RESUMEN
Pseudotumor cerebri syndrome is a syndrome of increased cerebrospinal fluid pressure without ventriculomegaly, mass lesion, or meningeal abnormality. It is either primary (idiopathic intracranial hypertension, IIH) or secondary. A secondary cause is unlikely when adhering to the diagnostic criteria. Permanent visual loss occurs if undetected or untreated, and the associated headaches may be debilitating. Fulminant disease may result in blindness despite aggressive treatment. This study addresses the diagnosis and management of IIH including new insights into the pathobiology of IIH, updates in therapeutics and causes of overdiagnosis.
Asunto(s)
Hipertensión Intracraneal , Papiledema , Seudotumor Cerebral , Humanos , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/etiología , Seudotumor Cerebral/terapia , Hipertensión Intracraneal/complicaciones , Cefalea/diagnóstico , Cefalea/etiología , Cefalea/terapia , Trastornos de la Visión/terapia , Síndrome , Papiledema/complicaciones , Papiledema/diagnósticoRESUMEN
Idiopathic intracranial hypertension (IIH) is a diagnosis of exclusion characterized by features of raised intracranial pressure (ICP) in the absence of brain parenchymal lesion, vascular malformations, hydrocephalus, or central nervous system (CNS) infection. Commonly used other terms for this entity include benign intracranial hypertension (BIH) or pseudotumor cerebri. Few case reports of systemic lupus erythematosus (SLE) presenting as IIH are available in the literature. We report a 12-year-old girl presented with chronic holocranial headache and occasional episodes of projectile vomiting for the last 6 months and then developed blurring of vision for the last month. She fulfilled the criteria for IIH. Subsequent evaluation revealed a diagnosis of SLE. The occurrence of IIH in SLE is not coincidental and is reported in 1%-5.4% of patients with SLE. Though corticosteroids have not been widely used in IIH, underlying SLE warranted administering corticosteroids with subsequent complete resolution of IIH. Pediatricians, neurologists, intensivists, and ophthalmologists should consider SLE as a differential diagnosis in children presenting with IIH.
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Lupus Eritematoso Sistémico , Seudotumor Cerebral , Humanos , Femenino , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Niño , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/etiología , Diagnóstico Diferencial , Cefalea/etiología , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/diagnósticoAsunto(s)
Seudotumor Cerebral , Humanos , Seudotumor Cerebral/etiología , Constricción Patológica , StentsRESUMEN
Purpose: Spaceflight-associated neuro-ocular syndrome (SANS) shares several clinical features with idiopathic intracranial-hypertension (IIH), namely disc edema, globe-flattening, hyperopia, and choroidal folds. Globe-flattening is caused by increased intracranial pressure (ICP) in IIH, but the cause in SANS is uncertain. If increased ICP alone causes SANS, then the ocular deformations should be similar to IIH; if not, alternative mechanisms would be implicated. Methods: Using optical coherence tomography (OCT) axial images of the optic nerve head, we compared "pre to post" ocular deformations in 22 patients with IIH to 25 crewmembers with SANS. We used two metrics to assess ocular deformations: displacements of Bruch's membrane opening (BMO-displacements) and Geometric Morphometrics to analyze peripapillary shape changes of Bruch's membrane layer (BML-shape). Results: We found a large disparity in the mean retinal nerve-fiber layer thickness between SANS (108 um; 95% confidence interval [CI] = 105-111 um) and IIH (300 um; 95% CI = 251-350.1 um). The pattern of BML-shape and BMO-displacements in SANS were significantly different from IIH (P < 0.0001). Deformations in IIH were large and preponderantly anterior, whereas the deformations in SANS were small and bidirectional. The degree of disc edema did not explain the differences in ocular deformations. Conclusions: This study showed substantial differences in the degree of disc edema and the pattern of ocular deformations between IIH and SANS. The precise cause for these differences is unknown but suggests that there may be fundamental differences in the underlying biomechanics of each consistent with the prevailing hypothesis that SANS is consequent to multiple factors beyond ICP alone. We propose a hypothetical model to explain the differences between IIH and SANS based on the pattern of indentation loads.
Asunto(s)
Hipertensión Intracraneal , Seudotumor Cerebral , Humanos , Seudotumor Cerebral/etiología , Seudotumor Cerebral/complicaciones , Presión Intracraneal/fisiología , Trastornos de la Visión , Visión Ocular , Tomografía de Coherencia Óptica/métodos , Hipertensión Intracraneal/complicacionesRESUMEN
Primary Spinal tumors presenting as increased intracranial pressure is a rare and intradural extramedullary (IDEM) spinal schwannoma with unique presentation of pseudotumour cerebri (PTC) is extremely rare. Here, we describe a case of 48 years old male patient who presented to us with six months' history of headache and visual disturbances and was found to have bilateral papilledema. CT scan of brain was normal and CSF opening pressure on Lumbar puncture (LP) was 30 cm of H2O with raised protein level. His headache and visual symptoms settled down after LP (Lumbo-peritoneal) shunt was performed. Three days postoperatively, patient complained of hypoesthesia and weakness of left leg that became an established complain after 2 weeks. A Lumbosacral MRI was performed with concerns of any postoperative complications of LP Shunt, which revealed IDEM spinal tumour at D11-D12 level. Patient underwent second surgery for excision of tumor. We reviewed the relevant literatures and discuss the possible mechanism of such atypical presentation of spinal tumors.
Asunto(s)
Hipertensión Intracraneal , Neurilemoma , Seudotumor Cerebral , Neoplasias de la Columna Vertebral , Humanos , Masculino , Persona de Mediana Edad , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/etiología , Seudotumor Cerebral/cirugía , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Hipertensión Intracraneal/complicaciones , Cefalea/etiología , Neurilemoma/diagnóstico , Neurilemoma/diagnóstico por imagenRESUMEN
BACKGROUND: This prospective cohort study compared the outcomes of stenting and medical treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). METHODS: In this single-center cohort study, patients with IIH and VSS were evaluated between January 2014 and December 2019 with follow-up periods of 1, 3, and 6 months. The patients received either stenting or medical treatment. The two groups underwent 1:1 matching using propensity score analysis, and the clinical outcomes were compared. RESULTS: Following 1:1 matching, 36 patients who underwent stenting and 36 who underwent medical treatment were matched. The median improvements in the papilledema Frisén grade were greater in the stenting group at 1 month (-2 vs 0), 3 months (-3 vs -1), and 6 months (-3 vs -1) than in the medical treatment group. Patients who received stenting treatment had a significantly higher prevalence of complete resolution of their respective symptoms (headache, tinnitus, or visual disturbances) at 3 months (58.3% vs 13.9%, OR 8.68, 95% CI 2.74 to 27.52) and 6 months (80.6% vs 22.2%, OR 14.50, 95% CI 4.64 to 45.32) than those receiving medical treatment. CONCLUSIONS: This matched-control study shows that stenting has a greater efficacy rate and rapid resolution of papilledema and its respective symptoms compared with medical treatment.
Asunto(s)
Hipertensión Intracraneal , Papiledema , Seudotumor Cerebral , Humanos , Seudotumor Cerebral/cirugía , Seudotumor Cerebral/etiología , Papiledema/terapia , Estudios de Cohortes , Estudios Prospectivos , Resultado del Tratamiento , Stents/efectos adversos , Constricción Patológica/etiología , Senos Craneales , Hipertensión Intracraneal/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: We report a novel presentation of deficit in anterior pituitary function with variable immune deficiency (DAVID) syndrome in a healthy young girl presenting in Addisonian crisis with raised intracranial pressure. Nearly all cases of DAVID syndrome described in the literature have presented with recurrent infections and variable immunodeficiency. Pseudotumour cerebri has not been reported in DAVID syndrome to date. CASE PRESENTATION: A four-year-old girl represented to hospital with vomiting, confusion and diplopia after ten days of tiredness, neck and abdominal pain, and headache. Her cranial nerve examination demonstrated a right abducens nerve palsy and papilloedema, and she was found to have ketotic hypoglycaemia and hypocortisolaemia secondary to adrenocorticotrophic hormone (ACTH) deficiency. Her neuroimaging was consistent with pseudotumour cerebri, and her lumbar puncture opening pressure confirmed raised intracranial pressure (30-40 cmH2O). Cerebrospinal fluid analysis was normal. The patient's symptoms improved with hydrocortisone replacement and acetazolamide, but the raised intracranial pressure recurred after acetazolamide was discontinued. She was subsequently found to have panhypogammaglobulinaemia, and DAVID syndrome was diagnosed. Genetic testing demonstrated a truncating mutation in the NFKB2 gene c.2557C > T, p.(Arg853*). CONCLUSIONS: This case demonstrates pseudotumour cerebri as a novel neurological presentation of DAVID syndrome, highlights the rare association between adrenal insufficiency and intracranial hypertension, and shows the challenges in diagnosing isolated ACTH deficiency. We emphasise that cortisol should be checked in pre-pubertal children with pseudotumour cerebri and a diagnosis of DAVID syndrome considered in those presenting with low cortisol and neurological symptoms.
Asunto(s)
Seudotumor Cerebral , Niño , Femenino , Humanos , Preescolar , Seudotumor Cerebral/etiología , Acetazolamida , Punción Espinal/efectos adversos , Síndrome , Hidrocortisona , Hormona AdrenocorticotrópicaRESUMEN
BACKGROUND Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS) is an exceptionally rare disease caused by prothrombin antibodies, resulting in reduced factor II levels. This disease can present with significant bleeding and is usually associated with autoimmune disorders, particularly systemic lupus erythematosus (SLE). There are currently no guidelines for the treatment of LAHPS, and corticosteroids remain the criterion standard therapy. Pseudotumor cerebri is a disease that involves an idiopathic rise in intracranial pressure in association with papilledema. The coexistence of pseudotumor cerebri with SLE is rare, with an overall incidence of 0.7%. CASE REPORT A 16-year-old male initially presented to our hospital with nausea, headaches, and decreased visual acuity. He was diagnosed with pseudotumor cerebri based on the findings of papilledema and a raised opening pressure on lumbar puncture. Three months later, he presented with macroscopic hematuria and persistent epistaxis. Further investigation revealed a prolonged activated partial thromboplastin time and prothrombin time, along with positive LA and reduced Factor II levels, resulting in a diagnosis of LAHPS. The patient received a dose of 1 mg/kg/day of prednisolone along with hydroxychloroquine, and he had a complete recovery with cessation of bleeding and normalization of laboratory parameters. CONCLUSIONS We are reporting a case of pseudotumor cerebri with a further presentation of LAHPS in a patient found to have SLE. As both associations are rare in the presence of SLE, it is vital to recognize them early to initiate adequate management and intervention to avoid life-threatening complications.
Asunto(s)
Síndrome Antifosfolípido , Hipoprotrombinemias , Lupus Eritematoso Sistémico , Papiledema , Seudotumor Cerebral , Adolescente , Corticoesteroides/uso terapéutico , Síndrome Antifosfolípido/complicaciones , Hemorragia , Humanos , Hidroxicloroquina/uso terapéutico , Hipoprotrombinemias/diagnóstico , Hipoprotrombinemias/tratamiento farmacológico , Hipoprotrombinemias/etiología , Inhibidor de Coagulación del Lupus , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Papiledema/complicaciones , Prednisolona/uso terapéutico , Protrombina/uso terapéutico , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/etiologíaRESUMEN
BACKGROUND: Idiopathic intracranial hypertension (IIH) can cause debilitating symptoms and optic nerve ischemia if untreated. Cerebrospinal fluid diversion is often necessary to reduce intracranial pressure; however, current ventriculoperitoneal and lumboperitoneal shunting techniques have high failure rates in patients with IIH. OBJECTIVE: To describe our experience treating IIH with a novel stereotactic-guided transcerebellar cisternoperitoneal shunt (SGTC-CPS) technique that places the proximal shunt catheter in the posterior cisterna magnum. METHODS: Retrospective perioperative and postoperative data from all patients who underwent SGTC-CPS placement for IIH from March 1, 2015, to December 31, 2020, were analyzed. Patients were positioned as for ventriculoperitoneal shunt placement but with the head turned farther laterally to adequately expose the retrosigmoid space. Using neuronavigation, an opening was made near the transverse-sigmoid junction, and the proximal catheter was inserted transcerebellarly into the posterior foramen magnum. RESULTS: Thirty-two patients underwent SGTC-CPS placement (29 female; mean body mass index, 36.0 ± 7.5; 14 with prior shunt failures). The mean procedure time for shunt placement was 145 minutes. No intraoperative complications occurred, and all patients were discharged uneventfully. At the 6-month follow-up, 81% of patients (21 of 26) had relief of their presenting symptoms. Shunt survival without revision was 86% (25 of 29) at 1 year and 67% (10 of 15) at 3 years, with no infections. CONCLUSION: The SGTC-CPS offers an alternative solution for cerebrospinal fluid diversion in patients with IIH and demonstrates a lower failure rate and more durable symptom relief compared with ventriculoperitoneal or lumboperitoneal shunt placement. Using proper techniques and equipment promotes safe and facile placement of the proximal catheter.
Asunto(s)
Seudotumor Cerebral , Femenino , Humanos , Neuronavegación/métodos , Seudotumor Cerebral/diagnóstico por imagen , Seudotumor Cerebral/etiología , Seudotumor Cerebral/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Derivación Ventriculoperitoneal/efectos adversosRESUMEN
Obesity and headache disorders are two very common conditions in the general population that have been increasing in incidence over the last decades. Recent studies have shown a significant relationship between obesity and headaches, particularly migraine, with an important role in whether the disease is chronic. On the other hand, no such association was found with tension-type headaches. Studies showing an overlapping of hunger-control pathways and those involved in the pathophysiology of migraine may justify the close association between obesity and migraine. Moreover, a secondary headache for which obesity is a strong risk factor is idiopathic Intracranial Hypertension (pseudotumor cerebri), with several studies showing the impact of weight reduction/bariatric surgery in the treatment of the disease. In conclusion, since obesity is a modifiable risk factor, it is important for physicians treating patients with headaches, and particularly migraine, to be aware of the association between these two disorders.
Asunto(s)
Trastornos de Cefalalgia , Trastornos Migrañosos , Seudotumor Cerebral , Cefalea/complicaciones , Trastornos de Cefalalgia/etiología , Humanos , Trastornos Migrañosos/complicaciones , Obesidad/complicaciones , Seudotumor Cerebral/etiologíaRESUMEN
Lumbar punctures are frequently used in the diagnostic evaluation of central nervous system diseases such as infections, administration of medications such as chemotherapy and for reduction in intracranial pressure in cases of idiopathic intracranial hypertension. Cerebrospinal fluid (CSF) leak through a dural tear can result in temporary side effects such as headache (postlumbar puncture headache) and backache. Rarely, more severe side effects may occur with neurological deficits if there is an extensive CSF collection or epidural haematoma. However, the majority of these lesions can be managed conservatively.
Asunto(s)
Cefalea Pospunción de la Duramadre , Seudotumor Cerebral , Pérdida de Líquido Cefalorraquídeo/etiología , Niño , Cefalea/etiología , Humanos , Cefalea Pospunción de la Duramadre/etiología , Cefalea Pospunción de la Duramadre/terapia , Seudotumor Cerebral/etiología , Punción Espinal/efectos adversosRESUMEN
Primary intracranial hypertension (PIH) is characterized by clinical signs of increased intracranial pressure, papilledema, elevated opening pressure, and absence of mass lesion, hydrocephalus, or meningeal enhancement on neuroimaging. Visual changes are a common presenting feature and if untreated there is risk of irreversible vision loss. There have been recent proposed changes to the criteria for PIH along with studies looking at the differences in imaging characteristics between adult and pediatric PIH. The presence of transverse sinus stenosis alone was highly sensitive and specific for pediatric PIH. The Idiopathic Intracranial Hypertension Treatment Trial was an adult, multicenter study that examined the use of acetazolamide and weight loss on the course of PIH. The study confirmed many previously held beliefs including the most common presenting symptom in PIH is headache. Most patients present with bilateral papilledema with 58.2% of patients having symmetric Frisen scale grading and within one grade in 92.8%. Although diplopia is a common reported symptom, very few have evidence of cranial nerve palsy. Male gender, high-grade papilledema, and decreased visual acuity at presentation are risk factors for treatment failure. Acetazolamide use is associated with mild metabolic acidosis. During acetazolamide treatment, monitoring for hypokalemia or aplastic anemia is not recommended. Monitoring transaminases in the titration phase of treatment should be considered due to a case of transaminitis and pancreatitis with elevated lipase. Newer case reports have also seen associations of secondary intracranial hypertension with concurrent COVID-19 infection and MIS-C.
Asunto(s)
Acetazolamida/administración & dosificación , COVID-19/diagnóstico , Inhibidores de Anhidrasa Carbónica/administración & dosificación , Cefalea/diagnóstico , Hipertensión Intracraneal , Papiledema/diagnóstico , Trastornos de la Visión/diagnóstico , Pérdida de Peso , Acetazolamida/efectos adversos , Adolescente , Adulto , COVID-19/complicaciones , Inhibidores de Anhidrasa Carbónica/efectos adversos , Niño , Terapia Combinada , Diagnóstico Diferencial , Femenino , Cefalea/etiología , Humanos , Hipertensión Intracraneal/complicaciones , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/terapia , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Papiledema/etiología , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/etiología , Seudotumor Cerebral/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Síndrome de Respuesta Inflamatoria Sistémica/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Tomografía de Coherencia Óptica , Trastornos de la Visión/etiología , Adulto JovenRESUMEN
Idiopathic intracranial hypertension (IIH) is defined by the presence of headache with or without associated visual impairment, elevated cerebrospinal fluid pressure, and exclusion of a secondary etiology. The increased risk of severe visual impairment prompts rapid recognition and initial management by general practitioners, even though the incidence of this condition is low. Based on a case report, the aim of this review is to describe the typical clinical presentation of IIH, to discuss the underlying pathophysiology as well as work-up and management.
L'hypertension intracrânienne idiopathique (HTII) se caractérise par la présence de céphalées, avec ou sans atteintes visuelles, associées à une augmentation de la pression du liquide céphalo-rachidien (LCR), en l'absence d'étiologie secondaire. Bien que son incidence soit faible, le risque d'atteinte visuelle grave en fait une pathologie qui doit être reconnue par les médecins internistes généralistes. En se basant sur un cas pratique, cet article a pour objectif de retracer la présentation clinique typique de cette pathologie, d'aborder les mécanismes physiopathologiques sous-jacents et de présenter le bilan étiologique ainsi que la prise en charge.
Asunto(s)
Seudotumor Cerebral , Cefalea/diagnóstico , Cefalea/etiología , Cefalea/terapia , Humanos , Incidencia , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/etiología , Seudotumor Cerebral/terapia , Trastornos de la VisiónRESUMEN
BACKGROUND: Coronavirus disease 2019 may have neurological manifestations including meningitis, encephalitis, post-infectious brainstem encephalitis and Guillain-Barre syndrome. Neuroinflammation has been claimed as a possible cause. Here, we present a child with multisystem inflammatory syndrome in children (MIS-C) who developed pseudotumor cerebri syndrome (PTCS) during the disease course. CASE: A 11-year-old girl presented with 5 days of fever, headache and developed disturbance of consciousness, respiratory distress, conjunctivitis and diffuse rash on her trunk. Immunoglobulin M and G antibodies against severe acute respiratory syndrome coronavirus 2 were positive in her serum. She was diagnosed with MIS-C. On day 10, she developed headache and diplopia. Left abducens paralysis and bilateral grade 3 papilledema were observed. Brain magnetic resonance imaging revealed optic nerve head protrusion, globe flattening. She was diagnosed with secondary PTCS. Papilledema and abducens paralysis improved under acetazolamide and topiramate. Neurological examination became normal after 2 months. CONCLUSION: PTCS may emerge related to MIS-C.
Asunto(s)
COVID-19 , Seudotumor Cerebral , Niño , Femenino , Humanos , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/tratamiento farmacológico , Seudotumor Cerebral/etiología , SARS-CoV-2 , Síndrome de Respuesta Inflamatoria SistémicaRESUMEN
Idiopathic intracranial hypertension (IIH) is being diagnosed more often in the UK due to the rise in obesity. In fact, patients who present with bilateral optic disc swelling are habitually put on the papilloedema pathway, often without consideration of other diagnoses. We report the case of a middle-aged woman diagnosed with papilloedema and managed as IIH, until, cerebrospinal fluid (CSF) analysis revealed evidence of lymphocytic meningitis secondary to syphilis. The patient was treated successfully with intravenous antibiotics. Syphilis is the great masquerader and should be a diagnosis to consider in patients who have CSF findings incongruent with their clinical presentation.
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Meningitis , Disco Óptico , Papiledema , Seudotumor Cerebral , Sífilis , Uveítis Posterior , Femenino , Humanos , Meningitis/diagnóstico , Meningitis/tratamiento farmacológico , Meningitis/etiología , Persona de Mediana Edad , Papiledema/diagnóstico , Papiledema/tratamiento farmacológico , Papiledema/etiología , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/tratamiento farmacológico , Seudotumor Cerebral/etiología , Sífilis/complicaciones , Sífilis/diagnóstico , Sífilis/tratamiento farmacológicoRESUMEN
BACKGROUND: It has been shown that idiopathic intracranial hypertension (IIH) in children is associated with cerebral hyperemia, which induces an increase in cerebral venous pressure. The current literature suggests venous pressure scales with blood flow in a linear fashion, however, a linear relationship would not raise the pressure high enough to induce IIH. There is, however, some evidence to suggest that this relationship could be quadratic in nature. The purpose of this paper is to characterize the relationship between cerebral blood flow and the pressure drop across the cerebral venous system. METHODS: 10 CT venogram data sets were collected for this study, with 5 useable geometries created. Computational fluid dynamics (CFD) models were generated using these geometries, with 10 simulations conducted per patient. The flow rates tested ranged from 200 mL/min to 2000 mL/min. 3D pressure and velocity streamline distributions were created and analyzed for each CFD model, with pressure drops across the cerebral venous system determined. The effective and hydraulic diameters were determined at the superior sagittal sinus, transverse sinus and both proximal and distal sigmoid sinuses. RESULTS: A quadratic relationship between blood flow and sinus pressure was found, with correlations of 0.99 or above in all five patients. The presence of vortical blood flow was found to explain this trend, with fluid curl and pressure drop correlations being above 0.97. This suggests that the presence of high blood flow should be considered in the diagnostic workup of IIH. CONCLUSIONS: The cerebral venous sinus blood flow and pressure response relationship are quadratic in nature, with the major cause of this being the degree of rotation induced in the flow. The elevated blood flow found in children with IIH can explain the increased ICP that is found, secondary to the increase in venous pressure that develops.
Asunto(s)
Circulación Cerebrovascular/fisiología , Senos Craneales/diagnóstico por imagen , Senos Craneales/fisiopatología , Hiperemia/fisiopatología , Seudotumor Cerebral/fisiopatología , Sistema de Registros , Adulto , Femenino , Humanos , Hiperemia/complicaciones , Masculino , Modelos Teóricos , Flebografía , Seudotumor Cerebral/etiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND PURPOSE: Dural venous sinus stenosis has been associated with idiopathic intracranial hypertension and isolated venous pulsatile tinnitus. However, the utility of characterizing stenosis as intrinsic or extrinsic remains indeterminate. The aim of this retrospective study was to review preprocedural imaging of patients with symptomatic idiopathic intracranial hypertension and pulsatile tinnitus, classify the stenosis, and assess a trend between stenosis type and clinical presentation while reviewing the frequencies of other frequently seen imaging findings in these conditions. MATERIALS AND METHODS: MRVs of 115 patients with idiopathic intracranial hypertension and 43 patients with pulsatile tinnitus before venous sinus stent placement were reviewed. Parameters recorded included the following: intrinsic or extrinsic stenosis, prominent emissary veins, optic nerve tortuosity, cephalocele, sella appearance, poststenotic fusiform enlargement versus saccular venous aneurysm, and internal jugular bulb diverticula. χ2 cross-tabulation statistics were calculated and recorded for all data. RESULTS: Most patients with idiopathic intracranial hypertension (75 of 115 sinuses, 65%) had extrinsic stenosis, and most patients with pulsatile tinnitus (37 of 45 sinuses, 82%) had intrinsic stenosis. Marked optic nerve tortuosity was more common in idiopathic intracranial hypertension. Cephaloceles were rare in both cohorts, with an increased trend toward the presence in idiopathic intracranial hypertension. Empty sellas were more common in idiopathic intracranial hypertension. Cerebellar tonsils were similarly located at the foramen magnum level in both cohorts. Saccular venous aneurysms were more common in pulsatile tinnitus. Internal jugular bulb diverticula were similarly common in both cohorts. CONCLUSIONS: In this cohort, most patients with idiopathic intracranial hypertension had extrinsic stenosis, and most patients with pulsatile tinnitus had intrinsic stenosis. Awareness and reporting of these subtypes may reduce the underrecognition of potential contributory stenoses in a given patient's idiopathic intracranial hypertension or pulsatile tinnitus.
Asunto(s)
Senos Craneales/patología , Seudotumor Cerebral/etiología , Acúfeno/etiología , Adulto , Anciano , Estudios de Cohortes , Constricción Patológica/complicaciones , Constricción Patológica/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Seudotumor Cerebral/patología , Estudios Retrospectivos , Acúfeno/patologíaRESUMEN
There has been concern about possible long-term sequelae resembling myalgic encephalomyelitis/chronic fatigue syndrome in COVID-19 patients. Clarifying the mechanisms underlying such a "post-COVID-19 fatigue syndrome" is essential for the development of preventive and early treatment methods for this syndrome. In the present paper, by integrating insights pertaining to the glymphatic system and the nasal cerebrospinal fluid outflow pathway with findings in patients with chronic fatigue syndrome, idiopathic intracranial hypertension, and COVID-19, I provide a coherent conceptual framework for understanding the pathophysiology of post-COVID-19 fatigue syndrome. According to this hypothesis, this syndrome may result from damage to olfactory sensory neurons, causing reduced outflow of cerebrospinal fluid through the cribriform plate, and further leading to congestion of the glymphatic system with subsequent toxic build-up within the central nervous system. I further postulate that patients with post-COVID-19 fatigue syndrome may benefit from cerebrospinal fluid drainage by restoring glymphatic transport and waste removal from the brain. Obviously, further research is required to provide further evidence for the presence of this post-viral syndrome, and to provide additional insight regarding the relative contribution of the glymphatic-lymphatic system to it. Other mechanisms may also be involved. If confirmed, the glymphatic-lymphatic system could represent a target in combating post-COVID-19 fatigue syndrome. Moreover, further research in this area could also provide new insights into the understanding of chronic fatigue syndrome.