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Tinnitus and Hyperacusis
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Simple blood tests are considered helpful to exclude anaemia and thyrotoxicosis. In the absence of an obvious cause, synchronous pulsatile tinnitus requires imaging. Over the years there has been much debate regarding the ideal imaging modality. If otoscopy reveals a retrotympanic mass, a contrast-enhanced computed tomography (CT) of the temporal bone, brain and scalp is indicated.199 If atherosclerotic carotid artery disease is suspected, duplex carotid ultrasonography can be helpful. Otherwise, the advantages and disadvantages of magnetic resonance angiography (MRA) over contrast-enhanced CT has not been satisfactorily resolved. The gold standard mode of imaging the vascular system of the temporal bone, brain and scalp is via formal angiographic imaging, but this is not without risk, so this is often reserved for severe, recalcitrant cases where less invasive techniques have not revealed an obvious pathology. If idiopathic intracranial hypertension is suspected, an ophthalmological assessment, lumbar puncture, measurement of intracranial pressure and diagnostic reduction of intracranial pressure by draining off some cerebrospinal fluid may be required.
Recurrent Headaches In Children
Published in Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan, Diagnosing and Treating Common Problems in Paediatrics, 2017
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan
Idiopathic intracranial hypertension is the clinical syndrome of raised intracranial pressure, in the absence of space-occupying or vascular lesions, without enlargement of the cerebral ventricles and for which no causative factor can be identified. It was previously known as benign intracranial hypertension; however, it is now recognised as a malignant phenomenon as it can rapidly lead to irreversible blindness. Idiopathic intracranial hypertension may present with a severe frontal headache that interferes with normal daily activities. The headache may increase in intensity on bending over and is often more frequent in the morning. The patient may also complain of intermittent darkening of parts or the whole of their visual fields (transient visual obscuration). Neurological examination is abnormal including papilloedema and optic atrophy on fundoscopy, and at times a sixth nerve palsy. Neuroimaging is normal. Diagnosis is based on history and exam including formal visual field assessment, and lumbar puncture demonstrating high opening pressure. Associated factors are obesity, steroids withdrawal, hormonal contraceptive use, some antimicrobial agents, vitamin A, and also venous sinus stenosis. Prompt referral to a tertiary centre is warranted. Treatment options include carbonic anhydrase inhibitors, loop diuretics, fenestration of the optic nerve, high volume lumbar puncture and cerebrospinal fluid shunting.
Tension-Type Headache
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Imaging studies of the brain, cervical spine, and soft tissue structures should be ordered based on clinical suspicion from history and physical examination. Cervical spine lesions are as common in TTH as in other headache disorders (27). Additional studies such as lumbar puncture for cerebrospinal fluid analysis and measurement of the opening pressure should be considered if idiopathic intracranial hypertension is in the differential diagnosis.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2022
David A. Bellows, John J. Chen, Jenny A. Nij Bijvank, Michael S. Vaphiades, Xiaojun Zhang
The authors conducted a retrospective study of 14 paediatric patients who underwent optic nerve sheath fenestration for papilloedema at the Children’s Hospital of Philadelphia. Ten (71%) were female and their ages ranged from 8.5 to 17.5. Ten of these patients had a diagnosis of idiopathic intracranial hypertension. Five patients underwent bilateral optic nerve sheath fenestration. Visual acuity improved from 20/138 to 20/68 in the operated eye and from 20/78 to 20/32 in the non-operated eye. Visual field mean deviation improved from −23.4 dB to −11.5 dB in the operated eye and from −19.8 dB to −6.8 dB in the non-operated eye. Colour vision significantly improved in the operated eyes. In the operated eyes, extra-ocular motility was abnormal in 13 (72.2%) eyes at presentation and improved to three (15.8%) at final visit, while the non-operated eye had abnormal extra-ocular motility in four (44.4%) eyes at presentation and all improved at final visit. Retinal nerve fibre layer thickness improved in the operated eye from 349.1 to 66.2 µm. In 13 out of 14 patients, optic nerve pallor was noted at the final visit. Improvement in some aspects of visual function was seen as early as post-operative day 1, such as visual acuity in the non-operated eye, while other variables reached a significant improvement 1 week or 1 month after surgery. None of the patients suffered any adverse effects from the optic nerve sheath fenestration procedure.
Contemporary management of the pseudotumor cerebri syndrome
Published in Expert Review of Neurotherapeutics, 2019
The pseudotumor cerebri syndrome (including idiopathic intracranial hypertension) remains challenging to manage with little in the way of evidence-based data to guide decision-making. Despite heightened awareness of the disorder over the past several decades, misdiagnosis and overdiagnosis remain problematic. The goals of treatment are to preserve vision, manage headaches and improve quality of life. The Idiopathic Intracranial Hypertension Treatment Trial provided a basis for treating patients with mild visual loss. However, an individualized approach, taking into account many factors is required to determine the appropriate treatment, which may include medication, surgery, weight loss, and lifestyle modifications. Headaches frequently require therapies independent of CSF-pressure lowering strategies. Management in children is similar to adults, being vigilant about excluding a secondary cause in pre-pubertal children. Recurrence is possible, necessitating ongoing monitoring.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2022
David A. Bellows, John J. Chen, Hui-Chen Cheng, Panitha Jindahra, Peter W. MacIntosh, Collin McClelland, Michael S. Vaphiades, Xiaojun Zhang
Recent weight gain is an important risk factor for idiopathic intracranial hypertension (IIH). Weight loss is associated with improvement in symptoms and signs. A recent IIH randomised controlled weight trial (IIH:WT) revealed that weight loss through bariatric surgery significantly reduced intracranial pressure (ICP) as compared with diet weight management. Sixty-six adult women with active IIH and a body mass index of ≥35 kg/m2 were included in the trial and divided into two groups according to their treatments. The first group received bariatric surgery (n = 23, mean age 31-years-old, mean body weight 119.5 kg) and the second received dietary control (n = 43, mean age 33.2-years-old). The baseline weight and ICP between the two groups were not different.