Idiopathic Intracranial Hypertension Is Associated with Depression Regardless of Weight: A Controlled Study

Research Background: Idiopathic intracranial hypertension (IIH) is a common disease among obese women during their childbearing years, and it could be associated with depression. It is unclear whether obesity contributes also to depression among these patients. Research Objective: To evaluate patients with IIH for the existence of depression using the Hamilton Depression Rating Scale (HAM-D) questionnaire score, compared to age- and BMI-matched healthy control group. Methods: Controlled IIH patients were prospectively recruited from the neuro-ophthalmology clinic at Tzafon Medical Center, Poria. Following consent, patients were interviewed and answered the HAM-D questionnaire. A healthy age- and body mass index (BMI)-matched participants from the same population (control group), were also recruited and interviewed by the same investigator answering the same questionnaire. Demographics and BMI were documented in both groups. HAM-D score of >10 is significantly associated with depression. Results: Thirty-two and 28 from the patients and control group, respectively, had completed the study. Mean age was 28.6 ± 7.51 and 32.467 ± 8.22 years of both patient and control groups, respectively (P = 0.07). Mean BMI was 32.8 ± 6.87 and 32.1 ± 3.78 respectively (P = 0.621). The IIH group’s mean HAM-D scores was 11.62 ± 8.2 as compared to 3.179 ± 2.407 in the control group (P = 0.000). The most significant differences included the questionnaire items of insomnia initial, work and activities, somatic general and somatic symptoms general. Conclusion: IIH patients had significantly higher HAM-D scores compared to the control group. This score seems to be irrelevant to the weight of the patient. Psychological support in addition to the conventional treatment of IIH, is needed to improve the quality of life of these patients.

Optical coherence tomography use in idiopathic intracranial hypertension

Idiopathic intracranial hypertension(IIH)is a condition in which elevated pressure in the cerebrospinal fluid can lead to optic nerve head(ONH)dysfunction and subsequent visual impairment.Physicians are currently limited in their ability to monitor and manage this condition,as clinical symptoms and exam findings are often delayed in response to changes in intracranial pressure.In order to find other biomarkers of disease,researchers are using imaging modalities such as optical coherence tomography(OCT)to observe microscopic changes in the eye in this condition.OCT can create 2-dimensional and 3-dimensional high definition images of the retina of the ONH and has been used to study various conditions such as glaucoma and multiple sclerosis.Numerous studies have used OCT in IIH as well,and they have shown that certain retinal layers and the ONH change in thickness and shape in both the short and long term with intracranial pressure changes.OCT is a promising modality for clinical and scientific evaluation of IIH as it is a noninvasive and practical tool to obtain in depth images.This review will discuss how OCT can be used to assess a patient with IIH,both before and after treatment,along with its limitations and future applications.

Idiopathic Intracranial Hypertension without Papilloedema “Case Report”

Purpose: The purpose of this case report is to share and spread the awareness of diagnosing and managing idiopathic intracranial hypertension in atypical scenarios as in this case, who presented with multiple other medical conditions, and had no papilloedema. The presenting signs and symptoms of mere headache were misleading. The other medical conditions could have explained the patient’s headache. These included cervical spine osteoporosis, and middle ear otolith disease. This case is unique because she was found to have IIH without papilloedema, and despite having multiple cancers in the uterus, breasts, and recently the thyroid, she had no malignant cells in the CSF. The patient was treated for IIH, and her malignancies were treated separately by the corresponding physicians. Method: The patient was assessed in 2019, and was followed up closely till 2021, in collaboration with her neurologist, oncologist, and orthopedist. Result: The patient had IIH after her neurologist attempted a lumbar puncture, which showed high CSF pressure. Conclusion: Headache is a common symptom presented by patients of different ages and backgrounds. The absence of papilloedema does not exclude the diagnosis of IIH. When possible etiologies for headache are ruled out (e.g. middle and inner ear infections, anemia, intracranial tumors, glaucoma, etc.), chronic headaches that do not respond to medications, and present with visual field changes may require a lumbar puncture.

Shunting,optic nerve sheath fenestration and dural venous stenting for medically refractory idiopathic intracranial hypertension:systematic review and meta-analysis

Background:Cerebrospinal fluid(CSF)-diversion procedures have traditionally been the standard of treatment for patients with medically refractive idiopathic intracranial hypertension(IIH).However,dural venous sinus stent(VSS)placement has been described as a safe and effective procedure for the management of medically refractive IIH.We performed a meta-analysis comparing outcomes and complications of CSF-diversion procedures,VSS and optic nerve sheath fenestration(ONSF)for the treatment of medically refractive IIH.Methods:Electronic searches were performed using six databases from 1988 to January 2017.Data was extracted and meta-analysed from the identified studies.Results:From 55 pooled studies,there were 538 CSF-diversion cases,224 dural venous stent placements,and 872 ONSF procedures.Similar improvements were found in terms of postoperative headaches(CSF vs.VSS vs.ONSF:84%vs.78%vs.62%,P=0.223),papilledema(CSF vs.VSS vs.ONSF:71%vs.86%vs.77%,P=0.192),whilst visual acuity changes favored venous stenting(CSF vs.VSS vs.ONSF:55%vs.69%vs.44%,P=0.037).There was a significantly lower rate of subsequent procedures with venous stent placement(CSF vs.VSS vs.ONSF:37%vs.13%vs.18%,P<0.001),but other complication rates were similar(CSF vs.VSS vs.ONSF:13%vs.8%vs.14%,P=0.28).Subgroup analysis of lumbar-peritoneal vs.ventriculoperitoneal shunts found no differences in symptom improvements,complications and subsequent procedure rates.Conclusions:Our findings suggest that dural venous sinus stenting may be a viable alternative to traditional surgical interventions in patients who are refractory to medical treatment.

An Unusual Cause of Irritability in a Single Ventricle Patient after Bidirectional Glenn Shunt

The differential diagnosis for irritability in children is broad.In patients with congenital heart disease,one must strongly consider cardiac etiologies such as low cardiac output or elevated central venous pressure(CVP).In patients with single-ventricle physiology,the second stage of palliation includes bidirectional Glenn,which involves anastomosis of the superior vena cava to the pulmonary artery resulting in volume offloading of the single systemic ventricle.Typically,early in the post-operative period,patients may experience a headache due to the acute increase in CVP,and symptoms improve over time.Idiopathic intracranial hypertension(IIH),also known as pseudotumor cerebri,is a rare neurologic disorder in children,characterized by raised intracranial pressure(ICP)in the absence of brain parenchymal lesions or cerebrospinal fluid(CSF)abnormalities.While the pathogenesis of IIH is unknown,early recognition and treatment of IIH are important to prevent permanent vision loss.There are only rare reports of IIH in patients with Fontan circulation.To our knowledge,we report the first case of IIH in a 2-year-old female after bidirectional Glenn.

Pediatric neuro-ophthalmology:not simply neuro-ophthalmology for small adults

Pediatric neuro-ophthalmology is a subspecialty within neuro-ophthalmology.Pediatric neuro-ophthalmic diseases must be considered separate from their adult counterparts,due to the distinctive nature of the examination,clinical presentations,and management choices.This manuscript will highlight four common pediatric neuro-ophthalmic disorders by describing common clinical presentations,recommended management,and highlighting recent developments.Diseases discussed include pediatric idiopathic intracranial hypertension(IIH),pseudopapilledema,optic neuritis(ON)and optic pathway gliomas(OPG).The demographics,diagnosis and management of common pediatric neuro-ophthalmic disease require a working knowledge of the current research presented herein.Special attention should be placed on the differences between pediatric and adult entities such that children can be appropriately diagnosed and treated.