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Eaton JE, Oguz I, Kazimuddin H, Bagnato F. Intracranial Hypertension Associated With Poly-Cranio-Radicular-Neuropathies: A Case Report and Review of the Literature. Neurologist 2024; 29:166-169. [PMID: 38372201 DOI: 10.1097/nrl.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
INTRODUCTION We present the case of a gentleman who developed rapidly progressive vision loss, ophthalmo-paresis, and flaccid quadriparesis in the context of severe intracranial hypertension. We reviewed the available cases in the literature to increase awareness of this rare clinical entity.Case Report:A 36-year-old man developed rapidly progressive vision loss, ophthalmo-paresis, and flaccid quadriparesis. He had an extensive workup, only notable for severe intracranial hypertension, >55 cm of H 2 O. No inflammatory features were present, and the patient responded to CSF diversion. Few similar cases are available in the literature, but all show markedly elevated intracranial pressure associated with extensive neuroaxis dysfunction. Similarly, these patients improved with CSF diversion but did not appear to respond to immune-based therapies. CONCLUSIONS We term this extensive neuroaxis dysfunction intracranial hypertension associated with poly-cranio-radicular-neuropathy (IHP) and distinguish it from similar immune-mediated clinical presentations. Clinicians should be aware of the different etiologies of this potentially devastating clinical presentation to inform appropriate and timely treatment.
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Affiliation(s)
| | - Ipek Oguz
- Department of Computer Science, Vanderbilt University
| | - Habeeb Kazimuddin
- Neuroimaging Unit, Department of Neurology, Neuroimmunology Division, Vanderbilt University Medical Center
- Department of Computer Science, Vanderbilt University
| | - Francesca Bagnato
- Department of Neurology
- Neuroimaging Unit, Department of Neurology, Neuroimmunology Division, Vanderbilt University Medical Center
- Department of Neurology, VA Hospital, TN Valley Healthcare System, Nashville, TN
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Sowmini PR, Kumar SP, Velayutham SS, Kannan V, Mugundhan K. Fulminant Idiopathic Intracranial Hypertension with Atypical Presentation. Ann Indian Acad Neurol 2023; 26:1026-1028. [PMID: 38229618 PMCID: PMC10789399 DOI: 10.4103/aian.aian_655_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- PR Sowmini
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - S Pramod Kumar
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - S Sakthi Velayutham
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - V Kannan
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Krishnan Mugundhan
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
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Theologou R, Nteveros A, Artemiadis A, Faropoulos K. Rare Causes of Cerebral Venus Sinus Thrombosis: A Systematic Review. Life (Basel) 2023; 13:life13051178. [PMID: 37240823 DOI: 10.3390/life13051178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/15/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Cerebral venous sinus thrombosis (CVST) is a rare manifestation of thrombosis commonly caused by thrombophilia, hormonal-related factors, non-cerebral malignancy, and hematologic diseases. The aim of this review was to identify and summarize rare CVST cases. Methods: A literature search of the Medline database was performed in November 2022. CVST cases of a common cause were excluded. Demographic and clinical data were extracted. Eligible cases were categorized into inflammatory, primary CNS tumors, post-operative/traumatic, and idiopathic groups to allow statistical group comparisons. Results: 76 cases were analyzed. Idiopathic CVST was most frequently reported followed by inflammatory, post-traumatic/operative and primary CNS tumor causes. The intracranial hemorrhage rate was 23.7% and it was found to increase in the inflammatory group (45.8%). Anticoagulation was used in the majority of cases and it was significantly related to better outcomes. A low rate of anticoagulation use (43.8%) was found among CVST cases in the post-operative/traumatic group. The overall mortality rate was 9.8%. 82.4% of patients showed significant early improvement. Conclusions: Most rare CVST cases were either of idiopathic or inflammatory origin. Interestingly, hemorrhage occurred often he idiopathic CVST cases. A low rate of anticoagulation use in neurosurgical CVST cases after trauma or head surgery was observed.
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Affiliation(s)
| | - Antonios Nteveros
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
| | - Artemios Artemiadis
- Department of Neurology, Nicosia General Hospital, 2029 Nicosia, Cyprus
- Medical School, University of Cyprus, 1678 Nicosia, Cyprus
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Hulens M, Dankaerts W, Rasschaert R, Bruyninckx F, De Mulder P, Bervoets C. The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure. J Pain Res 2023; 16:205-219. [PMID: 36721849 PMCID: PMC9884441 DOI: 10.2147/jpr.s394321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
The etiopathogenesis of fibromyalgia (FM) and chronic fatigue syndrome (CFS) is not yet elucidated. Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is reflected in the hormonal disturbances found in FM and CFS. Some study groups have introduced a novel hypothesis that moderate or intermittent intracranial hypertension may be involved in the etiopathogenesis of FM and CFS. In these conditions, hormonal disturbances may be caused by the mechanical effect of increased cerebrospinal fluid pressure, which hampers blood flow in the pituitary gland. Severe intracranial pressure may compress the pituitary gland, resulting in primary empty sella (ES), potentially leading to pituitary hormone deficiencies. The aim of this narrative review was to explore whether similar hormonal changes and symptoms exist between primary ES and FM or CFS and to link them to cerebrospinal fluid pressure dysregulation. A thorough search of the PubMed and Web of Science databases and the reference lists of the included studies revealed that several clinical characteristics were more prevalent in primary ES, FM or CFS patients than in controls, including increased cerebrospinal fluid pressure, obesity, female sex, headaches and migraine, fatigue, visual disturbances (visual acuity and eye motility abnormalities), vestibulocochlear disturbances (vertigo and neurosensorial hearing loss), and bodily pain (radicular pain and small-fiber neuropathy). Furthermore, challenge tests of the pituitary gland showed similar abnormalities in all three conditions: blunted adrenocorticotropic hormone, cortisol, growth hormone, luteinizing hormone, and thyroid stimulating hormone responses and an increased prolactin response. The findings of this narrative review provide further support for the hypothesis that moderately or intermittently increased cerebrospinal fluid pressure is involved in the pathogenesis of FM and CFS and should stimulate further research into the etiopathogenesis of these conditions.
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Affiliation(s)
- Mieke Hulens
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium,Correspondence: Mieke Hulens, Department of Rehabilitation Sciences, KU Leuven, Overwegstraat 14, 3051 Sint-Joris-Weert, Leuven, Belgium, Tel +32 477 338003, Fax +32 16 329197, Email
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Frans Bruyninckx
- Department of Physical Medicine & Rehabilitation, University Hospitals of Leuven, Leuven, Belgium
| | - Peter De Mulder
- Department of Anesthesiology and Pain Therapy, Imelda Hospital, Bonheiden, Belgium
| | - Chris Bervoets
- Department of Neurosciences, KU Leuven, Leuven, Belgium,Department of Ophthalmology, University Hospitals of Leuven, Leuven, Belgium,Department Adult Psychiatry, University Psychiatric Center of KU Leuven, Leuven, Belgium
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Raman SP, Velayutham SS, Jeyaraj KM, Kumar MS, Mugundhan K. Polyradiculopathy and Multiple Cranial Nerve Palsies - Rare Manifestations of Cerebral Venous Sinus Thrombosis. Neurol India 2021; 69:170-173. [PMID: 33642294 DOI: 10.4103/0028-3886.310084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report about two young males who developed significant proximal weakness of all four limbs secondary to intracranial hypertension due to intracranial venous sinus thrombosis. Intracranial venous sinus thrombosis can manifest in a variety of ways which includes isolated intracranial hypertension, focal neurological symptoms or signs and acute or subacute encephalopathy. Various false localising signs have been reported to occur in patients with raised intracranial pressure including cranial nerve palsies and extensive radiculopathy. In a patient presenting with flaccid areflexic quadriparesis and papilledema, the possibility of a potentially reversible dysfunction of the cranial nerves and spinal nerve roots due to a marked rise in intracranial and intraspinal pressure must be recognised. Lumboperitoneal shunt to reduce the intraspinal pressure on the spinal nerve roots has been advocated to reverse the symptoms of extensive radiculopathy in such patients. Both of our patients showed remarkable improvement in symptoms and signs with medical treatment of CVT.
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Affiliation(s)
| | - S Sakthi Velayutham
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - K Malcolm Jeyaraj
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - M Sathish Kumar
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - K Mugundhan
- Department of Neurology, Stanley Medical College, Chennai, Tamil Nadu, India
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Nathan C, O'Kula S, Bausell R, Hamedani A. Pseudotumor Cerebri Syndrome Complicated by Diffuse Ophthalmoparesis and Polyradiculopathy. Neurohospitalist 2021; 11:71-74. [PMID: 33868562 DOI: 10.1177/1941874420945565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pseudotumor cerebri syndrome (PTCS), also known as idiopathic intracranial hypertension (IIH), is defined by elevated intracranial pressure in the absence of a structural or cerebrospinal fluid (CSF) abnormality. Typical features include headache, visual symptoms, and pulsatile tinnitus. Cranial nerve deficits are seen in a minority of cases, most often sixth nerve palsies. We present a unique cause of PTCS complicated by diffuse ophthalmoparesis and polyradiculopathy. A 27-year-old healthy woman presented with 2 weeks of blurry vision, diplopia, and facial and arm weakness. On examination, she had decreased visual acuity, markedly constricted visual fields in both eyes, with severe bilateral optic disc edema on fundus examination. There was diffuse ophthalmoparesis, right upper and lower facial weakness, and bilateral arm weakness. Magnetic resonance imaging brain revealed optic disc protrusion and a partially empty sella but no other abnormalities. Electromyogram (EMG) was consistent with bilateral C5-6 radiculopathies. Lumbar puncture revealed an opening pressure of 56 cm H2O with otherwise normal CSF constituents. She was treated with high-dose acetazolamide and methylprednisolone followed by optic nerve sheath fenestration. Due to progressive vision loss, she ultimately required ventriculoperitoneal shunting, after which her papilledema, ophthalmoparesis, and facial and arm weakness rapidly improved. This is a unique case of PTCS associated with diffuse ophthalmoparesis and polyradiculopathy. This constellation of abnormalities usually suggests an underlying inflammatory process in the subarachnoid space. However, once this has been excluded, the possibility of PTCS should be considered as early treatment can result in rapid reversal of symptoms and preserve visual function.
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Affiliation(s)
- Cody Nathan
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Rebecca Bausell
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ali Hamedani
- University of Pennsylvania, Philadelphia, PA, USA
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Chen BS, Newman NJ, Biousse V. Atypical presentations of idiopathic intracranial hypertension. Taiwan J Ophthalmol 2021; 11:25-38. [PMID: 33767953 PMCID: PMC7971435 DOI: 10.4103/tjo.tjo_69_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/11/2020] [Indexed: 11/05/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that results in isolated raised intracranial pressure. Classic symptoms and signs of IIH include headache, papilledema, diplopia from sixth nerve palsy and divergence insufficiency, and pulsatile tinnitus. Atypical presentations include: (1) highly asymmetric or even unilateral papilledema, and IIH without papilledema; (2) ocular motor disturbances from third nerve palsy, fourth nerve palsy, internuclear ophthalmoplegia, diffuse ophthalmoplegia, and skew deviation; (3) olfactory dysfunction; (4) trigeminal nerve dysfunction; (5) facial nerve dysfunction; (6) hearing loss and vestibular dysfunction; (7) lower cranial nerve dysfunction including deviated uvula, torticollis, and tongue weakness; (8) spontaneous skull base cerebrospinal fluid leak; and (9) seizures. Although atypical findings should raise a red flag and prompt further investigation for an alternative etiology, clinicians should be familiar with these unusual presentations.
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Affiliation(s)
- Benson S. Chen
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
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Elavarasi A, Dash D, Singh PK, Tripathi M. High-Pressure Normocephalus-Raised Intracranial Pressure with False Localizing Signs. Ann Indian Acad Neurol 2020; 23:536-538. [PMID: 33223673 PMCID: PMC7657280 DOI: 10.4103/aian.aian_431_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/04/2022] Open
Abstract
Normal-sized ventricles and absence of papilledema do not rule out shunt failure and raised intracranial pressure (ICP). Raised ICP can present with false localizing signs which may be cranial nerve palsies or extensive polyradiculopathy. Our patient with a history of ventriculoperitoneal (VP) shunt presented with rapidly progressive vision loss without papilledema, as well as multiple cranial nerve palsies and radiculopathy. Imaging did not reveal hydrocephalus, however, cerebrospinal fluid (CSF) manometry revealed high CSF opening pressure. After lumbar thecoperitoneal shunting, vision did not improve, but the rest of cranial nerve palsies and radiculopathy improved. In a patient in whom VP shunt is in situ, headache and vomiting should prompt evaluation for raised ICP though there is no ventriculomegaly of papilledema. Vision can be saved if raised ICP is suspected, CSF opening pressure measured at presentation and prompt surgery is performed.
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Affiliation(s)
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Li B, Sursal T, Bowers C, Cole C, Gandhi C, Schmidt M, Mayer S, Al-Mufti F. Chameleons, red herrings, and false localizing signs in neurocritical care. Br J Neurosurg 2020; 36:298-306. [PMID: 32924623 DOI: 10.1080/02688697.2020.1820945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
False localizing signs (FLS) and other misleading neurological signs have long been an intractable aspect of neurocritical care. Because they suggest an incorrect location or etiology of the pathological lesion, they have often led to misdiagnosis and mismanagement of the patient. Here, we reviewed the existing literature to provide an updated, comprehensive descriptive review of these difficult to diagnose signs in neurocritical care. For each sign presented, we discuss the non-false localizing presentation of symptoms, the common FLS or misleading presentation, etiology/pathogenesis of the sign, and diagnosis, as well as any other clinically relevant considerations. Within cranial neuropathies, we cover cranial nerves III, IV, V, VI, VII, VIII, as well as multiple cranial nerve involvement of IX, X, and XII. FLS ophthalmologic symptoms indicate diagnostically challenging neurological deficits, and here we discuss downbeat nystagmus, ping-pong-gaze, one-and-a-half syndrome, and wall-eyed bilateral nuclear ophthalmoplegia (WEBINO). Cranial herniation syndromes are integral to any discussion of FLS and here we cover Kernohan's notch phenomenon, pseudo-Dandy Walker malformation, and uncal herniation. FLS in the spinal cord have also been relatively well documented, but in addition to compressive lesions, we also discuss newer findings in radiculopathy and disc herniation. Finally, pulmonary syndromes may sometimes be overlooked in discussions of neurological signs but are critically important to recognize and manage in neurocritical care, and here we discuss Cheyne-Stokes respiration, cluster breathing, central neurogenic hyperventilation, ataxic breathing, Ondine's curse, and hypercapnia. Though some of these signs may be rare, the framework for diagnosing and treating them must continue to evolve with our growing understanding of their etiology and varied presentations.
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Affiliation(s)
- Boyi Li
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Tolga Sursal
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Chad Cole
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Chirag Gandhi
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Meic Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Stephan Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
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11
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Hulens M, Rasschaert R, Vansant G, Stalmans I, Bruyninckx F, Dankaerts W. The link between idiopathic intracranial hypertension, fibromyalgia, and chronic fatigue syndrome: exploration of a shared pathophysiology. J Pain Res 2018; 11:3129-3140. [PMID: 30573989 PMCID: PMC6292399 DOI: 10.2147/jpr.s186878] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Idiopathic intracranial hypertension (IICH) is a condition characterized by raised intracranial pressure (ICP), and its diagnosis is established when the opening pressure measured during a lumbar puncture is elevated >20 cm H2O in nonobese patients or >25 cm H2O in obese patients. Papilledema is caused by forced filling of the optic nerve sheath with cerebrospinal fluid (CSF). Other common but underappreciated symptoms of IICH are neck pain, back pain, and radicular pain in the arms and legs resulting from associated increased spinal pressure and forced filling of the spinal nerves with CSF. Widespread pain and also several other characteristics of IICH share notable similarities with characteristics of fibromyalgia (FM) and chronic fatigue syndrome (CFS), two overlapping chronic pain conditions. The aim of this review was to compare literature data regarding the characteristics of IICH, FM, and CFS and to link the shared data to an apparent underlying physiopathology, that is, increased ICP. METHODS Data in the literature regarding these three conditions were compared and linked to the hypothesis of the shared underlying physiopathology of increased cerebrospinal pressure. RESULTS The shared characteristics of IICH, FM, and CFS that can be caused by increased ICP include headaches, fatigue, cognitive impairment, loss of gray matter, involvement of cranial nerves, and overload of the lymphatic olfactory pathway. Increased pressure in the spinal canal and in peripheral nerve root sheaths causes widespread pain, weakness in the arms and legs, walking difficulties (ataxia), and bladder, bowel, and sphincter symptoms. Additionally, IICH, FM, and CFS are frequently associated with sympathetic overactivity symptoms and obesity. These conditions share a strong female predominance and are frequently associated with Ehlers-Danlos syndrome. CONCLUSION IICH, FM, and CFS share a large variety of symptoms that might all be explained by the same pathophysiology of increased cerebrospinal pressure.
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Affiliation(s)
- Mieke Hulens
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, University of Leuven, Leuven, Belgium,
| | - Ricky Rasschaert
- Department of Neurosurgery, Sint-Jozefziekenhuis, Bornem, Belgium
| | - Greet Vansant
- Department of Social and Primary Health Care, Public Health Nutrition, University of Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Department of Neurosciences, Ophthalmology Research Group, University of Leuven KU Leuven, Leuven, Belgium
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Frans Bruyninckx
- Clinical Electromyography Laboratory, Department of Academic Consultants, Faculty of Medicine, University Hospitals UZ Leuven, Leuven, Belgium
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Unit, University of Leuven, Leuven, Belgium,
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Hulens M, Rasschaert R, Dankaerts W, Stalmans I, Vansant G, Bruyninckx F. Spinal fluid evacuation may provide temporary relief for patients with unexplained widespread pain and fibromyalgia. Med Hypotheses 2018; 118:55-58. [DOI: 10.1016/j.mehy.2018.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 01/08/2023]
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Fibromyalgia and unexplained widespread pain: The idiopathic cerebrospinal pressure dysregulation hypothesis. Med Hypotheses 2018; 110:150-154. [PMID: 29317060 DOI: 10.1016/j.mehy.2017.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/22/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022]
Abstract
Fibromyalgia (FM) is a debilitating, widespread pain disorder that is assumed to originate from inappropriate pain processing in the central nervous system. Psychological and behavioral factors are both believed to underlie the pathogenesis and complicate the treatment. This hypothesis, however, has not yet been sufficiently supported by scientific evidence and accumulating evidence supports a peripheral neurological origin of the symptoms. We postulate that FM and several unexplained widespread pain syndromes are caused by chronic postural idiopathic cerebrospinal hypertension. Thus, the symptoms originate from the filling of nerve root sleeves under high pressure with subsequent polyradiculopathy from the compression of the nerve root fibers (axons) inside the sleeves. Associated symptoms, such as bladder and bowel dysfunction, result from compression of the sacral nerve root fibers, and facial pain and paresthesia result from compression of the cranial nerve root fibers. Idiopathic Intracranial Hypertension, Normal Pressure Hydrocephalus and the clinical entity of symptomatic Tarlov cysts share similar central and peripheral neurological symptoms and are likely other manifestations of the same condition. The hypothesis presented in this article links the characteristics of fibromyalgia and unexplained widespread pain to cerebrospinal pressure dysregulation with support from scientific evidence and provides a conclusive explanation for the multitude of symptoms associated with fibromyalgia.
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Ragab O, Ghali A, Al-Malt A, Al-Ahwal S. Radiculopathy as unusual presentation of idiopathic intracranial hypertension: A case report. Clin Neurol Neurosurg 2017; 163:81-83. [PMID: 29078127 DOI: 10.1016/j.clineuro.2017.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/10/2017] [Accepted: 10/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a disorder of young obese females and characterized by headache, papilledema with raised intracranial pressure in the absence of known pathological cause. However, ophthalmoplegia is common presentation of IIH, limb weakness is rare and may led to misdiagnosis and poor outcome. CASE We report female patient presented with acute onset of quadriparesis, headache and ophthalmoplegia, the fundus examination showed papilledema, the MRI brain showed no detectable abnormal finding.The intracranial pressure (ICP) was elevate. Nerve conduction study revealed sever radiculopathy. Our provisional diagnosis was fulminant idiopathic intracranial hypertension versus Gulliane Barre syndrome. The patient was submitted to CSF shunting which resulted in improvement of her symptoms. conclusion quadreparesis is a rare presentation of idiopathic intracranial hypertension, which may delay diagnosis and affect outcome. And urgent lumbo-peritoneal shunt was critical in saving patient vision and regaining ability to walk.
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Affiliation(s)
- Osama Ragab
- Tanta University, Neurology department, Tanta, Egypt.
| | - Azza Ghali
- Tanta University, Neurology department, Tanta, Egypt
| | - Ayman Al-Malt
- Tanta University, Neurology department, Tanta, Egypt
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15
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[Clinical presentation suggesting Bickerstaff encephalitis and intracranial hypertension]. Rev Neurol (Paris) 2010; 167:164-8. [PMID: 20728913 DOI: 10.1016/j.neurol.2010.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 03/18/2010] [Accepted: 06/15/2010] [Indexed: 11/22/2022]
Abstract
A 20-year-old man had progressive headache, neck pain and visual loss after upper airway infection. After 3 weeks, he developed ophtalmoplegia, ataxia, areflexia, autonomic failure, four limbs paresis with impaired consciousness. Brain and cervical MRI were normal. Ophthalmological examination confirmed bilateral papilledema. Cerebro-spinal fluid pressure was high, cell count was normal and proteins were mildly elevated. Electromyography showed presence of both proximal and distal demyelination. Electroencephalogram was slowed, with diffuse delta and theta waves. Anti-GM1 and GQ1b antibodies were negative. The patient was treated with intravenous immunoglobulins (0.4 g/kg/day) for 5 days, associated with high doses of acetazolamide and corticosteroids for papilledema. His neurological condition improved for gait, strength, pain, ophtalmoplegia and ataxia. He kept severe visual loss with optic atrophy. Diagnosis is discussed: Bickerstaff encephalitis with intracranial hypertension or malignant pseudotumor cerebri?
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Santiago-Palma J, Jimenez J, Barna S, Messina K. Radicular pain in a patient with aqueductal cerebral stenosis. PM R 2009; 1:884-6. [PMID: 19769925 DOI: 10.1016/j.pmrj.2009.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 07/08/2009] [Accepted: 07/12/2009] [Indexed: 11/26/2022]
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Kincaid O, Rowin J. Intracranial hypertension causing polyradiculopathy and late or absent F-waves. J Neurol Neurosurg Psychiatry 2006; 77:1384-6. [PMID: 17110754 PMCID: PMC2077419 DOI: 10.1136/jnnp.2006.092387] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Skau M, Brennum J, Gjerris F, Jensen R. What is new about idiopathic intracranial hypertension? An updated review of mechanism and treatment. Cephalalgia 2006; 26:384-99. [PMID: 16556239 DOI: 10.1111/j.1468-2982.2005.01055.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Idiopathic intracranial hypertension (IIH) is the syndrome of raised intracranial pressure without clinical, laboratory or radiological evidence of intracranial pathology. IIH is a relatively rare disease but rapidly increasing incidence is reported due to a global increasing incidence of obesity. Disease course is generally said to be self-limiting within a few months. However, some patients experience a disabling condition of chronic severe headache and visual disturbances for years that limit their capacity to work. Permanent visual defects are serious and not infrequent complications. The pathophysiology of IIH is still not fully understood. Advances in neuroimaging techniques have facilitated the exclusion of associated conditions that may mimic IIH. No causal treatment is yet known for IIH and existing treatment is symptomatic and rarely sufficient. The aim of this review is to provide an updated overview of this potentially disabling disease which may show a future escalating incidence due to obesity. Theories of pathogenesis, diagnostic criteria and treatment strategies are discussed.
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Affiliation(s)
- M Skau
- Danish Headache Centre, Glostrup University Hospital, Glostrup, Denmark.
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