- Re: Chang et al.: Accuracy of diagnostic imaging modalities for classifying pediatric eyes as papilledema versus pseudopapilledema (Ophthalmology. 2017;124:1839-1848). [Letter]
- OOphthalmology 2018; 125(3):e23
- Ventriculoperitoneal shunt treatment in a pregnant renal transplant recipient with idiopathic intracranial hypertension: Case report and review of the literature. [Journal Article]
- NNNeurol Neurochir Pol 2018 Feb 06
- Idiopathic intracranial hypertension (IIH) is a relatively uncommon disorder characterised by raised intracranial pressure without an established pathogenesis. Diagnosis of IIH requires the demonstra...
Idiopathic intracranial hypertension (IIH) is a relatively uncommon disorder characterised by raised intracranial pressure without an established pathogenesis. Diagnosis of IIH requires the demonstration of symptoms and signs referable only to elevated intracranial pressure; cerebrospinal fluid (CSF) opening pressure >25cm H2O measured in the lateral decubitus position; normal CSF composition; and no evidence for an underlying structural cause demonstrated by using MRI or contrast-enhanced CT scan for typical patients and MRI and MR venography for atypical patients such as man, children and those with low body mass index. We present a 38-year old primigravid renal transplant patient at 7 weeks of gestation who presented with 2 weeks of intense, throbbing, holocranial headache, nausea, vomiting, photophobia, diplopia and progressive visual loss. When medical treatment fails and/or not appropriate to use due to the reported of teratogenic risks in pregnant women, surgical interventions gain importance. In this particular patient, venticuloperitoneal shunt was chosen as the CSF diversion technique. In this case report indications, contraindications in addition to outcomes regarding headache, vision loss and the resolution of papilloedema of the present surgery options for IIH are discussed.
- Trapped ventricle after laser ablation of a subependymal giant cell astrocytoma complicated by intraventricular gadolinium extravasation: case report. [Journal Article]
- JNJ Neurosurg Pediatr 2018 Feb 16; :1-5
- Magnetic resonance imaging-guided stereotactic laser ablation of intracranial targets, including brain tumors, has expanded dramatically over the past decade, but there have been few reports of compl...
Magnetic resonance imaging-guided stereotactic laser ablation of intracranial targets, including brain tumors, has expanded dramatically over the past decade, but there have been few reports of complications, especially those occurring in a delayed fashion. Laser ablation of subependymal giant cell astrocytomas (SEGAs) is an attractive alternative to maintenance immunotherapy in some children with tuberous sclerosis complex (TSC); however, the effect of treatment on disease progression and the nature and frequency of potential complications remains largely unknown. The authors report the case of a 5-year-old boy with TSC who underwent stereotactic laser ablation of a SEGA at the right foramen of Monro on 2 separate occasions. After the second ablation, immediate posttreatment MRI revealed gadolinium extravasation from the tumor into the lateral ventricle. Nine months later, the patient presented with papilledema and delayed obstructive hydrocephalus secondary to intraventricular adhesions causing a trapped right lateral ventricle. This was successfully treated with endoscopic septostomy. The authors discuss the potential cause and clinical management of a delayed complication not previously reported after a relatively novel surgical therapy.
- Life-Threatening Headaches in Children: Clinical Approach and Therapeutic Options. [Journal Article]
- PAPediatr Ann 2018 Feb 01; 47(2):e74-e80
- Life-threatening headaches in children can present in an apoplectic manner that garners immediate medical attention, or in an insidious, more dangerous form that may go unnoticed for a relatively lon...
Life-threatening headaches in children can present in an apoplectic manner that garners immediate medical attention, or in an insidious, more dangerous form that may go unnoticed for a relatively long period of time. The recognition of certain clinical characteristics that accompany the headache should prompt recognition and referral to an institution equipped with neuroimaging facilities, pediatric neurosurgeons, and neurologists. Thunderclap headaches, which reach a peak within a very short period of time, may be the presenting feature of conditions such as arterial dissection, venous sinus thrombosis, and reversible cerebral vasoconstriction syndrome, which can be addressed by specific pharmacological options instituted in an intensive care setting. On the other hand, subacute to chronic headaches that are accompanied by focal neurological signs, such as abducens nerve palsy, restriction of upward gaze, or papilledema, may be indicative of the need for urgent imaging and neurosurgical referral. [Pediatr Ann. 2018;47(2):e74-e80.].
- Pediatric Intracranial Hypertension: a Current Literature Review. [Review]
- CPCurr Pain Headache Rep 2018 Feb 13; 22(2):14
- The purpose of this review is to provide an update on pediatric intracranial hypertension.
The purpose of this review is to provide an update on pediatric intracranial hypertension.
- Characterization of Retinal Ganglion Cell and Optic Nerve Phenotypes Caused by Sustained Intracranial Pressure Elevation in Mice. [Journal Article]
- SRSci Rep 2018 Feb 12; 8(1):2856
- Elevated intracranial pressure (ICP) can result in multiple neurologic sequelae including vision loss. Inducible models of ICP elevation are lacking in model organisms, which limits our understanding...
Elevated intracranial pressure (ICP) can result in multiple neurologic sequelae including vision loss. Inducible models of ICP elevation are lacking in model organisms, which limits our understanding of the mechanism by which increased ICP impacts the visual system. We adapted a mouse model for the sustained elevation of ICP and tested the hypothesis that elevated ICP impacts the optic nerve and retinal ganglion cells (RGCs). ICP was elevated and maintained for 2 weeks, and resulted in multiple anatomic changes that are consistent with human disease including papilledema, loss of physiologic cupping, and engorgement of the optic nerve head. Elevated ICP caused a loss of RGC somas in the retina and RGC axons within the optic nerve, as well as a reduction in both RGC electrical function and contrast sensitivity. Elevated ICP also caused increased hypoxia-inducible factor (HIF)-1 alpha expression in the ganglion cell layer. These experiments confirm that sustained ICP elevation can be achieved in mice and causes phenotypes that preferentially impact RGCs and are similar to those seen in human disease. With this model, it is possible to model human diseases of elevated ICP such as Idiopathic Intracranial Hypertension and Spaceflight Associated Neuro-ocular Syndrome.
- Complications of Optic Nerve Sheath Fenestration as a Treatment for Idiopathic Intracranial Hypertension. [Review]
- SOSemin Ophthalmol 2018; 33(1):36-41
- There are a number of surgical options for treatment of idiopathic intracranial hypertension (IIH) when it is refractory to medical treatment and weight loss. Optic nerve sheath fenestration (ONSF) i...
There are a number of surgical options for treatment of idiopathic intracranial hypertension (IIH) when it is refractory to medical treatment and weight loss. Optic nerve sheath fenestration (ONSF) is one of these options. Use of this procedure varies among centers due to experience with the procedure and concern for associated complications that can result in severe loss of vision. This review summarizes the literature concerning post-surgical complications of ONSF for IIH.
- Long-term visual outcome in a Danish population of patients with idiopathic intracranial hypertension. [Journal Article]
- AOActa Ophthalmol 2018 Feb 06
- CONCLUSIONS: Idiopathic intracranial hypertension (IIH) is associated with long-term loss of visual function, and relevant treatment strategies need to be improved.
- Papilledema in Idiopathic Intracranial Hypertension. [Journal Article]
- HHeadache 2018 Feb 05
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- Forgetting the fundoscope - A case of fulminant idiopathic intracranial hypertension causing rapid visual loss. [Journal Article]
- JCJ Clin Neurosci 2018 Jan 26
- Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure without evidence of intracranial mass lesion or venous thrombosis, and bland cerebrospinal fluid examination...
Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure without evidence of intracranial mass lesion or venous thrombosis, and bland cerebrospinal fluid examination. It mostly affects overweight women of childbearing age and if left untreated, can lead to permanent visual loss. Visual decline in this condition is generally slow, over months to years. However, a small proportion of patients develop rapidly progressive visual loss within days or weeks of onset of headaches. We describe a 29 year-old patient with fulminant IIH in whom inadequate fundoscopy and assessment of vision contributed to a delay in diagnosis and poor outcome. Unfortunately, competence with the bedside examination technique of fundoscopy is declining. We emphasise the importance of thorough assessment of vision and fundi in patients presenting with new-onset headache.