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Schuchardt FF, Lützen N, Küchlin S, Reich M, Lagrèze WA, Mast H, Weigel M, Meckel S, Urbach H, Weiller C, Harloff A, Demerath T. Clinical value of neuroimaging indicators of intracranial hypertension in patients with cerebral venous thrombosis. Neuroradiology 2024:10.1007/s00234-024-03363-6. [PMID: 38676750 DOI: 10.1007/s00234-024-03363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Intracranial hypertension (IH) frequently complicates cerebral venous thrombosis (CVT). Distinct neuroimaging findings are associated with IH, yet their discriminative power, reversibility and factors favoring normalization in prospective CVT patients are unknown. We determined test performance measures of neuroimaging signs in acute CVT patients, their longitudinal change under anticoagulation, association with IH at baseline and with recanalization at follow-up. METHODS We included 26 consecutive acute CVT patients and 26 healthy controls. Patients were classified as having IH based on CSF pressure > 25 cmH2O and/or papilledema on ophthalmological examination or ocular MRI. We assessed optic nerve sheath diameter (ONSD), optic nerve tortuousity, bulbar flattening, lateral and IVth ventricle size, pituitary configuration at baseline and follow-up, and their association with IH and venous recanalization. RESULTS 46% of CVT patients had IH. ONSD enlargement > 5.8 mm, optic nerve tortuousity and pituitary grade ≥ III had highest sensitivity, ocular bulb flattening and pituitary grade ≥ III highest specificity for IH. Only ONSD reliably discriminated IH at baseline. Recanalization was significantly associated with regressive ONSD and pituitary grade. Other neuroimaging signs tended to regress with recanalization. After treatment, 184.9 ± 44.7 days after diagnosis, bulbar flattening resolved, whereas compared with controls ONSD enlargement (p < 0.001) and partially empty sella (p = 0.017), among other indicators, persisted. CONCLUSION ONSD and pituitary grading have a high diagnostic value in diagnosing and monitoring CVT-associated IH. Given their limited sensitivity during early CVT and potentially persistent alterations following IH, neuroimaging indicators can neither replace CSF pressure measurement in diagnosing IH, nor determine the duration of anticoagulation.
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Affiliation(s)
- Florian F Schuchardt
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Niklas Lützen
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Küchlin
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjörg Mast
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Allschwil, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Stephan Meckel
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Diagnostic and Interventional Neuroradiology, RKH Kliniken Ludwigsburg, Ludwigsburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lerner A, Sheikh-Bahaei N, Go JL. Utility of Neuroimaging in the Management of Chronic and Acute Headache. Otolaryngol Clin North Am 2022; 55:559-577. [PMID: 35490044 DOI: 10.1016/j.otc.2022.02.010] [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: 10/18/2022]
Abstract
Imaging plays an important role in identifying the cause of the much less common secondary headaches. Such headaches may be caused by a variety of pathologic conditions which can be categorized as intracranial and extracranial. Idiopathic intracranial hypertension imaging findings include "empty sella," orbital changes, and dural venous sinus narrowing. Intracranial hypotension (ICH) is frequently caused by CSF leaks. Imaging findings include loss of the CSF spaces, downward displacement of the brain, as well as dural thickening and enhancement. Severe cases of ICH may result in subdural hematomas. A variety of intracranial and skull base tumors may cause headaches due to dural involvement. Extracranial tumors and lesions that frequently present with headaches include a variety of sinonasal tumors as well as mucoceles. Neurovascular compression disorders causing headaches include trigeminal and glossopharyngeal neuralgia. Imaging findings include displacement and atrophy of the cranial nerve caused by an adjacent arterial or venous structure.
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Affiliation(s)
- Alexander Lerner
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA.
| | - Nasim Sheikh-Bahaei
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
| | - John L Go
- Keck Medical Center of USCD, Department of Radiology, 1500 San Pablo Street, 2nd Floor, Imaging, Los Angeles, CA 90033, USA
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Differentiation of transverse sinus thrombosis from congenitally atretic transverse sinus with time-resolved contrast-enhanced magnetic resonance angiography. Clin Radiol 2022; 77:e372-e378. [DOI: 10.1016/j.crad.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/01/2022] [Indexed: 01/21/2023]
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Serova NK, Eliseeva NM. [Papilledema as a sign of intracranial hypertension]. Vestn Oftalmol 2022; 138:87-93. [PMID: 36004596 DOI: 10.17116/oftalma202213804187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Papilledema (choked disk) is a sign of intracranial hypertension (ICH) - condition that presents danger not only for patient's vision, but also for their life. Despite the fact that ICH is usually a neurosurgical pathology, sometimes an ophthalmologist is the first doctor such patients visit, most often in a primary healthcare clinic. At the same time, as practice shows, not all ophthalmologists are well aware about in this pathology; difficulties occur in differential diagnosis of papilledema against similar changes of the optic nerve head seen during ophthalmoscopic examination. This article reviews scientific literature on ICH, including benign ICH, diagnosis and differential diagnosis of papilledema. The authors also share their decades-long experience of working in a neurosurgical facility.
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Affiliation(s)
- N K Serova
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - N M Eliseeva
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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Netravathi M, Holla VV, Saini J, Mahadevan A. Prodromal emesis in MOG-antibody associated disorder. Mult Scler Relat Disord 2021; 58:103463. [PMID: 34933247 DOI: 10.1016/j.msard.2021.103463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exclusive emesis has been observed in few patients of MOG-associated disorder (MOGAD). OBJECTIVES To study the occurrence of emesis in patients of Demyelinating disorders and determine their clinical and radiological features. METHODS AND RESULTS Medical records of 551 patients of CNS demyelinating disorders were reviewed. Exclusive emesis without hiccups was observed in 1 (0.1%) patient of MS, 17 (6.5%) patients of MOGAD while none were observed in patients of AQP4-ab associated disorders (p < 0.001). There were 17(M:F-8:9) patients with exclusive emesis in MOGAD in 58.8% pediatric age group, adults (35.3%) and late-onset (5.9%). ADEMON (acute demyelinating encephalomyelitis -ADEM followed by optic neuritis) was observed in 7 patients. Preceding clinical syndrome was ON (41.2%), brainstem syndrome (BS) (23.5%), involvement of both ON and BS in 23.5%, myelopathy (11.8%). MRI analysis showed combination of lesions affecting the brainstem (11), optic nerve (10), juxtacortical white matter (10) and periventricular lesions (3). Odds ratio for the presence of ADEM, lesions in medulla, pons, MCP or any of the three areas was found to be significant. CONCLUSIONS Exclusive emesis without hiccups appears to be common in MOG-antibody associated disorder and may occur as a prodromal illness or exclusive clinical episode. It is known to occur most commonly in association with ADEM and/or Optic neuritis.
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Affiliation(s)
- M Netravathi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India.
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Neuroradiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Pediatric Intracranial Hypertension: A Spotlight on Imaging, the Idiopathic Intracranial Hypertension Treatment Trial, and COVID-19 Associated Cases. Semin Pediatr Neurol 2021; 40:100922. [PMID: 34749916 DOI: 10.1016/j.spen.2021.100922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
Primary intracranial hypertension (PIH) is characterized by clinical signs of increased intracranial pressure, papilledema, elevated opening pressure, and absence of mass lesion, hydrocephalus, or meningeal enhancement on neuroimaging. Visual changes are a common presenting feature and if untreated there is risk of irreversible vision loss. There have been recent proposed changes to the criteria for PIH along with studies looking at the differences in imaging characteristics between adult and pediatric PIH. The presence of transverse sinus stenosis alone was highly sensitive and specific for pediatric PIH. The Idiopathic Intracranial Hypertension Treatment Trial was an adult, multicenter study that examined the use of acetazolamide and weight loss on the course of PIH. The study confirmed many previously held beliefs including the most common presenting symptom in PIH is headache. Most patients present with bilateral papilledema with 58.2% of patients having symmetric Frisen scale grading and within one grade in 92.8%. Although diplopia is a common reported symptom, very few have evidence of cranial nerve palsy. Male gender, high-grade papilledema, and decreased visual acuity at presentation are risk factors for treatment failure. Acetazolamide use is associated with mild metabolic acidosis. During acetazolamide treatment, monitoring for hypokalemia or aplastic anemia is not recommended. Monitoring transaminases in the titration phase of treatment should be considered due to a case of transaminitis and pancreatitis with elevated lipase. Newer case reports have also seen associations of secondary intracranial hypertension with concurrent COVID-19 infection and MIS-C.
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Elmaaty AAA, Zarad CA, Belal TI, Elserafy TS. Diagnostic value of brain MR imaging and its correlation with clinical presentation and cognitive functions in idiopathic intracranial hypertension patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Idiopathic intracranial hypertension (IIH) is a neurological disorder of unknown etiology and ambiguous pathophysiology due to cerebrospinal fluid dysregulation. This study is designed to evaluate the role of brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in diagnosis of IIH, to clarify the nature and extent of cognitive deficits, and to detect if there is a correlation between radiology, clinical findings, and cognitive dysfunctions in those patients.
Results
The study included 34 patients and 34 age-, sex-, body mass index (BMI)-, and education-matched healthy control subjects. MR brain imaging and Montreal cognitive assessment (MoCA) test were used for both groups. MRI and MRV sensitivity for IIH diagnosis were 85.2% and 85.3% with 100% and 94.1% specificity respectively. 44.1% had cognitive impairment, memory was the most affected domain, followed by attention, abstraction, and orientation with statistically significantly lower total MoCA score (p < 0.005). Domain comparisons reveal a statistically significantly lower memory/delayed recall (p < 0.001) and abstract scores (p < 0.007) in IIH cases versus control subjects. In comparing patients with cognitive impairment (CI) versus those without CI, there were statistically significantly higher CI in low education level, presence of diplopia, hormonal contraceptive use, abnormal MRI brain, papilledema grades, BMI, and opening pressure.
Conclusions
Presence of more than or equal 3 MR imaging findings, bilateral transverse sinus stenosis, and less than or equal 4 combined conduit score increase the specificity and sensitivity of MRI and MRV for IIH diagnosis. IIH had detrimental effect on different cognitive domains especially when patient have low education level, diplopia, papilledema ≥ grade III, high OP ≥ 61.5 cm H2O, and BMI ≥ 34 Kg/m2 with abnormal MRI and MRV findings.
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Seber T, Bayram N, Bayram AK, Seber TU. Apparent diffusion coefficient echoplanar imaging maps of the optic nerves in childhood idiopathic intracranial hypertension. J Neuroimaging 2021; 31:1184-1191. [PMID: 34388272 DOI: 10.1111/jon.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Dueto motion artifacts, optic nerve (ON) findings of idiopathic intracranial hypertension (IIH) can easily be overlooked on T2-weighted (T2w) turbo spin-echo sequence. This study aimed to investigate the contribution of the apparent diffusion coefficient (ADC) map derived from the interleaved multi-shot (IMS) echoplanar imaging (EPI) to the ON findings of IIH in children. METHODS MRIs of 42 pediatric patients aged 3-17 years diagnosed with definite IIH according to modified Dandy criteria were retrospectively re-evaluated, between April 2018 and January 2021. Forty-two age- and sex-matched subjects with no IIH symptoms and reported as normal were included as a control group. RESULTS ON sheath distance (ONSD) on the ADC map (p = .005) and vertical tortuosity (p = .030) were significant single MRI parameters for predicting IIH. Other single parameters were not statistically significant. Flattening of the posterior sclera (FPS) and ON protrusion (ONP) were observed on ADC maps more frequently than T2w (42.8% vs. 19% and 19% vs. 4.7%, respectively). From combined MRI parameters, the presence of at least one of ONP, FPS, or ONSD on ADC maps (p = .001) showed greater significance than the presence of T2w (p = .048). The predictive values of other MRI findings evaluated together were not statistically significant (p > .05). CONCLUSIONS This study's results show that due to the short readout time and less sensitivity to motion, the ADC map obtained from IMS-EPI can contribute to orbital findings of IIH, in addition to T2w.
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Affiliation(s)
- Turgut Seber
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Nurettin Bayram
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Ayşe Kaçar Bayram
- Department of Pediatric Neurology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Tuğba Uylar Seber
- Department of Radiology, Kayseri City Education and Research Hospital, Kayseri, Turkey
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Spadaro A, Scott KR, Koyfman A, Long B. Cerebral venous thrombosis: Diagnosis and management in the emergency department setting. Am J Emerg Med 2021; 47:24-29. [PMID: 33765589 DOI: 10.1016/j.ajem.2021.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon neurologic emergency associated with significant morbidity and mortality that can be difficult to differentiate from other conditions. It is important for the emergency clinician to be familiar with this disease as it requires a high index of suspicion, and early diagnosis and management can lead to improved outcomes. OBJECTIVE This narrative review provides an evidence-based update concerning the presentation, evaluation, and management of CVT for the emergency clinician. DISCUSSION CVT is due to thrombosis of the cerebral veins resulting in obstruction of venous outflow and increased intracranial pressure. Early recognition is important but difficult as the clinical presentation can mimic more common disease patterns. The most common patient population affected includes women under the age of 50. Risk factors for CVT include pregnancy, medications (oral contraceptives), inherited thrombophilia, prior venous thromboembolic event, malignancy, recent infection, and neurosurgery. CVT can present in a variety of ways, but the most common symptom is headache, followed by focal neurologic deficit, seizure, and altered mental status. Imaging studies such as computed tomography (CT) venography or magnetic resonance (MR) venography should be obtained in patients with concern for CVT, as non-contrast CT will be normal or have non-specific findings in most patients. Treatment includes anticoagulation, treating seizures and elevated ICP aggressively, and neurosurgical or interventional radiology consultation in select cases. CONCLUSIONS CVT can be a challenging diagnosis. Knowledge of the risk factors, patient presentation, evaluation, and management can assist emergency clinicians.
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Affiliation(s)
- Anthony Spadaro
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Kevin R Scott
- Department of Emergency Medicine, University of Pennsylvania Health System, Philadelphia, PA, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
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A clinical and radiological study in patients with idiopathic intracranial hypertension. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00189-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Idiopathic intracranial hypertension (IIH) is one of the chronic causes of elevated intracranial pressure with no evident cause in neuroimaging and normal CSF analysis. It primarily affects overweight women of childbearing age.
Aim of work
To describe the clinical picture of IIH, neuroimaging and response to treatment after 3 months follow up in a sample of Egyptian patients.
Patients and methods
This was a prospective study carried out on 25 patients presented at Alexandria University Hospital with symptomatology of IIH. All the patients were subjected to complete history taking, neurological examination, fundus examination, lumbar puncture, and MRI brain and MR cerebral venography. The patients were followed-up for 3 months for assessment of treatment response.
Results
Patients’ ages ranged from 1 0to 50 years, with a mean BMI 32.32 ± 5.28 kg m2. Headache was the presenting manifestation in 100% of the patients. About 60% of the sample were either misdiagnosed or had a delayed diagnosis. There was a significant positive correlation between CSF opening pressure (r = 0.504, p = 0.010), severity of headache (r = 0.472, p = 0.017) and grade of papilledema. Optic hydropes and empty sellaturcica were the most common MRI abnormalities occurring in 95.8% and 70.8%, respectively. Only 30% of the cases had normal MRV. Stenosis at genu junction and focal stenosis at transverse sinus occurred in 24% and 20% of the cases, respectively. Combined medical and serial lumbar puncture were the most effective line of therapy in the recruited patients.
Conclusion
Headache is the most common presentation of IIH, and its severity is positively correlated with papilledema grade. CSF pressure is also positively correlated with papilledema grade.
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Zong C, Yu X, Liu J, Liu Y. Dural Venous Sinuses: What We Need to Know. Curr Med Imaging 2020; 16:1259-1270. [PMID: 32101130 DOI: 10.2174/1573405616666200226102642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/29/2019] [Accepted: 12/27/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The dural venous sinuses (DVS), in general, are frequently asymmetrical and display far more anatomical variations than arterial systems. A comprehensive study of the anatomy and variants of the DVS can help surgeons in the preoperative evaluation and management as well as minimizing possible complications in the following treatment. METHODS The current review was designed to provide a general overview of the normal anatomy and notable variants of the cerebral venous system as surveyed from the available literature. The pros and cons of different multimodal imaging methods for investigating DVS are also outlined. Finally, cases of various pathological entities are illustrated from our clinical practice. CONCLUSION There are many anatomical variations and lesions involving the DVS. MRI examination can provide essential information both on anatomical variation and morphological or functional change of the offending DVS in most circumstances. Multimodal non-invasive venography protocols may become a feasible alternative to the classical digital subtraction angiography and would improve the diagnostic accuracy in future studies.
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Affiliation(s)
- Changqing Zong
- Department of Imaging, Tianjin Union Medical Center, Tianjin, China
| | - Xiang Yu
- Department of Imaging, Tianjin Union Medical Center, Tianjin, China
| | - Jun Liu
- Department of Imaging, Tianjin Union Medical Center, Tianjin, China
| | - Yawu Liu
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
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Onder H, Kisbet T. Neuroimaging findings in patients with idiopathic intracranial hypertension and cerebral venous thrombosis, and their association with clinical features. Neurol Res 2020; 42:141-147. [PMID: 31910744 DOI: 10.1080/01616412.2019.1710408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To investigate the frequency of neuroimaging findings of intracranial hypertension in patients with idiopathic intracranial hypertension (IIH) and cerebral venous thrombosis (CVT). We also aimed to compare these findings in two patient groups and investigate the association of these findings with some clinical parameters.Methods: Patients with IIH and CVT admitted to the neurology, neuro-ophthalmology outpatient clinics, and emergency services between 2017 and 2019 were enrolled in this study. The presence of eight previously defined neuroimaging signs of intracranial hypertension were evaluated on MRIs. The values of total MRI scores were formed to use in the analyses investigating the association between neuroimaging findings and clinical parameters.Results: Twenty-three patients with proven IIH and seven patients with CVT with signs of intracranial hypertension were included in this study. Body mass index (BMI) values were higher in the IIH group than in the CVT group (31.0/25.9; p = 0.022). There were no differences in terms of gender distribution, age, ortotal MRI scores between the patient groups. The most common neuroimaging parameters found in the IIH group were the following: increased peri-optic cerebrospinal fluid (CSF) (n = 20) and optic nerve tortuosity (n = 12). There were no significant correlations between values of total MRI scores, lumbar puncture opening pressure, and BMI.Conclusion: Neuroimaging findings are useful tools with high diagnostic sensitivity in IIH. The most sensitive finding was increased peri-optic CSF. The utility of these neuroimaging correlates and their potential significance as solely diagnostic markers in IIH should be investigated in future large-scale studies.
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Affiliation(s)
- Halil Onder
- Neurology Clinic, Yozgat City Hospital, Yozgat, Turkey
| | - Tanju Kisbet
- Radiology Clinic, Yozgat City Hospital, Yozgat, Turkey
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Bai C, Xu Y, Zhou D, Ding J, Yang Q, Ding Y, Ji X, Meng R. The comparative analysis of non-thrombotic internal jugular vein stenosis and cerebral venous sinus stenosis. J Thromb Thrombolysis 2019; 48:61-67. [PMID: 30689154 DOI: 10.1007/s11239-019-01820-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Internal jugular vein (IJV) stenosis and cerebral venous sinus (CVS) stenosis belong to cerebral venous outflow insufficiency. This study aimed to analyze the similarities and differences between IJV stenosis and CVS stenosis. Patients with either IJV stenosis or CVS stenosis confirmed by contrast-enhanced magnetic resonance venography between October 2017 and July 2018 were enrolled in this retrospective study. The similarities and differences between IJV stenosis and CVS stenosis on the aspects of clinical and imaging features were compared. A total of 82 eligible patients entered into the final analysis. The similarities of the two subsets of cerebral venous outflow insufficiency mainly included headache, head noises or tinnitus, visual disorders, and sleeping disorders, as well as cloud-like white matter hyperintensity in T2WI and FLAIR sequences of MRI. However, there were differences in between, the ratio of patients with higher intracranial pressure (ICP) was common in CVS stenosis (p < 0.001). Namely, higher ratios of papilledema (p = 0.001) and visual damage (p = 0.029), as well as poor Frisen papilledema grade scores were more commonly observed in CVS stenosis (p = 0.004), while abnormal collateral-vessels appeared more frequently in IJV stenosis (100.00%) than CVS stenosis (28.57%). Continuous head noises, tinnitus and cloud-like white matter hyperintensity in MRI are the features of both IJV stenosis and CVS stenosis. Whereas, severe headache, visual damage, papilledema, and intracranial hypertension (IH) were more common in CVS stenosis, and the appearance of collateral-vessels is a key feature of IJV stenosis.
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Affiliation(s)
- Chaobo Bai
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yaoming Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Da Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Zheng YM, Chen J, Yuan MG, Wu ZJ, Dong C. Does a change in ventricular size predict a diagnosis of cerebral venous thrombosis-related acute intracranial hypertension? Results of a retrospective imaging study. Acta Radiol 2019; 60:1308-1313. [PMID: 30638039 DOI: 10.1177/0284185118823346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ying-Mei Zheng
- Department of Health Examination Center, The Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Jing Chen
- Deapartment of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, PR China
| | - Ming-Gang Yuan
- Department of Nuclear Medicine, Qingdao Central Hospital, Second Affiliated Hospital of Qingdao University, Qingdao, Shandong, PR China
| | - Zeng-Jie Wu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Cheng Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, PR China
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Zetchi A, Labeyrie MA, Nicolini E, Fantoni M, Eliezer M, Houdart E. Empty Sella Is a Sign of Symptomatic Lateral Sinus Stenosis and Not Intracranial Hypertension. AJNR Am J Neuroradiol 2019; 40:1695-1700. [PMID: 31537518 DOI: 10.3174/ajnr.a6210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Empty sella has been reported in patients with idiopathic intracranial hypertension and is thought to be a sign of elevation of intracranial pressure. However, it can also be found in patients with lateral sinus stenosis presenting with isolated pulsatile tinnitus without signs of intracranial hypertension. We hypothesized that the volume of the sella turcica would be similar in both groups of patients undergoing stent placement for lateral sinus stenosis. MATERIALS AND METHODS Consecutive patients with idiopathic intracranial hypertension or isolated venous pulsatile tinnitus and undergoing lateral sinus stent placement from January 2012 to December 2017 were included. The primary outcome was the estimated volume of the sella turcica based on preoperative CTA measurements. The ratio of the pituitary gland height/sellar height was calculated on preoperative MR imaging. Sellar volumes were compared among the 3 groups: pulsatile tinnitus, idiopathic intracranial hypertension, and a control group, matched by age and sex. RESULTS Eighty-eight patients underwent lateral sinus stent placement. The median age was 37 years, and 94% were women. No difference in age, sex, or body mass index was found among the groups. Patients undergoing venous stent placement had significantly higher sellar volumes than the control group (P < 0.001). There was no difference in the sellar volumes (P = .63) or gland/sellar height ratios (P = .25) between the pulsatile tinnitus and idiopathic intracranial hypertension groups. CONCLUSIONS Empty sella is found in 2 differing groups of patients undergoing lateral sinus stent placement, suggesting that it is a radiologic sign of symptomatic hemodynamic lateral sinus stenosis rather than elevated intracranial pressure.
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Affiliation(s)
- A Zetchi
- From the Service de Neuroradiologie du Pr Houdart, Hôpital Lariboisière, Paris, France.
| | - M-A Labeyrie
- From the Service de Neuroradiologie du Pr Houdart, Hôpital Lariboisière, Paris, France
| | - E Nicolini
- From the Service de Neuroradiologie du Pr Houdart, Hôpital Lariboisière, Paris, France
| | - M Fantoni
- From the Service de Neuroradiologie du Pr Houdart, Hôpital Lariboisière, Paris, France
| | - M Eliezer
- From the Service de Neuroradiologie du Pr Houdart, Hôpital Lariboisière, Paris, France
| | - E Houdart
- From the Service de Neuroradiologie du Pr Houdart, Hôpital Lariboisière, Paris, France
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16
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Peker E, Kuru Öz D, Kul M, Erdoğan M, Öztuna D, Erden Mİ. Neuro-Ophthalmologic MRI Findings in the Detection of Rhinorrhoea Aetiology. Neuroophthalmology 2019; 43:244-249. [PMID: 31528189 DOI: 10.1080/01658107.2018.1540643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022] Open
Abstract
The purpose of this study is to evaluate the importance of neuro-ophthalmological magnetic resonance imaging (MRI) findings in the identification of the aetiology of rhinorrhoea, and the differentiation of spontaneous rhinorrhoea from non-spontaneous rhinorrhoea. MR images of 25 patients with spontaneous and 21 patients with non-spontaneous rhinorrhoea were evaluated for the presence of neuro-ophthalmological findings of intracranial hypertension (IHT). These include optic nerve vertical tortuosity, optic nerve sheath enlargement, flattening of the posterior sclera and optic nerve protrusion, as well as other MRI findings of ICH, such as partial empty sella, dilatation of Meckel's cave and the presence of arachnoid pits. IHT findings were more common in the spontaneous group. Six criteria (optic nerve distention, optic nerve vertical tortuosity, posterior flattening of the sclera, partial empty sella, Meckel's cave dilatation and presence of arachnoid pits) differentiate between patient and control groups. Patients with spontaneous cerebrospinal fluid (CSF) leaks should be evaluated for signs of IHT on MRI, as they are present in the majority of spontaneous CSF leaks and are representative of increased intracranial pressure.
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Affiliation(s)
- Elif Peker
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Diğdem Kuru Öz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Melahat Kul
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Erdoğan
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Derya Öztuna
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Memet İlhan Erden
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
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17
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Systematic review and meta-analysis of MRI signs for diagnosis of idiopathic intracranial hypertension. Eur J Radiol 2019; 116:106-115. [DOI: 10.1016/j.ejrad.2019.04.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/06/2019] [Accepted: 04/29/2019] [Indexed: 01/02/2023]
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18
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Hartmann AJPW, Latting MW, Lee MS, Moster ML, Saindane AM, Newman NJ, Biousse V. Papilloedema from Dural Venous Sinus Compression by Meningiomas. Neuroophthalmology 2018; 43:171-179. [PMID: 31312241 DOI: 10.1080/01658107.2018.1524499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
Abstract
Intracranial mass lesions may cause intracranial hypertension secondary to venous hypertension when they compress the dural venous sinuses (DVS) and may present with isolated papilloedema, mimicking idiopathic intracranial hypertension. We report a series of 16 patients with isolated papilloedema related to meningiomas compressing the DVS seen from 2012 to 2016 at three institutions. Correct diagnosis was delayed in 10/16 patients and treatment required a multidisciplinary approach, often with multiple sequential interventions, including combinations of acetazolamide, cerebrospinal fluid-shunt, optic nerve sheath fenestration, surgical resection of the meningioma, radiation therapy, and endovascular venous stenting. Two patients also received anticoagulation for venous thrombosis secondary to venous sinus compression.
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Affiliation(s)
- Alexander J P W Hartmann
- Departments of Ophthalmology and Neurology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Michelle W Latting
- Department of Neuro-Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Michael S Lee
- Departments of Ophthalmology and Visual Neurosciences, Neurology, and Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark L Moster
- Department of Neuro-Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Departments of Neurology and Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J Newman
- Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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19
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Zhao T, Wang G, Dai J, Liu Y, Wang Y, Li S. Cases of visual impairment caused by cerebral venous sinus occlusion-induced intracranial hypertension in the absence of headache. BMC Neurol 2018; 18:159. [PMID: 30268100 PMCID: PMC6162896 DOI: 10.1186/s12883-018-1156-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cerebral venous sinus thrombosis or stenosis (here collectively referred to as cerebral venous sinus occlusion, CVSO) can cause chronically-elevated intracranial pressure (ICP). Patients may have no neurological symptoms other than visual impairment, secondary to bilateral papilledema. Correctly recognizing these conditions, through proper ophthalmological examination and brain imaging, is very important to avoid delayed diagnosis and treatment. Case presentation We report a case series of 3 patients with chronic CVSO, who were admitted to an ophthalmological department in Chongqing, China, from 2015 March to 2017 February. All patients presented with decreased vision and bilateral papilledema, but had no headache or other neurological symptoms. The visual fields of all patients were impaired. Flash visual evoked potentials (VEPs) in two patients showed essentially normal peak time of P2 wave, and pattern VEPs in one patient displayed decreased P100 amplitude in one eye, while a normal P100 wave in the other eye. In all patients, lumbar puncture (LP) revealed significantly elevated ICP. And magnetic resonance venography (MRV) demonstrated cerebral venous sinus abnormalities in every patient: one right sigmoid sinus thrombosis, one superior sagittal sinus thrombosis, and one right transverse sinus stenosis. Conclusions CVSO can cause chronically-elevated ICP, leading to bilateral papilledema and visual impairment. A considerable amount of patients have no apparent neurological symptoms other than visual loss. Unlike other optic nerve lesions, such as neuritis or ischemic optic neuropathy, the optic disc edema in CVSO is usually bilateral, the flash or pattern VEP is often normal or only mildly affected, and patients are often not sensitive to steroid therapy. CVSO should be suspected in such patients when unenhanced brain imaging is normal. Further investigations, such as LP and contrast-enhanced imaging (MRV and digital subtraction angiography), should be performed to diagnose or exclude CVSO.
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Affiliation(s)
- Tongtao Zhao
- Department of Ophthalmology, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Gang Wang
- Department of Ophthalmology, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Jiaman Dai
- Department of Ophthalmology, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Yong Liu
- Department of Ophthalmology, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi Wang
- Department of Ophthalmology, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China.,Aier Eye Hospital, Chongqing, China
| | - Shiying Li
- Department of Ophthalmology, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing, China.
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20
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Quan T, Li X, Xu H, Lin Y, Liu C, Li D, Guan S. Percutaneous endovascular biopsy in the diagnosis of venous sinus lesions: technical note. J Neurosurg 2018; 131:462-466. [PMID: 30141756 DOI: 10.3171/2018.3.jns173143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/19/2018] [Indexed: 11/06/2022]
Abstract
Intracranial hypertension (IH) may be misdiagnosed owing to the lack of typical imaging features and pathological confirmation of the sinus lesions. The authors report the use of percutaneous endovascular biopsy (PEB) for the diagnosis of IH in patients with venous sinus lesions. A total of 9 patients (age 46 ± 9 years) underwent PEB between June 2016 and August 2017. All patients underwent lumbar puncture and contrast-enhanced MRI before the procedure. PEB was technically successful in 6 patients. No intra- or postprocedural complications occurred. The confirmed lesions were meningioma in 2 patients and fibrous thrombus in 4 patients. All patients received individualized treatment. PEB of venous sinus lesions is a safe and efficient method to establish an early diagnosis and appropriate treatment in patients with IH.
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Affiliation(s)
- Tao Quan
- Departments of1Interventional Neuroradiology
| | | | - Haowen Xu
- Departments of1Interventional Neuroradiology
| | - Yanan Lin
- 3Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Chao Liu
- Departments of1Interventional Neuroradiology
| | - Dongdong Li
- Departments of1Interventional Neuroradiology
| | - Sheng Guan
- Departments of1Interventional Neuroradiology
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21
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22
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Holbrook J, Saindane AM. Imaging of Intracranial Pressure Disorders. Neurosurgery 2017; 80:341-354. [PMID: 27471977 DOI: 10.1227/neu.0000000000001362] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/26/2016] [Indexed: 01/03/2023] Open
Abstract
Intracranial pressure (ICP) is the pressure inside the bony calvarium and can be affected by a variety of processes, such as intracranial masses and edema, obstruction or leakage of cerebrospinal fluid, and obstruction of venous outflow. This review focuses on the imaging of 2 important but less well understood ICP disorders: idiopathic intracranial hypertension and spontaneous intracranial hypotension. Both of these ICP disorders have salient imaging findings that are important to recognize to help prevent their misdiagnosis from other common neurological disorders.
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Affiliation(s)
- John Holbrook
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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23
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Idiopathic Intracranial Hypertension Progressing to Venous Sinus Thrombosis, Subarachnoid Hemorrhage, and Stroke. J Neuroophthalmol 2017; 38:60-64. [PMID: 28742639 DOI: 10.1097/wno.0000000000000540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure (ICP), the absence of structural lesions on neuroimaging, and normal cerebrospinal fluid composition. Cerebral venous sinus thrombosis (CVST) is a common cause of increased ICP and can be differentiated from IIH with magnetic resonance venography. We describe a young woman with typical IIH who underwent lumbar puncture and was treated with a short course of high-dose corticosteroids followed by acetazolamide. She subsequently developed CVST, subarachnoid hemorrhage, and stroke. Risk factors that may have resulted in CVST are discussed.
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24
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Morris PP, Lachman N, Black DF, Carter RA, Port J, Campeau N. Increased Curvature of the Tentorium Cerebelli in Idiopathic Intracranial Hypertension. AJNR Am J Neuroradiol 2017; 38:1789-1793. [PMID: 28663268 DOI: 10.3174/ajnr.a5289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Transverse sinus effacement is detectable on MRV examinations in almost all patients with idiopathic intracranial hypertension. This effacement of the transverse sinus is presumed to be mediated by elevation of intracranial pressure, resulting in compression and inward collapse of the dural margins of the sinus. We sought to establish whether supratentorial broad-based downward deformity of the tentorium might explain transverse sinus effacement in idiopathic intracranial hypertension. MATERIALS AND METHODS MRV examinations of 53 adult patients with idiopathic intracranial hypertension were reviewed retrospectively and compared with 58 contemporaneously acquired controls. The curvature of the tentorium with reference to a line connecting the transverse sinus laterally with the confluence of the tentorial leaves medially was calculated as a segment of a circle. The height and area of the segment and the angle subtended by the midpoint of the tentorium from the falx were calculated. RESULTS The height and area of the segment described by the chord connecting the transverse sinus with the apex of the tentorial confluence and subtended midtentorial angle were greater in the idiopathic intracranial hypertension group; this finding supports the hypothesis that increased tentorial bowing is present in idiopathic intracranial hypertension. CONCLUSIONS Increased bowing of the tentorium in patients with idiopathic intracranial hypertension compared with controls is a new observation, lending itself to new hypotheses on the nature and localization of elevated intracranial pressure in idiopathic intracranial hypertension. Bowing of the tentorium may play a part in distorting the contour of the transverse sinuses, resulting, at least in part, in the effacement of the transverse sinuses in idiopathic intracranial hypertension.
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Affiliation(s)
- P P Morris
- From the Departments of Radiology (P.P.M., D.F.B., R.A.C., J.P., N.C.)
| | - N Lachman
- Anatomy (N.L.), Mayo Clinic, Rochester, Minnesota
| | - D F Black
- From the Departments of Radiology (P.P.M., D.F.B., R.A.C., J.P., N.C.)
| | - R A Carter
- From the Departments of Radiology (P.P.M., D.F.B., R.A.C., J.P., N.C.)
| | - J Port
- From the Departments of Radiology (P.P.M., D.F.B., R.A.C., J.P., N.C.)
| | - N Campeau
- From the Departments of Radiology (P.P.M., D.F.B., R.A.C., J.P., N.C.)
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25
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Morris PP, Black DF, Port J, Campeau N. Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension. AJNR Am J Neuroradiol 2017; 38:471-477. [PMID: 28104635 DOI: 10.3174/ajnr.a5055] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Patients with idiopathic intracranial hypertension have transverse sinus stenosis on gadolinium-bolused MRV, but other MR imaging signs are less consistently seen. Our aim was to demonstrate that transverse sinus stenosis could be identified on conventional MR imaging, and this identification would allow improved diagnostic sensitivity to this condition. MATERIALS AND METHODS MR imaging and MRV images from 63 patients with idiopathic intracranial hypertension and 96 controls were reviewed by using 3 independent procedures. MRV images were graded for the presence and degree of stenosis of the transverse sinus. Postgadolinium coronal T1-weighted sequences were evaluated independent of MRV. The dimensions of the proximal and distal transverse sinus were measured from the MRV examinations, and the cross-sectional area of the transverse sinus was calculated. Correlation among the 3 modes of evaluation of the transverse sinus was conducted by using Wilcoxon/Kruskal-Wallis, Pearson, and Spearman ρ nonparametric statistical techniques. RESULTS Transverse sinus stenosis was identified bilaterally on MRV in 94% of patients with idiopathic intracranial hypertension and in 3% of controls. On coronal T1 postgadolinium MR images, transverse sinus stenosis was identified in 83% of patients with idiopathic intracranial hypertension and 7% of controls. Previously described MR imaging signs of intracranial hypertension were identified in 8%-61% of patients with idiopathic intracranial hypertension. Correlation among the 3 modes of evaluation was highly significant (P < .0001). CONCLUSIONS Even without the assistance of an MRV sequence, neuroradiologists can validly identify bilateral transverse sinus stenosis in patients with intracranial hypertension more reliably than other previously described MR imaging findings in this condition. We conclude that transverse sinus stenosis is the most useful and sensitive imaging indicator of this disease state.
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Affiliation(s)
- P P Morris
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
| | - D F Black
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J Port
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - N Campeau
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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26
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Hartmann AJPW, Soares BP, Bruce BB, Saindane AM, Newman NJ, Biousse V, Peragallo JH. Imaging Features of Idiopathic Intracranial Hypertension in Children. J Child Neurol 2017; 32:120-126. [PMID: 28195748 DOI: 10.1177/0883073816671855] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Magnetic resonance imaging (MRI) signs of elevated intracranial pressure and idiopathic intracranial hypertension have been well characterized in adults but not in children. The MRIs of 50 children with idiopathic intracranial hypertension and 46 adults with idiopathic intracranial hypertension were reviewed for optic nerve head protrusion, optic nerve head enhancement, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, empty or partially empty sella, tonsillar herniation, enlargement of Meckel's cave meningoceles, and transverse venous sinus stenosis(TSS). Compared to adolescents (11-17 years, n = 40) and adults (>17 years, n = 46), prepubescent children (<11 years, n = 10) had lower frequencies of scleral flattening (50% vs 89% and 85%, P = .02), increased perioptic cerebrospinal fluid (60% vs 84% and 89%, P = .08), optic nerve tortuosity (20% vs 46% and 59%, P = .07), empty or partially empty sella (56% vs 78% and 93%, P = .007), and TSS (67% vs 93% and 96%, P = .04). Children with idiopathic intracranial hypertension have similar MRI findings as adults, but they are less frequent in prepubescent children.
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Affiliation(s)
| | - Bruno P Soares
- 2 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Beau B Bruce
- 1 Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.,3 Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,4 Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA, USA
| | - Amit M Saindane
- 2 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- 1 Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.,3 Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,5 Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA
| | - Valérie Biousse
- 1 Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.,3 Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason H Peragallo
- 1 Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.,6 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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27
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Venous sinus stenting in idiopathic intracranial hypertension: a safer surgical approach? Curr Opin Ophthalmol 2016; 27:481-485. [PMID: 27585210 DOI: 10.1097/icu.0000000000000315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose is to summarize treatment strategies in idiopathic intracranial hypertension (IIH), a potentially sight-threatening disease, with a focus on the most current outcome data for venous sinus stenting. RECENT FINDINGS Historically, the primary treatment options for medically refractory IIH consisted of either optic nerve sheath fenestration or cerebrospinal fluid diversion procedures. The visual outcomes of these procedures are favorable, though they tend to be associated with a high rate of complication and failure. Recent trials suggest that venous sinus stenting offers both comparable rates of efficacy - with improved papilledema in 97% of patients, resolved headache in 83%, and improved visual acuity in 78% - and improved safety and reliability relative to older surgical techniques. SUMMARY Patients whose sight is threatened by medically refractory IIH must often consider invasive procedures to control their disease. Venous sinus stenting may offer equal efficacy and lower failure and complication rates than traditional surgical approaches such as optic nerve sheath fenestration and cerebrospinal fluid diversion.
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28
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Vaiman M, Sigal T, Kimiagar I, Bekerman I. Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage. J Clin Neurosci 2016; 34:177-181. [PMID: 27612672 DOI: 10.1016/j.jocn.2016.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/02/2016] [Accepted: 06/25/2016] [Indexed: 12/21/2022]
Abstract
The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. The ONSD/eyeball transverse diameter (ETD) ratio was calculated. The correlation analysis was performed with the Glasgow Coma Scale score, Hemispheric Stroke Scale score, Glasgow Outcome Score, and invasive ICP readings. ONSD was enlarged in 95% of patients with intracerebral hemorrhage or SAH. Pathological ONSDs were 6.6±0.8mm (cut-off value >5.5mm; p<0.05). ONSD/ETD ratio was 0.29±0.05 against normative 0.19±0.02 (p<0.01) with no correlation with initial Glasgow Coma Scale score or Hemispheric Stroke Scale score. There was an inverse correlation between ONSD/ETD ratio and Glasgow Outcome Score (r=-0.7) and direct correlation with invasive ICP readings. This study provides further evidence that in patients with intracranial hemorrhage and SAH, the presence of ONSD greater than a threshold of 5.5mm is significantly predictive of invasively measured elevated ICP. The prediction of raised ICP can be further refined by measuring ONSD at the point where the optic nerve and the ophthalmic artery cross, and by determining the ratio between the ONSD and ETD.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology - Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Tal Sigal
- Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Kimiagar
- Department of Neurology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inessa Bekerman
- Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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29
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Abstract
BACKGROUND The primary role of brain imaging in idiopathic intracranial hypertension (IIH) is to exclude other pathologies causing intracranial hypertension. However, subtle radiologic findings suggestive of IIH have emerged with modern neuroimaging. This review provides a detailed description of the imaging findings reported in IIH and discusses their possible roles in the pathophysiology and the diagnosis of IIH. EVIDENCE ACQUISITION References were identified by searches of PubMed from 1955 to January 2015, with the terms "idiopathic intracranial hypertension," "pseudotumor cerebri," "intracranial hypertension," "benign intracranial hypertension," "magnetic resonance imaging," "magnetic resonance venography," "computed tomography (CT)," "CT venography," "imaging," and "cerebrospinal fluid (CSF) leak." Additional references were identified by hand search of relevant articles. When possible, we extracted the number of patients and control subjects from each study for each radiological finding. When at least 2 studies used the same criteria to define a radiological finding, all patients from these studies were pooled to obtain a mean sensitivity and specificity with 95% confidence interval. RESULTS Specific neuroimaging findings may suggest long-standing IIH, including empty sella, flattening of the posterior globes, optic nerve head protrusion, distention of the optic nerve sheaths, tortuosity of the optic nerve, cerebellar tonsillar herniation, meningoceles, CSF leaks, and transverse venous sinus stenosis. CONCLUSION Although IIH remains a diagnosis of exclusion, the most recently proposed diagnostic criteria have included neuroimaging findings to suggest IIH when major diagnostic criteria are not fulfilled. However, these findings are not diagnostic of IIH, and their presence is not required for the diagnosis of definite IIH. Their incidental discovery on brain imaging should not prompt invasive procedures, unless other signs of IIH, such as papilledema, are present.
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Onder H. Letter regarding article: Cerebral venous etiology of intracranial hypertension and differentiation from idiopathic intracranial hypertension. Kaohsiung J Med Sci 2016; 32:387-8. [PMID: 27450029 DOI: 10.1016/j.kjms.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/19/2016] [Accepted: 04/11/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Halil Onder
- Department of Neurology, Sıhhıye, Hacettepe University Hospital, Ankara, Turkey.
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Dong C, Zheng YM, Li XL, Wang HX, Hao DP, Nie P, Pang J, Xu WJ. Morphometric MRI changes in intracranial hypertension due to cerebral venous thrombosis: a retrospective imaging study. Clin Radiol 2016; 71:691-7. [PMID: 27180083 DOI: 10.1016/j.crad.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/07/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
AIM To evaluate whether some magnetic resonance imaging (MRI) signs suggesting idiopathic intracranial hypertension (IIH) could also be found in intracranial hypertension (IH) due to cerebral venous thrombosis (CVT) and to assess their possible contribution to diagnosing this disorder. MATERIALS AND METHODS Thirty-one patients with IH due to CVT were evaluated prospectively using MRI. A group of 33 age- and sex-matched healthy volunteers served as controls. The optic nerve and sheath, pituitary gland, and ventricles were assessed. The prevalence of each imaging feature was compared between the two groups. RESULTS Optic nerve sheath (ONS) dilatation and decreased pituitary gland height were the most valid signs suggesting IH in CVT patients: sensitivity 70.97% and 87.1%, respectively; specificity 96.97% and 72.73%, respectively; area under the curve 0.840 and 0.809, respectively. The MRI finding that showed the strongest association with IH in CVT patients was ONS dilatation (odds ratio 78.5). CONCLUSIONS The combination of T1-weighted volumetric MRI and magnetic resonance venography could be helpful for diagnosing IH with CVT. Abnormalities of the ONS and the pituitary gland were reliable diagnostic signs for IH due to CVT.
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Affiliation(s)
- Cheng Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Ying-Mei Zheng
- Department of Health Examination Center, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Xiao-Li Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - He-Xiang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Da-Peng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Jing Pang
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Wen-Jian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China.
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Goerig NL, Frey B, Korn K, Fleckenstein B, Überla K, Schmidt MA, Dörfler A, Engelhorn T, Eyüpoglu I, Rühle PF, Putz F, Semrau S, Gaipl US, Fietkau R. Frequent occurrence of therapeutically reversible CMV-associated encephalopathy during radiotherapy of the brain. Neuro Oncol 2016; 18:1664-1672. [PMID: 27286796 DOI: 10.1093/neuonc/now120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/06/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Neurological decline during radio(chemo)therapy of the brain is often attributed to disease progression or side effects of radiotherapy. Diagnosis of opportunistic neurotropic infections such as cytomegalovirus (CMV) infections is uncommon, even though high-grade gliomas and some brain metastases are known to contain CMV particles. We prospectively examined the frequency of CMV encephalopathy during radiotherapy of the brain. METHODS Fifty patients requiring whole-brain radiotherapy for brain metastases (n = 27) or local radio(chemo)therapy of the brain for high-grade gliomas (n = 23) were observed in the prospective observational GLIO-CMV-01 study. MRIs and blood samples were obtained before, halfway through, and at the end of radiotherapy. MRIs were screened for disease progression or increased intracranial pressure. Blood was tested for anti-CMV immunoglobulin (Ig)M, anti-CMV IgG, and CMV DNA. RESULTS Thirty-two of 50 (64%) patients were positive for anti-CMV IgG before radio(chemo)therapy. Fifteen of those 32 (48%) developed viremia during or up to 28 days after treatment. Thirteen of those 15 (87%) required treatment for CMV-associated encephalopathy. MRIs were negative for disease progression, edema, or bleeding. None of the patients negative for anti-CMV IgG developed viremia, suggesting a reactivation rather than a primary infection.In the group at risk consisting of anti-CMV IgG+ patients, age >65 (P = .004) and the amount of dexamethasone taken during radio(chemo)therapy (P = .004) were associated with an increased risk for CMV-associated encephalopathy. One hundred and fifty days after the start of radio(chemo)therapy, survival was 74% (14/19) (no encephalopathy) versus 54% (7/13) (encephalopathy) (odds ratio, 0.42; 95% CI, 0.03-1.86; P = .25). CONCLUSION CMV reactivation frequently causes encephalopathy during radio(chemo)therapy of the brain. The unexpected high incidence of this infection makes it highly clinically relevant for every treating physician.
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Affiliation(s)
- Nicole L Goerig
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Klaus Korn
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Bernhard Fleckenstein
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Klaus Überla
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Manuel A Schmidt
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Arnd Dörfler
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Tobias Engelhorn
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Ilker Eyüpoglu
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Paul F Rühle
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Sabine Semrau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (N.L.G., B.F., P.F.R., F.P., S.S., U.S.G., R.F.); Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (K.K., B.F., K.U.); Institute of Neuroradiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (M.A.S., A.D., T.E.); Department of Neurosurgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (I.E.)
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Julayanont P, Karukote A, Ruthirago D, Panikkath D, Panikkath R. Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects. J Pain Res 2016; 9:87-99. [PMID: 26929666 PMCID: PMC4767055 DOI: 10.2147/jpr.s60633] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) is an uncommon disorder characterized by increased intracranial pressure without radiological or laboratory evidence of intracranial pathology except empty sella turcica, optic nerve sheath with filled out cerebrospinal fluid spaces, and smooth-walled nonflow-related venous sinus stenosis or collapse. This condition typically affects obese women. The incidence of IIH is increasing with the rising prevalence of obesity. Persistent headache is the most common symptom. Visual impairment is a serious complication that may not be recognized by the patients. This paper reviews clinical manifestations, diagnostic challenges, and current treatments of IIH in adults. Various imaging modalities have been studied on their validity for detection of IIH and papilledema. This review also includes new studies on medical, surgical, and interventional management of this condition. Acetazolamide and topiramate are the only two medications that have been studied in randomized controlled trials about their efficacy in treatment of IIH. In patients who have severe visual impairment or progressive visual deterioration despite medical management, surgical or interventional treatment may be considered. The efficacy and complications of cerebrospinal fluid diversion, optic nerve sheath fenestration, and endovascular venous stenting reported in the last 3 decades have been summarized in this review. Finally, the prospective aspects of biomarkers and treatments are proposed for future research.
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Affiliation(s)
- Parunyou Julayanont
- Department of Neurology, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Amputch Karukote
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Doungporn Ruthirago
- Department of Neurology, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Deepa Panikkath
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Ragesh Panikkath
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA
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Vaiman M, Abuita R, Bekerman I. Optic nerve sheath diameters in healthy adults measured by computer tomography. Int J Ophthalmol 2015; 8:1240-4. [PMID: 26682181 DOI: 10.3980/j.issn.2222-3959.2015.06.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/18/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To measure optic nerve sheath diameters (ONSD) in different locations by computer tomography (CT) and to recommend the best location for cases when ONSD is used for intracranial pressure monitoring. METHODS In a prospective cohort study, CT data of 300 healthy adults were analyzed (600 eyes). In all cases, the CT investigation was performed at the Emergency Department because of the various conditions that proved not to be connected with ophthalmological or neurological pathology. The ONSD were measured at 3 mm and 8 mm distance from the globe, and 3 mm from the anterior opening of the optic canal. The correlation analysis was performed with gender, age, and ethnic background. RESULTS The right/left ONSD are 4.94±1.51/5.17±1.34 mm at 3 mm, 4.35±0.76/4.45±0.62 mm at 8 mm from the globe, and 3.55±0.82/3.65±0.7 mm at 3 mm from the optic canal. No significant differences correlated with gender of the patients, their age, and ethnic background were found. CONCLUSION In healthy persons, the ONSD varies from 5.17±1.34 mm to 3.55±0.82 mm in different locations within the intraorbital space. The most stable results with lesser standard deviation can be obtained if it is measured 8-10 mm from the globe.
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Affiliation(s)
- Michael Vaiman
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Rani Abuita
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Inessa Bekerman
- Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
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Abstract
OBJECTIVE Transverse sinus stenosis is an imaging finding very highly associated with elevated intracranial pressure (ICP). Patients with the Chiari I malformation may potentially have elevated ICP due to impairment of CSF flow at the foramen magnum. This study evaluated whether patients with Chiari I malformation have transverse sinus stenosis and other imaging findings indicative of elevated ICP. MATERIALS AND METHODS Thirty patients with Chiari I malformation treated surgically and 76 control subjects were identified retrospectively. All control subjects and all patients with Chiari I malformation (preoperatively) underwent standardized contrast-enhanced brain MRI including a contrast-enhanced 3D T1-weighted sequence from which curved reformats of the transverse sinuses were generated. Two different readers blinded to the diagnosis then independently evaluated these curved reformats for severity of transverse sinus stenosis. Orbital and skull-base findings previously described in association with elevated ICP were also evaluated. Frequency of MRI findings between the two groups was compared. RESULTS Patients with Chiari I malformation had significantly greater frequency of unilateral or bilateral transverse sinus stenosis than did control subjects (p < 0.001). There was complete interreader agreement on presence or absence of transverse sinus stenosis by patient (κ = 1.0 [95% CI, 0.89-1.0]). Logistic regression analysis controlling for age, sex, and body mass index found that transverse sinus stenosis significantly predicted Chiari I malformation versus control status (odds ratio, 11.2 [95% CI, 2.1-59.0]; p = 0.004) but that no other features were significantly associated with the Chiari I malformation. Patients with Chiari I malformation who had transverse sinus stenosis had significantly greater pituitary flattening than did those without transverse sinus stenosis (p = 0.02). CONCLUSION Patients with Chiari I malformation have higher likelihood of transverse sinus stenosis, which may reflect associated elevated ICP.
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Abstract
Measurement of intracranial pressure (ICP) is critical for the evaluation and management of many neurological and neurosurgical conditions. The invasiveness of ICP measurement limits the frequency with which ICP can be evaluated, hampering the clinical care of patients with ICP disorders. Thus, there has been substantial interest in developing noninvasive methods for the assessment of ICP. Numerous approaches have been applied to the problem, although none seems to represent a complete solution. The goal of this review is to familiarize the reader with the currently available methods to noninvasively evaluate ICP.
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Affiliation(s)
- Beau B Bruce
- Departments of Ophthalmology and Neurology, Emory University, Atlanta, Georgia
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Abstract
Background Idiopathic intracranial hypertension or pseudotumour cerebri is primarily a disorder of young obese women characterised by symptoms and signs associated with raised intracranial pressure in the absence of a space-occupying lesion or other identifiable cause. Summary The overall incidence of idiopathic intracranial hypertension is approximately two per 100,000, but is considerably higher among obese individuals and, given the global obesity epidemic, is likely to rise further. The pathophysiology of this condition is poorly understood, but most theories focus on the presence of intracranial venous hypertension and/or increased cerebrospinal fluid outflow resistance and how this relates to obesity. A lack of randomised clinical trials has resulted in unsatisfactory treatment guidelines and although weight loss is important, especially when used in conjunction with drugs that reduce cerebrospinal fluid production, resistant cases remain difficult to manage and patients invariably undergo neurosurgical shunting procedures. The use of transverse cerebral sinus stenting remains contentious and long-term benefits are yet to be determined. Conclusion An understanding of the clinical features, diagnostic work-up and therapeutic options available for patients with idiopathic intracranial hypertension is important both for neurologists and ophthalmologists as visual loss maybe permanent if untreated.
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Affiliation(s)
- BR Wakerley
- The Oxford Headache Centre, Department of Neurology, John Radcliffe Hospital, UK
| | - MH Tan
- Department of Ophthalmology, Royal Perth Hospital, Australia
| | - EY Ting
- Diagnostic Imaging, National University Hospital, Singapore
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