Expanded Disability Status Scale (EDSS) values, administered treatments, and the existence of spinal lesions on magnetic resonance imaging (MRI) were investigated. RESULTS: The mean age of the 136 patients was 60.96±6.42 years (51-79), the mean age at diagnosis was 54.94±4.30 years, and 89 (65.4 %) of the patients were female. Most of the cases, 61.1 % (83) had at least one comorbidity. In 97 patients who underwent lumbar puncture (LP), OCB positivity was observed in 63.6 %. In 114 patients (83.8 %), spinal lesions were detected on MRI. Eighty-seven patients had relapsing-remitting MS (RRMS) (64 %), 27 patients had secondary progressive MS (SPMS) (19.9 %), and 22 patients had primary progressive MS (PPMS) (16.2 %). The mean EDSS at the time of diagnosis was 2.44±1.46, and the mean current EDSS was 3.15±2.14. CONCLUSIONS: In LOMS patients, the rates of delay in the diagnostic process, treatment disruption and progressive disease are higher than in the general MS population. The high rates of LP applying and OCB positivity of this study may indicate the habit of looking for clear evidences in advanged age in our country. This situation and comorbidities may cause a delay in diagnosis and eliminates the window of opportunity for early diagnosis. Although the high number of spinal lesions is a known marker for progressive disease, it is an issue that needs to be discussed whether the increased frequency of progressive course at older ages is due to the nature of the disease or immune aging itself.

Epilepsy's effect on cardiac rhythm and the autonomic nervous system.

OBJECTIVE: Sudden unexpected death in epilepsy is the most common cause of death in young patients with epilepsy. The aim of this study was to evaluate changes in interictal electrocardiogram parameters and sympathetic skin responses as markers of autonomic dysfunction in patients with epilepsy and to determine their effects on the type and duration of epilepsy, frequency of seizures, and responses to treatment. METHODS: A total of 97 patients with epilepsy and 94 healthy controls were recruited. We recorded their clinical and demographic characteristics and analyzed sympathetic skin response latency and amplitude, electrocardiogram recordings, and seven cardiac rhythm parameters: P-wave duration, PR segment, QRS duration, QT interval, QT interval distribution, Tpe duration, and Tpe/QT interval ratio. RESULTS: P-wave durations, T-wave durations, QT and QT interval durations, and Tpe and sympathetic skin response latency were significantly longer among patients with epilepsy than the controls, and their heart rate was significantly lower. However, sympathetic skin response latency and heart rate were negatively correlated, and T-wave duration, QT duration, QT interval duration, and Tpe were positively correlated. CONCLUSION: Our results from interictal electrocardiograms indicate clinically significant arrhythmias among patients with epilepsy and the correlation of such arrhythmias with sympathetic skin responses. Thus, noninvasive tests that evaluate the autonomic system should be used to predict the risk of sudden unexpected death in epilepsy among patients with epilepsy.

Epilepsy's effect on cardiac rhythm and the autonomic nervous system

SUMMARY OBJECTIVE: Sudden unexpected death in epilepsy is the most common cause of death in young patients with epilepsy. The aim of this study was to evaluate changes in interictal electrocardiogram parameters and sympathetic skin responses as markers of autonomic dysfunction in patients with epilepsy and to determine their effects on the type and duration of epilepsy, frequency of seizures, and responses to treatment. METHODS: A total of 97 patients with epilepsy and 94 healthy controls were recruited. We recorded their clinical and demographic characteristics and analyzed sympathetic skin response latency and amplitude, electrocardiogram recordings, and seven cardiac rhythm parameters: P-wave duration, PR segment, QRS duration, QT interval, QT interval distribution, Tpe duration, and Tpe/QT interval ratio. RESULTS: P-wave durations, T-wave durations, QT and QT interval durations, and Tpe and sympathetic skin response latency were significantly longer among patients with epilepsy than the controls, and their heart rate was significantly lower. However, sympathetic skin response latency and heart rate were negatively correlated, and T-wave duration, QT duration, QT interval duration, and Tpe were positively correlated. CONCLUSION: Our results from interictal electrocardiograms indicate clinically significant arrhythmias among patients with epilepsy and the correlation of such arrhythmias with sympathetic skin responses. Thus, noninvasive tests that evaluate the autonomic system should be used to predict the risk of sudden unexpected death in epilepsy among patients with epilepsy.

Multi-inflammatory index as a new predictive and prognostic marker of acute symptomatic seizures in patients with cerebral venous sinus thrombosis.

BACKGROUND: The multi-inflammatory index (MII) is a novel marker that indicates the diagnosis, prognosis, and clinical severeness of inflammation-associated diseases. It is indicated that inflammatory biomarkers may help predict the occurrence of acute symptomatic seizures(ASS) after ischemic stroke. OBJECTIVE: Our goal was to search the predictive and prognostic capability of the MII-1 and MII-2 for ASS in cerebral venous sinus thrombosis (CVST) patients. METHOD: 91 patients with CVST were retrospectively analyzed from the medical records of patients between 2010 and 2023 and divided into the ASS group and non-ASS group. The MII-1 and MII-2 levels on admission, demographic and clinic features, predisposing risk factors, radiological characteristics involving thrombotic cerebral veins, and the type of parenchymal lesions were documented. Modified Rankin Scale (mRS) on admission and at the 3rd month were evaluated to determine the disability. RESULTS: MII-1 and MII-2 were statistically significantly higher in the ASS group and predictors for the occurrence of seizures with CVST in multivariate analysis. The area under the curve (AUC) of the receiver operating characteristics (ROC) curve for MII-1 was 0.791 (95 %CI = 0.691-0.891, p < 0.001), and AUC for MII-2 was 0.761 (95%CI = 0.660-0.861, p < 0.001). When the clinical variables that were included in the multivariate analysis and MII-1 and MII-2 were combined, the predictive power was greater with the AUC of 0.959. A significant positive correlation was found between mRS at the 3rd month and MII-1 and MII-2 in the ASS group. CONCLUSION: MII-1 and MII-2 can be used as new predictive and prognostic markers of ASS in patients with CVST.

The relationship between sleep disorders with patients' demographic-clinical characteristics and quality of life in patients with multiple sclerosis.

OBJECTIVES: In this study, the effect of sleep disturbance on the quality of life in MS patients and its relationship between demographic and clinical characteristics of the patients were investigated. METHODS: 67 MS patients and 51 healthy individuals were included in our study. The patient group consisted of 43 women and 24 men. The control group consisted of 32 women and 19 men. Demographic and clinical characteristics of the patients; age, gender, duration of illness, annual number of attacks, treatments, and medical history were recorded and neurological examinations of all patients were performed and disability was determined for each patient with Kurtzke's expanded disability status scale (EDSS). Evaluations were made using demographic data, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Expanded Disability Status Scale (EDSS), Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Berlin Questionnaire and Multiple Sclerosis Quality of Life (MSYK) - 54 Instrument. RESULTS: We found that the quality of life was significantly impaired in MS patients compared to healthy controls (p < 0.001). And we found that this was related to the presence of progressive MS and chronic fatigue among the clinical features of the patient, sleep-disordered breathing among sleep disorders, poor sleep quality, comorbid anxiety and depression (p = 0.001, p:0.009, p = 0.022, p = 0.007, p < 0.001 and p = 0.001, respectively). CONCLUSION: All these findings show that sleep disorders in patients with MS are a condition that should be questioned and treated in the follow up of the disease, otherwise it may affect the quality of life of patients negatively.

COVID-19 and post-poliomyelitis syndrome: coincidence?

Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel virus, many central and peripheral nervous system manifestations associated with coronavirus disease-19 (COVID-19) infection have been reported. Beyond the neurologic manifestations, we may still have much to learn about the neuropathologic mechanism of SARS-CoV-2 infection. Here we report a case of post-poliomyelitis syndrome (PPS) related to COVID-19 and attempt to predict the possible pathophysiologic mechanism behind this association.

Interleukin-33 and oxidative stress in epilepsy patients.

OBJECTIVE: Inflammation and oxidative stress plays an important role in the etiology of epilepsy. Interleukin-33 (IL-33), a new member of the cytokine family associated with interleukin-1 (IL-1), has been found to play a role in pathogenesis of central nervous system diseases and cause the production of proinflammatory cytokines and oxidative stress molecules. Our aim was to investigate IL-33 and oxidative stress values (total antioxidant capacity (TAS), total oxidant capacity (TOS), and oxidative stress index (OSI)) in patients with epilepsy and to evaluate their relationship with each other. METHODS: The study included 60 patients with epilepsy and 35 healthy controls. The group of patients with epilepsy consisted of 21 patients with treatment-resistant epilepsy and 39 patients with well-controlled epilepsy. The patients with epilepsy were also classified as monotherapy and polytherapy group according to the number of antiepileptic drugs they used, and focal and generalized epilepsy group according to the seizure type. Serum IL-33, TAS, TOS and OSI levels were measured in the patients with epilepsy and the control group. RESULTS: The mean serum TAS level was significantly lower in the all patients with epilepsy group compared to the control group, and the mean serum IL-33, TOS, and OSI levels were significantly higher. The mean serum TOS and OSI levels were significantly lower and TAS levels were significantly higher in the patients with well-controlled epilepsy than the patients with treatment-resistant epilepsy. While there was a positive correlation between serum IL-33 and OSI levels in the all patients with epilepsy group, a negative correlation was shown between IL-33 and TAS levels. CONCLUSION: The IL-33/ST2 pathway may represent a new promising therapeutic strategy both for the treatment and the prevention of the disease.

Positive effects of ocrelizumab in patients with familial mediterranean fever and coexistent multiple sclerosis.

OBJECTIVES: This study aims to evaluate the effects of ocrelizumab (OCZ) on familial Mediterranean fever (FMF) attacks in multiple sclerosis (MS) patients with FMF (MS+FMF patients). PATIENTS AND METHODS: This retrospective observational study included 11 patients (2 males, 9 females; mean age 46.6±9.2; range, 22 to 55 years) with MS+FMF hospitalized between January 2016 and July 2019. Demographic, clinical, and laboratory parameters and patient reported outcomes were analyzed in patients treated with OCZ for 18 months. RESULTS: Combining OCZ with colchicine in MS+FMF patients significantly reduced the frequency of FMF attacks (p=0.003) and the frequency of joint attacks (p=0.002). Consistent with the clinical improvement, the maximum serum C-reactive protein levels were significantly decreased after combination therapy compared to before combination therapy (p=0.003). MS+FMF patients reported that FMF disease activity improved after OCZ therapy (Visual Analog Scale [VAS] 74±9.6 vs. VAS 46.5±8.1 mm, p=0.003). CONCLUSION: Ocrelizumab therapy led to a prominent decrease in the frequency of FMF attacks, alleviated functional impairment, and improved quality of life in MS+FMF patients.

MS and COVID-19 challenge: asymptomatic COVID-19 infection during treatment with cladribine.

BACKGROUND: The use of disease-modifying therapies (DMTs) in people with multiple sclerosis (pwMS) may affect COVID-19 infection outcomes due to DMTs' immunomodulatory and immunosuppressive effects on immune response. The yet unknown issues are both the early response to the infection, as well as the post-infection development of immunity against the virus under these treatments due to their interaction with the immune system. METHODS: We report two asymptomatic cases of COVID-19 in patients with relapsing-remitting multiple sclerosis (RRMS) shortly after starting cladribine therapy, both developed anti-SARS-CoV-2 antibody response. RESULTS: Patients with MS who are under newly initiated treatment with cladribine tablets may experience an asymptomatic COVID-19 infection and they may develop immunity against SARS-CoV-2. CONCLUSION: These observations raise the probability that DMTs with immunosuppressive effects, such as cladribine, may be considered as a treatment option for selected MS patients with high disease activity during the COVID-19 pandemic.

The Relationship Between Clinico-Pathological Properties and p-Glycoprotein Expression in Hippocampal Sclerosis Among Patients with Mesial Temporal Lobe Epilepsy Who Undergo Selective Amygdalohippocampectomy Operation.

INTRODUCTION: The overproduction of the efflux transporters in the blood-brain barrier is considered to play a role in the development of drug resistance in mesial temporal lobe epilepsy (MTLE) patients. The aim of the present study was to investigate the relationship of clinical features of patients with MTLE accompanied by hippocampal sclerosis (HS) and the p-glycoprotein (p-gp) expression and neuronal loss in the hippocampus. METHODS: This study included a total of 33 patients who underwent selective amygdala-hippocampectomy operation. A detailed medical history of each patient, including age, side of HS, sex, age of habitual seizure onset, duration of habitual seizures, type and age of initial precipitating injury, presence and duration of latent period, presence and duration of silent period, monthly seizure frequency within 1 year prior to operation, mean age at the time of operation was evaluated retrospectively. RESULTS: The p-gp expression was significantly higher in the patient group with a seizure frequency of more than 15 days per month and a disease duration of more than 20 years. There was no significant difference between the p-gp expression and the clinical features of the MTLE-HS patients. CONCLUSION: These results suggest that p-gp expression is affected by disease duration and seizure frequency rather than a patient's clinical and pathological properties. In patients with HS-MTLE, potential use of the p-gp inhibitors as additional therapy and developing novel drugs not carried by multidrug carriers expressed in blood-brain barrier should be regarded as the new treatment targets.

The Serum Prolidase Enzyme Activity as a Biomarker for Evaluation of the Subclinical Vascular Damage in Children with Epilepsy.

BACKGROUD: Epilepsy is a chronic medical condition requiring long term or even lifelong therapy. Various researches have shown that epilepsy patients have vascular risk factors such as abnormal lipids, insulin, elevated oxidative stress, chronic inflammation, and subclinical atherosclerosis. OBJECTIVES: The purpose of the present study was to determine serum prolidase enzyme activity as a biomarker in children taking antiepileptic drug treatment through comparison with control cases. MATERIALS AND METHODS: The present study group consists of 61 children (20 females, 41 males) with epilepsy and a control group was formed of 32 healthy individuals (14 females, 18 males). Aspectrophotometric method was used to measure serum prolidase enzyme activity. RESULTS: The epilepsy group demonstrated statistically significantly higher prolidase enzyme activity values when compared with the control group (P = 0.003). It was measured that the serum TOS and OSI values were significantly elevated in patients with epilepsy compared to controls (P < 0.001). However, serum TAS values were significantly lower in the epilepsy group than in the control group (P = 0.032). CONCLUSIONS: These results supported that epileptic patients taking the antiepileptic treatment had increased serum prolidase enzyme activity, suggesting that it may show an increased risk of subclinical vascular damage related to both chronic inflammation and fibrotic process associated with degenerated collagen turnover. Therefore, serum prolidase enzyme activity could be considered a useful biomarker for evaluation of the subclinical vascular damage in children with epilepsy on some antiepileptic drugs.

An investigation on the effects of carbamazepine and sodium valproate on neuromuscular transmission.

The aim of this study was to investigate the effects of sodium valproate (SV) and carbamazepine (CBZ) on neuromuscular transmission using single-fibre electromyography (SFEMG) in patients with epilepsy. We performed SFEMG during the voluntary contraction of extensor digitorum communis muscle. 30 epileptic patients taking SV, 25 epileptic patients taking CBZ, and 25 age-matched healthy volunteers were included in the study. Mean jitter values (MCD) of subjects taking SV and CBZ were compared with normal controls. MCD values of subjects taking SV and CBZ were statistically significantly higher than those of control group. Review of the correlation between disease duration and MCD values of patients showed that MCD values were increased with the prolonged use of drugs, and thus, indicated a positive relationship between these two parameters. These results suggest that both SV and CBZ reduce neuromuscular transmission in patients without a neuromuscular junction disease.

Acute motor and sensory axonal neuropathy associated with Sjögren's syndrome.

Sjögren's syndrome (SS) is an autoimmune disease with mononuclear cell infiltration and destruction of the lacrimal gland and salivary glands, which cause dryness of the eyes and mouth. The most common neurological condition seen in SS is peripheral neuropathy. Initial manifestation of SS as an acute fulminant peripheral neuropathy is extremely rare. We report a 42-year-old patient presenting with acute motor sensory-axonal neuropathy in the presence of SS. She showed partial response to intravenous immunoglobulin but favourable clinical improvement was seen after initiation of corticosteroid treatment.

The measurement of both carotid intima-media thickness and epicardial adipose tissue thickness in children with epilepsy receiving antiepileptic drug therapy.

OBJECTIVE: The aim of this study was to evaluate the carotid intima-media thickness together with the thickness of the epicardial adipose tissue in patients receiving antiepileptic drug therapy and to investigate the presence of increased cardiovascular risk in these patients. METHODS: The study included a total of 52 patients comprising 32 males and 20 females who were diagnosed as having epilepsy and who were using one or more antiepileptic drugs. The control group consisted of 34 healthy individuals comprising 16 males and 18 females. The individuals selected for the study group were requested to go to the hospital after overnight fasting. After blood sampling for serum lipid value, the carotid intima-media thickness was measured with high resolution B-mode ultrasonography and epicardial adipose tissue thickness with echocardiography in the patients and the control group subjects. RESULTS: The carotid intima-media thickness was determined as 0.47 ±â€¯0.05 mm in the patient group and 0.44 ±â€¯0.04 mm in the control group (p = 0.028). The carotid intima-media thickness was measured as 0.45 ±â€¯0.05 mm in patients with epilepsy taking monotherapy and 0.49 ±â€¯0.04 mm in those taking polytherapy (p = 0.003). The epicardial adipose tissue thickness was determined as 3.42 ±â€¯0.09 mm in the patient group and 1.72 ±â€¯0.90 mm in the control group (p = 0.000). The epicardial adipose tissue thickness was measured as 3.16 ±â€¯0.87 mm in patients with epilepsy taking monotherapy and 3.77 ±â€¯0.83 mm in those taking polytherapy (p = 0.041). CONCLUSIONS: It was determined that carotid intima-media thickness and epicardial adipose tissue thickness were significantly high in children with epilepsy taking long-term antiepileptic drugs. These results demonstrate that these patients could be at increased risk of the development of cardiovascular complications. There is a need for more extensive studies on this subject.

Comparison of cytokines and prooxidants/antioxidants markers among adults with refractory versus well-controlled epilepsy: A cross-sectional study.

PURPOSE: This study aims to investigate the serum adiponectin, interleukin (IL)-6 and oxidative stress in epilepsy patients who are refractory or non-refractory to treatments. METHOD: The study comprised 31 refractory epilepsy, 29 well-controlled epilepsy patients and control group including 29 healthy individuals. The serum adiponectin, IL-6, total antioxidant status (TAS), total oxidant status levels (TOS) and oxidative stress index (OSI) were determined. RESULTS: The mean serum adiponectin and TAS levels were significantly lower in the refractory epilepsy patients than in the healty controls, and mean IL-6, TOS and OSI levels were significantly higher. The serum adiponectin, IL-6, TAS, TOS and OSI levels were not significantly different between the well-controlled epilepsy patients and the healthy controls. CONCLUSIONS: The mean serum IL-6 and oxidative stress levels in refractory epilepsy patients were higher and the serum adiponectin level was lower than the healthy control group. These findings may be associated with an increased risk of seizures, atherosclerosis and cardiovascular disease in refractory epilepsy patients.

Effect of serum inflammatory markers on the prognosis of adult and pediatric patients with Guillain-Barré syndrome.

OBJECTIVE: The aim of this study was to evaluate blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), C-reactive protein (CRP), and albumin levels for their prognostic value in adult Guillain-Barré syndrome (GBS-A) and pediatric Guillain-Barré syndrome (GBS-P) patients. PATIENTS AND METHODS: We retrospectively analyzed the medical records of 68 Guillain-Barré syndrome (GBS) patients (36 adults, 32 children) who were treated as inpatients at Harran University Faculty of Medicine, Neurology and Pediatric Neurology Departments. The pretreatment NLR, PLR, CRP, and albumin levels and Hughes scores at hospital admission, discharge, and third-month control were documented. RESULTS: In GBS-A patients, the mean CRP and NLR levels at admission/discharge and third-month control were significantly higher, and the mean albumin level was significantly lower in the Hughes disability scale (HDS)≥3 group. In GBS-P group, the mean NLR level at third month was significantly higher in the HDS≥3 group. GBS-A patients had higher mean NLR, PLR, and CRP levels and lower mean albumin values than GBS-P patients. Both GBS-A and GBS-P patients had higher mean NLR, PLR, and CRP levels and lower mean albumin values than healthy controls. Only the albumin level of the GBS-A group was found to be a significant predictor of prognosis at discharge from hospital. CONCLUSION: NLR, CRP, and albumin levels in the GBS-A group and NLR levels in the GBS-P group may be helpful in predicting the prognosis of the disease. The albumin level of GBS-A patients is an independent risk factor for prognosis at discharge from hospital.

Surgical treatment of pseudotumor cerebri.

AIM: To share our experience with idiopathic intracranial hypertension. MATERIAL AND METHODS: All patients believed to have pseudotumor cerebri underwent a fundus oculi examination to confirm the existence of papillary stasis and lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure. Patients who did not respond to medical treatment underwent fundus oculi examinations at 3-week intervals. Patients with CFS pressures exceeding 240 mm H2O underwent at least three LPs at 3-day intervals. Patients with higher CFS pressures were treated surgically. RESULTS: The mean patient age was 40.8 (range 31-58) years and the mean body mass index (BMI) was 30.9 (range 28.8-36.4) kg/m2. Papillary stasis was observed in 15 (46.8%) cases. The mean initial CSF pressure was 455.6 (range 360-560) mmHg, and after a mean of 4.3 (range 3-6) repeat measurements, this decreased to 213.4 (range 160-320) mmHg (Table I). Complications in our series included a lumbar pouch in three patients, and an abdominal pouch, meningitis, and abdominal migration in one patient each. DISCUSSION: Surgical treatment of idiopathic intracranial hypertension is necessary when the intracranial pressure does not decrease despite medical treatment and repeat LP. CONCLUSIONS: Idiopathic intracranial hypertension is a clinical syndrome of unclear pathogenesis that is closely related to obesity. KEY WORDS: Cerebrospinal fluid, Idiopathic intracranial hypertension, Pseudotumor cerebri, Obesity.