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Idiopathic intracranial hypertension and CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
The modified Dandy’s criteria for a diagnosis of IIH (2002) are as follows:3Signs and symptoms of papilledema or generalized intracranial hypertension.Elevated intracranial pressures documented in the lateral decubitus position.Normal CSF composition.No evidence of hydrocephalus, mass, structural, or vascular lesion seen on computed tomography (CT) or magnetic resonance imaging (MRI).No identified cause of intracranial hypertension.
Acute CSF rhinorrhoea
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
With spontaneous leaks, the patient will usually complain of a unilateral, clear nasal discharge that may be intermittent and sometimes copious. They may have a salty taste when the leak is active. Occasionally an episode of meningitis occurs that triggers the search for an underlying cause. The leak is often from the lateral lamella of the cribriform plate (40%) (Figure 3.1), the frontal sinus (15%) or the sphenoid sinus (15%). It occurs more commonly in overweight women, as they appear to be more likely to have idiopathic intracranial hypertension, which is a causative factor. These leaks rarely resolve spontaneously.
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.
Intracranial Hypertension Associated With Testosterone Therapy In Female-To-Male Transgender Patients: A Case Report And Literature Review
Published in Seminars in Ophthalmology, 2023
Alisha Kamboj, Meghan M. Brown, Anne S. Abel
In severe cases of intracranial hypertension, surgical management may be imperative. Optic nerve sheath fenestration, lumboperitoneal shunt, ventriculoperitoneal shunt, and dural venous sinus stenting often play a critical role in improving both visual acuity and visual outcomes in IIH.25,26 In our review, four cases required surgical intervention: two unilateral optic nerve sheath fenestrations, one lumboperitoneal shunt placement, and one endovascular venous sinus stent placement. Of note, no patients were found to have optic neuropathy. In the setting of optic neuropathy and/or vision loss, timely patient assessment and close collaboration between neuro-ophthalmology, oculoplastic surgery, and neurosurgery are paramount to ascertain the risks and benefits of medication management and/or surgical intervention.
An update on the pharmacological management and prevention of cerebral edema: current therapeutic strategies
Published in Expert Opinion on Pharmacotherapy, 2021
Melissa Pergakis, Neeraj Badjatia, J. Marc Simard
When the use of pharmacological intervention with osmotherapy has failed, surgical decompression may be considered. First pioneered by Theodor Kocher in 1901 and subsequently Harvey Cushing in 1908, decompressive craniectomy for traumatic brain injury dates back to over a century ago [26,27]. Multiple cohort studies have shown that intracranial hypertension is an independent risk factor of death and poor outcome in patients suffering from TBI [28,29]. Two randomized controlled trials for intracranial hypertension in patients with traumatic brain injury, Decompressive Craniectomy in Diffuse Traumatic Brain Injury (DECRA) in 2011 [30] and Trial of Craniectomy for Traumatic Intracranial Hypertension (RESCUEicp) in 2016 [31] have assessed the efficacy of decompressive craniectomy after traumatic brain injury.
Vision treatment strategy for acute blindness in adolescent female with diffuse leptomeningeal glioneuronal tumor
Published in International Journal of Neuroscience, 2020
Siqin Zhou, Miao Zhang, Huihui Wu, Guangjian Liu, Ying Wang, Yi Bao
The case of acute visual loss is rarely diagnosed as a diffuse leptomeningeal glioneuronal tumor. The diagnosis of this disease in adolescent women without a history of cancer has not previously been reported. For the loss of vision, most of the reasons are considered to be caused by intracranial hypertension. Under normal conditions, timely treatment can save part of vision, but generally poor visual acuity recovery. When it comes to a sharp drop in vision and no sense of light, ordinary treatments are difficult to save visual acuity. This article introduces a case that after dehydration treatment failed, cranial pressure was reduced by surgery, combined with drugs and hyperbaric oxygen chamber comprehensive treatment, and finally the patient’s vision was restored to normal. The specific situation is reported as follows.