- Noninvasive methods of detecting increased intracranial pressure. [REVIEW, JOURNAL ARTICLE]
- Childs Nerv Syst 2016 Jun 28.
The detection of elevated intracranial pressure (ICP) is of paramount importance in the diagnosis and management of a number of neurologic pathologies. The current gold standard is the use of intraventricular or intraparenchymal catheters; however, this is invasive, expensive, and requires anesthesia. On the other hand, diagnosing intracranial hypertension based on clinical symptoms such as headaches, vomiting, and visual changes lacks sensitivity. As such, there exists a need for a noninvasive yet accurate and reliable method for detecting elevated ICP. In this review, we aim to cover both structural modalities such as computed tomography (CT), magnetic resonance imaging (MRI), ocular ultrasound, fundoscopy, and optical coherence tomography (OCT) as well as functional modalities such as transcranial Doppler ultrasound (TCD), visual evoked potentials (VEPs), and near-infrared spectroscopy (NIRS).
- [The Current Diagnostic Possibilities and Cooperation of Oftalmologist and Neurologist Concerning in Patients with Idiopatic Intracranial Hypertension]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Cesk Slov Oftalmol 2016; 72(2):32-38.
The aim of this paper is to present the current possibilities in idiopatic intracranial hypertension (IIH) diagnostics. Optical coherence tomography belongs to these possibilities in last few years. The necesarry interdisciplinary co-operation of ophthalmologist and neurologist concerning in IIH patients is pointed out in the mentioned case reports.The issue of diagnostics and care of IIH patients is presented in two case reports.After ophthalmological and neurological examination the diagnosis of idiopathic intracranial hypertension was assessed and the treatment with acetazolamide was started. The patients have been observed in The department of ophthalmology University hospital in Pilsen during the run of the disease by the neoroophthalmologist. The edema of optic nerve has been monitored by fundoscopy and optical coherence tomography. Initially highly distended retinal nerve fiber layer thickness has been decreased with the normalizing of optic nerve head appearence. The patient´s difficulties have gone off during couple of month and the edema of optic nerve papilla has disappeared. According to the education and the regime acquisition our two patients reduced their body weight, so that they influenced favourably the development of their disorder.IIH is consequential disorder causing patient´s crucial restriction in an ordinary lifestyle. It could cause difficult changes in vision. The early diagnosis and proper leading of the therapy is fundamental for the next development of patient´s health.idiopatic intracranial hypertension, optical coherence tomography, edema of optic nerve head, papilloedema.
- An olfactory groove schwannoma with a pseudocyst compressing the basal ganglia, internal capsule and optic tracts. [JOURNAL ARTICLE]
- Childs Nerv Syst 2016 Jun 21.
Olfactory groove schwannomas (OGSs) are extremely rare tumours, particularly in the paediatric population.A 13-year-old girl presented with two epileptic seizures, papilloedema and incomplete binasal quadrantanopia. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a large heterogeneously enhancing tumour of the anterior skull base with a prominent dorsal pseudocyst. Interestingly, the pseudocyst embraced the right ICA bifurcation and displaced the optic tracts, optic chiasm and optic nerves and the ipsilateral basal ganglia. The patient underwent surgery via the frontolateral approach, and the tumour was completely removed. The pseudocyst was opened, and its wall was partially resected. It subsequently resolved completely. Histopathological examination yielded the rare diagnosis of schwannoma of the anterior skull base.Although extremely rare, olfactory groove schwannomas can be seen in paediatric patients. Our patient is the youngest ever reported with this histopathological diagnosis along with the formation of a large pseudocyst.
- CLINICAL FEATURES AND OUTCOME ANALYSIS OF INTRACRANIAL HYDATID CYSTS. [Journal Article]
- J Ayub Med Coll Abbottabad 2016 Jan-Mar; 28(1):39-43.
Hydatid cyst of the brain is serious zoonotic parasitic infections which have profound health consequences if left untreated. The surgical excisions of the cysts are rewarding for both the patient the neurosurgeon.The study was conducted prospectively at Department of Neurosurgery Hayatabad Medical Complex Peshawar from January 2013 to December 2014. Patients with a diagnosis of intracranial hydatid cysts were included, clinical and radiological features recorded, intervention and postoperative outcome were analysed.Eleven patients with a male to female ratio of 1.7:1. Mean age was 12.4 (SD ± 6.5) years with median GCS on arrival of 10 (SD ± 2.5). Clinical features were headache (81.8%), vomiting (90.9%), seizures (36.4%), focal deficits (54.5%) and papilloedema (72.7%). The median GCS on discharge was 13 (SD ± 1.1) while GOS at 1 month follow up was 4 (SD ± 0.7). The bivariate analysis showed inverse correlation (R² = -0.68; p = 0.02) between duration of symptoms and outcome while GCS on admission was positively correlated (r(s) = 0.75; p = 0.007) with the outcome. There was no mortality.Despite its rarity the clinical features are non-specific while radiological features help in establishing diagnosis. Earlier diagnosis and prompt intervention is the key to favourable outcome.
- Neuro-Behçet's disease presenting with tumour-like lesions and responding to rituximab. [JOURNAL ARTICLE]
- J Clin Neurosci 2016 Jun 16.
We describe a patient with neuro-Behçets disease (NBD) that presented with symptoms of raised intracranial pressure including papilloedema. MRI revealed tumour-like lesions which, on biopsy, confirmed an active vasculitis. Treatment was commenced with prednisone and cyclophosphamide which proved unsuccessful with enlargement of the cerebral mass lesions. Infliximab and mycophenolate were trialled also without benefit. The patient required ventriculoperitoneal shunts to relieve the symptoms of hydrocephalus. Rituximab was then commenced with significant symptomatic and imaging improvement. The case is unique, in our experience, in the need for shunting to relieve the symptoms of hydrocephalus related to vasculitis.
- Papilledema Due to Mirtazapine. [Journal Article]
- Balkan Med J 2016 May; 33(3):363-5.
Mirtazapine is a tetracyclic antidepressant that enhances both noradrenergic and serotonergic transmission. The most common cause of papilledema is increased intracranial pressure due to brain tumor. Also it may occur as a result of idiopathic intracranial hypertension (IIH, pseudo tumor cerebri). Moreover, papilledema may also develop due to retinitis, vasculitis, Graves' disease, hypertension, leukemia, lymphoma, diabetes mellitus and radiation.In this article, a patient who developed papilledema while under treatment with mirtazapine (30 mg/day) for two years and recovered with termination of mirtazapine treatment was discussed to draw the attention of clinicians to this side effect of mirtazapine.Idiopathic intracranial hypertension and papilledema due to psychotropic drugs has been reported in the literature. Mirtazapine may rarely cause peripheral edema. However, papilledema due to mirtazapine has not been previously reported. Although papilledema is a very rare side effect of an antidepressant treatment, fundoscopic examinations of patients must be performed regularly.
- Role of Serum Lactate and Malarial Retinopathy in Prognosis and Outcome of Falciparum and Vivax Cerebral Malaria: A Prospective Cohort Study in Adult Assamese Tribes. [Journal Article]
- J Glob Infect Dis 2016 Apr-Jun; 8(2):61-7.
There is no comprehensive data or studies relating to clinical presentation and prognosis of cerebral malaria (CM) in the tribal settlements of Assam. High rates of transmission and deaths from complicated malaria guided us to conduct a prospective observational cohort study to evaluate the factors associated with poor outcome and prognosis in patients of CM.We admitted 112 patients to the Bandarpara and Damodarpur Tribal Health Centers (THCs) between 2011 and 2013 with a strict diagnosis of CM. We assessed the role of clinical, fundoscopy and laboratory findings (mainly lactic acid) in the immediate outcome in terms of death and recovery, duration of hospitalization, neurocognitive impairment, cranial nerve palsies and focal neurological deficit.The case fatality rate of CM was 33.03% and the prevalence of residual neurological sequelae at discharge was 16.07%. These are significantly higher than the previous studies. The mortality rate and neurological complications rate in patients with retinal whitening was 38.46% and 23.07%, with vessel changes was 25% and 18.75%, with retinal hemorrhage was 55.55% and 11.11% and with hyperlactatemia was 53.85% and 18.46%, respectively. Three patients of papilledema alone died.Our study suggests a strong correlation between hyperlactatemia, retinal changes (whitening, vessel changes and hemorrhage) and depth and duration of coma with longer duration of hospitalization, increased mortality, neurological sequelae and death. Plasmodium vivax mono-infection as a cause of CM has been confirmed. Prognostic evaluation of CM is useful for judicious allocation of resources in the THC.
- [Aneurysmal bone cyst: A rare cause of orbital disease]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- J Fr Ophtalmol 2016 Jun 7.
Aneurysmal bone cyst is a rare benign bone neoplasm of unknown cause. The most commonly affected anatomical sites are the vertebral column and long bones. We report two uncommon cases of primary orbital aneurysmal bone cyst presenting as an acute orbital compartment syndrome due to subperiosteal hemorrhage. Case 1 is a 45-year-old woman. Imaging studies revealed a small cystic frontal bone tumour associated with a subperiosteal hematoma. The patient achieved full visual recovery after drainage of the hematoma, with no recurrence after treatment. Case 2 is a 74-year-old woman whose visual acuity was light perception due to severe papilledema. Imaging studies of the orbit revealed a large cystic frontal bone tumor associated with a subperiosteal hematoma causing globe and optic nerve compression. Preoperative arteriography showed a moderate vascular blush. Drainage of the hematoma was performed. A local recurrence with hematoma formation occurred two years after the surgery.
- Intracranial hypertension secondary to a skull lesion without mass effect. [JOURNAL ARTICLE]
- J Clin Neurosci 2016 Jun 6.
We report and discuss five patients with intracranial hypertension due to a skull lesion reducing cerebral sinus patency with a compressive, non-thrombotic mechanism. We illustrate the importance of a high level of suspicion for this condition in patients presenting with headache, papilledema and increased intracranial pressure in the absence of focal signs or radiological evidence of mass effect.
- Rapid Visual Deterioration Caused by Posterior Fossa Arachnoid Cyst. [Journal Article]
- J Korean Neurosurg Soc 2016 May; 59(3):314-8.
Posterior fossa is a site next to the middle fossa where arachnoid cyst frequently occurs. Generally, most arachnoid cysts are asymptomatic and are found incidentally in most cases. Although arachnoid cysts are benign and asymptomatic lesions, patients with posterior fossa arachnoid cysts often complain of headaches, gait disturbance, and ataxia due to the local mass effects on the cerebellum. We observed a patient with a posterior fossa arachnoid cyst who had visual symptoms and a headache, but did not have gait disturbance and ataxia. We recommended an emergency operation for decompression, but the patient refused for personal reasons. After 7 days, the patient revisited our hospital in a state of near-blindness. We suspected that the arachnoid cyst induced the hydrocephalus and thereby the enlarged third ventricle directly compressed optic nerves. Compressed optic nerves were rapidly aggravated during the critical seven days; consequently, the patient's vision was damaged despite the operation. Considering the results of our case, it is important to keep in mind that the aggravation of symptoms cannot be predicted; therefore, symptomatic arachnoid cysts should be treated without undue delay.