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Kubinec CJ, Lamoureux D, Lester A, Sweet M, Bhambhwani V. Drug-induced intracranial hypertension due to mirtazapine: case report and literature review. Can J Ophthalmol 2024; 59:e274-e276. [PMID: 38145627 DOI: 10.1016/j.jcjo.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/29/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023]
Affiliation(s)
| | | | - Alison Lester
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON
| | - Margaret Sweet
- Northern Ontario School of Medicine University, Thunder Bay, ON; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON
| | - Vishaal Bhambhwani
- Northern Ontario School of Medicine University, Thunder Bay, ON; Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON.
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2
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Lagacé M, Oskoui M, Myers K. Not a Benign Vitamin: Infant with Vitamin A Toxicity and Acute Intracranial Hypertension. Can J Neurol Sci 2024; 51:308-309. [PMID: 36503562 DOI: 10.1017/cjn.2022.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Micheline Lagacé
- University of British Columbia, Division of Neurology, Vancouver, BC, Canada
| | - Maryam Oskoui
- Research Institute of the McGill University Medical Centre, Montreal, QC, Canada
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Kenneth Myers
- Research Institute of the McGill University Medical Centre, Montreal, QC, Canada
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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3
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Louly Nathan A, O'Broin C, Lally A. Increasing awareness of the risk of drug-induced intracranial hypertension in patients with acne requiring treatment for bacterial STI. Sex Transm Infect 2024; 100:121. [PMID: 38050136 DOI: 10.1136/sextrans-2023-055936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Anusha Louly Nathan
- The Charles Centre Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Cathal O'Broin
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Aoife Lally
- The Charles Centre Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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4
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Reifenrath J, Rupprecht C, Gmeiner V, Haslinger B. Intracranial hypertension after rosacea treatment with isotretinoin. Neurol Sci 2023; 44:4553-4556. [PMID: 37646978 PMCID: PMC10641047 DOI: 10.1007/s10072-023-07039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Johannes Reifenrath
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Rupprecht
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Vincent Gmeiner
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haslinger
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Abstract
ABSTRACT Doxycycline is widely used to treat early and disseminated Lyme disease. Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a rare but serious adverse reaction to this medication. This article reviews the pathophysiology, presentation, diagnosis, and treatment of a patient with disseminated Lyme disease complicated by doxycycline-induced IIH.
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Affiliation(s)
- Dana Campetti
- Dana Campetti practices in gastroenterology at Philadelphia (Pa.) Gastroenterology Consultants. Andrew Kelly practices in family medicine at Penn Family Medicine in Phoenixville, Pa. Karen Diaz practices at WiseCare Urgent Care in Pasadena, Md. The authors have disclosed no potential conflicts of interest, financial or otherwise
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6
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Mahon M, Cody D. Benign Intracranial Hypertension Necessitating Ventriculoperitoneal Shunt Insertion Secondary to Growth Hormone Therapy. Ir Med J 2019; 112:936. [PMID: 31411389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Presentation Constant bilateral frontal headache associated with early morning awakenings, two episodes of vomiting and blurred vision. Diagnosis Benign Intracranial Hypertension. Treatment Repeat Lumbar Punctures were performed. GH was stopped and acetazolamide commenced. Later requiring VP shunt due to refractory symptoms with full resolution of symptoms. Conclusion Surgical management involving shunt procedures are reserved for refractory cases and are highly effective at resolving intractable symptoms.
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Affiliation(s)
| | - D Cody
- Our Lady’s Children’s Hospital Crumlin (OLCHC)
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7
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Kini AT, Rohani N, Othman BA, Lee AG. Recurrence of elevated intracranial pressure following tetracycline antibiotic use. Cutis 2019; 103:142-156. [PMID: 31039231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ashwini T Kini
- Blanton Eye Institute, Department of Ophthalmology, Houston Methodist Hospital, Texas, USA
| | | | - Bayan Al Othman
- Blanton Eye Institute, Department of Ophthalmology, Houston Methodist Hospital, Texas, USA
| | - Andrew G Lee
- Blanton Eye Institute, Department of Ophthalmology, Houston Methodist Hospital, Texas, USA
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8
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Roethlisberger M, Gut L, Zumofen DW, Fisch U, Boss O, Maldaner N, Croci DM, Taub E, Corti N, Burkhardt JK, Guzman R, Bozinov O, Mariani L. Cerebral venous thrombosis requiring invasive treatment for elevated intracranial pressure in women with combined hormonal contraceptive intake: risk factors, anatomical distribution, and clinical presentation. Neurosurg Focus 2018; 45:E12. [PMID: 29961388 DOI: 10.3171/2018.4.focus1891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population. METHODS The authors conducted a 2-center, retrospective chart review of 168 cases of CVT in women between 2000 and 2012. Eligible patients were classified as having had a mild or a severe clinical course, the latter category including all patients who underwent invasive or surgical ICP treatment and all who had an unfavorable outcome (modified Rankin Scale score ≥ 3 or Glasgow Outcome Scale score ≤ 3). The Mann-Whitney U-test was used for continuous parameters and Fisher's exact test for categorical parameters, and odds ratios were calculated with statistical significance set at p ≤ 0.05. RESULTS Of the 168 patients, 57 (age range 16-49 years) were determined to be eligible for the study. Six patients (10.5%) required invasive or surgical ICP treatment. Three patients (5.3%) developed refractory ICP > 30 mm Hg despite early surgical decompression; 2 of them (3.5%) were treated with barbiturate coma and induced hypothermia, with documented infectious, thromboembolic, and hemorrhagic complications. Coma on admission, thrombosis of the deep venous system with consecutive hydrocephalus, intraventricular hemorrhage, and hemorrhagic venous infarction were associated with a higher frequency of surgical intervention. Coma, quadriparesis on admission, and hydrocephalus were more commonly seen among women with unfavorable outcomes. Thrombosis of the transverse sinus was less common in patients with an unfavorable outcome, with similar distribution in patients needing invasive or surgical ICP treatment. CONCLUSIONS The need for invasive or surgical ICP treatment in women taking CHCs who have CVT is partly predictable on the basis of the clinical and radiological findings on admission. The use of nonsurgical treatments for refractory ICP, such as barbiturate coma and induced hypothermia, is associated with systemic infectious and hematological complications and may worsen morbidity in this patient population. The significance of these factors should be studied in larger multicenter cohorts.
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Affiliation(s)
| | | | - Daniel Walter Zumofen
- Departments of1Neurosurgery and
- 2Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel and University of Basel, Basel
| | | | | | | | | | | | | | - Jan-Karl Burkhardt
- 5Department of Neurological Surgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York
- 6Neurosurgery, University Hospital Zürich and University of Zürich, Zürich, Switzerland; and
| | | | - Oliver Bozinov
- 6Neurosurgery, University Hospital Zürich and University of Zürich, Zürich, Switzerland; and
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9
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Abstract
ABSTRACT:Background:Sympathomimetic-related intracerebral hemorrhage is well-documented. Most cases are associated with phenylpropanolamine use.Case Report:We report a case of intracerebral hemorrhage occurring in a middle-aged man who suffered from chronic sinusitis and had been ingesting pseudoephedrine daily for one year. This patient was previously well with no known cardiovascular risk factors. Clinical examination revealed no evidence of vasculitis nor coagulopathy and initial neuroimaging (i.e., computed tomography, angiography, magnetic resonance imaging) demonstrated no features consistent with aneurysm, arteriovenous malformation (AVM), cavernoma, nor cerebral metastases. A follow-up cerebral angiogram demonstrated a small AVM arising off a branch of the pericallosal artery and a small arteriovenous fistula arising off the costal marginal branch. The AVM was embolized without incident, however, the AVF was not accessible.Conclusions:Sympathomimetics have long been associated with intracerebral hemorrhage. Since 1979, over 30 published case reports have documented the relationship between phenylpropanolamine and stroke. Only one report links phenylpropanolamine consumption to an intracerebral hemorrhage in a patient with an AVM. There is a paucity of literature etiologically inculpating other ephedra alkaloids in the causation of intracerebral hemorrhage. This is a case of pseudoephedrine-induced intracerebral hemorrhage in a patient with an underlying vascular malformation.
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Affiliation(s)
- Steven K Baker
- Department of Medicine (Neurology & Rehabilitation), McMaster University, Hamilton, Ontario, Canada
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10
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Loflin R, Koyfman A. When used for sedation, does ketamine increase intracranial pressure more than fentanyl or sufentanil? Ann Emerg Med 2014; 65:55-6. [PMID: 25233812 DOI: 10.1016/j.annemergmed.2014.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/14/2014] [Accepted: 08/15/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Rob Loflin
- Carilion Clinic-Virginia Tech Carilion Emergency Medicine Residency Program, Carilion Roanoke Memorial Hospital, Roanoke, VA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern Medical Center/Parkland Memorial Hospital, Dallas, TX
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11
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Ferrando C, Carbonell JA, Aguilar G, Badenes R, Belda FJ. [Intracranial hypertension related to sedation with sevoflurane using the AnaConDa(®) device in a patient with severe traumatic brain injury]. Rev Esp Anestesiol Reanim 2013; 60:472-475. [PMID: 22920835 DOI: 10.1016/j.redar.2012.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/19/2012] [Accepted: 05/23/2012] [Indexed: 06/01/2023]
Abstract
Sedation in neurocritical patients remains a challenge as there is no drug that meets all the requirements. Since the appearance of the AnaConDa(®) device, and according to the latest recommendations, sevoflurane has become an alternative for patients with brain injury. The use of AnaConDa(®) produces an increase in the anatomical dead space that leads to a decrease in alveolar ventilation. If the decrease in the alveolar ventilation is not offset by an increase in minute volume, there will be an increase in PaCO2. We report the case of a patient with severe traumatic brain injury who suffered an increase in intracranial pressure as a result of increased PaCO2 after starting sedation with the AnaConDa(®) device.
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Affiliation(s)
- C Ferrando
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valencia, Valencia, España.
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12
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Ferraz-de-Souza B, Martin RM, Correa PHS. Symptomatic intracranial hypertension and prolonged hypocalcemia following treatment of Paget's disease of the skull with zoledronic acid. J Bone Miner Metab 2013; 31:360-5. [PMID: 23076294 DOI: 10.1007/s00774-012-0395-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/17/2012] [Indexed: 11/29/2022]
Abstract
Skull involvement in Paget's disease of bone can lead to neurological symptoms, prompting treatment. Intravenous zoledronic acid (ZA) has emerged as an effective and safe treatment option for patients with Paget's, leading to sustained remission and improved quality of life. A previously untreated 61-year-old female presented with 2-year history of facial asymmetry with progressive hearing impairment. Serum calcium levels were normal with upper normal levels of PTH and low 25OHD levels. Serum alkaline phosphatase was markedly increased and bone scan showed extensive pagetic involvement of the skull. Head CT and MRI revealed hydrocephalus with cerebellar tonsillar herniation, platybasia and basilar invagination. In the absence of clinical signs or symptoms of intracranial hypertension, she was treated with intravenous ZA after 15-day supplementation with calcium and vitamin D. Twelve hours after the infusion, the patient became confused, agitated and disoriented and developed urinary incontinence; cortical sulci became effaced on CT indicating increased intracranial pressure. Over the following days, she developed frank hypocalcemia requiring intravenous calcium infusion and calcitriol. Neurological status returned to normal within 24 h of onset, except for urinary incontinence. Nine months later she remained incontinent and still required calcitriol to maintain normocalcemia. Zoledronic acid is a first-line option for the treatment of Paget's disease, yet there can be complications in particular clinical scenarios such as pagetic hydrocephalus, as seen in this case. Plentiful supplementation of calcium and vitamin D before bisphosphonate therapy is paramount in order to minimize the risk of prolonged post-treatment hypocalcemia.
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Affiliation(s)
- Bruno Ferraz-de-Souza
- Unidade de Doenças Osteometabólicas, Serviço de Endocrinologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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13
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Zabolotskikh IB, Trembach NV, Gormakova EV. [Dynamics of intracerebral and cerebral perfusion pressure during major abdominal surgery]. Anesteziol Reanimatol 2013:21-24. [PMID: 24340991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Purpose of the study was to compare an influence of anaesthesia with sevoflurane and propofol on intracerebral and cerebral perfusion pressure by data of ophthalmo-dynamometry of the central retinal vein. MATERIALS AND METHODS The article deals with study of 75 patients which were undergoing major abdominal surgery. Combined anaesthesia with sevoflurane and fentanyl and total intravenous anaesthesia with propofol and fentanyl were used during the operations. Subgroups were identified in the groups of patients depended on the basic intracerebral pressure (ICP); subgroup of patients with normal ICP (< or = 12 mmHg) and subgroup of patients with intracerebral hypertension (ICP > 12 mmHg) RESULTS Intracerebral pressure increased by 56% and cerebral perfusion pressure decreased by 35% in patients with intracerebral hypertension during the application of combined anaesthesia with sevoflurane. ICP decreased to normal parameters during application of total intravenous anaesthesia with propofol in patients with intracerebral hypertension. There was no changes of intracerebral and cerepral perfusion pressure (CPP) in patients without cerebral hypertension. Awaking time in patients with intracerebral hypertension was longer by 1.6 times after anaesthesia with sevoflurane than after anaesthesia with propofol. CONCLUSION Combined inhalation anaesthesia with sevoflurane causes the increasing of ICP and decreasing of CPP and increasing of awaking time. Total intravenous anaesthesia with propofol and fentanyl provides stable cerebral haemodynamics. Total intravenous anaesthesia with propofol is a technique of choice in patients with underling intracerebral hypertension.
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14
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Rylova AV, Lubnin AI, Kutin MA, Beliaev AI. [Acute intracranial hypertension during xenon anesthesia in a patient with a giant brainstem tumor and cerebrospinal fluid flow obstruction: a case report]. Anesteziol Reanimatol 2010:36-39. [PMID: 20524329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Today there are prospects for the wide use of xenon for anesthesia or analgesic sedation in neurosurgical patients, but clinical trials of and experience in using the agent in neurosurgery are scanty. The paper reports the first case of acute intracranial hypertension during xenon anesthesia in a patient with a giant brain base tumor and cerebrospinal fluid flow obstruction in the presence of subcompensated intracranial hypertension. Comparison of intracranial pressure, blood pressure, cerebral perfusion pressure, and linear blood flow velocity suggests the nature of the effect of xenon on cerebral vascular tone, cerebral blood flow, and its autoregulation. Based on the findings, the authors discuss whether xenon may be used in patients with intracranial hypertension.
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Castillo LB, Bugedo GA, Paranhos JL. Mannitol or hypertonic saline for intracranial hypertension? A point of view. CRIT CARE RESUSC 2009; 11:151-154. [PMID: 19485880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osmotically active solutions, particularly mannitol, havebeen used for more than 30 years in the treatment ofintracranial hypertension. Recently hypertonic saline hasemerged as an alternative to mannitol. Both solutions areused worldwide, and their indications and long-term sideeffects are well known. More recently, knowledge abouttheir effects has increased, both limiting and expandingtheir clinical use. Here, we compare the systemic andcerebral effects of mannitol and hypertonic saline, as well astheir side effects and complications. Finally, we makerecommendations about their clinical use.
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Affiliation(s)
- Luis B Castillo
- Departamento de Medicina Intensiva, Facultad de Medicina, Universidad Católica de Chile, Santiago, Chile.
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17
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Abstract
CONTEXT Turner syndrome (TS) affects more than 50,000 girls and women in the United States. The National Cooperative Growth Study (NCGS) has collected efficacy and safety data for 5220 TS children treated with recombinant human GH (rhGH) during the last 20 yr. OBJECTIVES Our objective was to determine frequencies of specific targeted adverse events (AEs) and additional AEs of interest in TS patients. Corresponding safety data in non-TS patients or normal populations were compared for selected AEs. METHODS Patients may be enrolled at rhGH initiation and followed until discontinuation. Investigators submit AE reports describing any event that is potentially rhGH related or is a targeted event. RESULTS The Genentech Drug Safety department received 442 AE reports for TS NCGS patients as of June 30, 2006, including 117 serious AEs. Seven deaths occurred; five resulted from aortic dissections/ruptures. The incidence of certain events known to be associated with rhGH (targeted events), including intracranial hypertension, slipped capital femoral epiphysis, scoliosis, and pancreatitis, was increased compared with other non-TS patients in NCGS. There were 10 new-onset malignancies that occurred, including six in patients without known risk factors. Type 1 diabetes also appeared to be increased compared with other NCGS groups. CONCLUSIONS Children with TS who were treated with rhGH exhibit an increased underlying risk for selected AEs associated with rhGH and for type 1 diabetes, which is likely unrelated to rhGH. The aortic dissection/rupture incidence reflects the higher baseline risk for these events in TS, was consistent with current epidemiological data in smaller TS populations, and is likely unrelated to rhGH. It is not known whether the reported malignancies represent an inherently increased risk in TS patients. Twenty years of experience in 5220 patients indicates no new rhGH-related safety signals in the TS population. The NCGS and similar registries, although focused on the years during rhGH treatment, may also be a window into the natural history of TS in childhood.
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Affiliation(s)
- Katrina Bolar
- University of Texas Medical Branch, Galveston, Texas 77555, USA.
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18
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Abstract
INTRODUCTION We describe the neurointensive care (NIC) management of a patient with severe cerebral swelling and raised intracranial pressure (ICP) after severe sodium valproic acid (VPA) intoxication. A previously healthy 25-year old male with mild tonic-clonic epilepsy was found unconscious with serum VPA levels >10,000 micromol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised ICP. Early ICP was elevated, >50 mm Hg, and continuous EEG monitoring showed isoelectric readings. METHODS The patient was treated with an ICP-guided protocol including mild hyperventilation, normovolemia, head elevation and intermittent doses of mannitol. Due to refractory elevations of ICP, high-dose pentobarbital infusion was initiated, and ICP gradually normalised. RESULTS There were several systemic complications including coagulopathy, hypocalcemia and pancreatitis. The patient remained in a depressed level of consciousness for 2 months but gradually recovered, showing a good recovery with minor subjective cognitive deficits by 6 months. CONCLUSION We conclude that NIC may be an important treatment option in cases of severe intoxication causing cerebral swelling.
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Affiliation(s)
- Niklas Marklund
- Department of Neuroscience, Uppsala University Hospital, Uppsala, 75185 Sweden.
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19
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Chieregato A, Tanfani A, Compagnone C, Pascarella R, Targa L, Fainardi E. Cerebral blood flow in traumatic contusions is predominantly reduced after an induced acute elevation of cerebral perfusion pressure. Neurosurgery 2007; 60:115-2; discussion 123. [PMID: 17228259 DOI: 10.1227/01.neu.0000249194.76527.28] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the response to an acute elevation of cerebral perfusion pressure (CPP) of the regional cerebral blood flow (rCBF) measured in the edematous area of traumatic contusions. METHODS rCBF was measured in the intracontusional low-density area, in the pericontusional healthy-appearing brain tissue surrounding the contusion, in a healthy-appearing area in the contralateral hemisphere, in 16 head-injured patients with 16 traumatic contusions larger than 2 cm at baseline, and after 20 minutes of norepinephrine-induced 20-mmHg elevation of CPP levels. RESULTS After an induced acute elevation of CPP from baseline values of 65.8 ml/100 g/min (standard deviation, 8.6) to final values of 88.7 ml/100 g/min (standard deviation, 8.9; P < or = 0.0001), we found that rCBF mean levels decreased in the intracontusional low-density area (P = 0.0278), and change in rCBF was inversely associated to the baseline values. After grouping contusions according to the rCBF response to induced acute CPP elevation, rCBF mean values recorded at baseline were significantly lower in lesions with "rCBF improvement" than in those with "rCBF reduction" in the intracontusional low-density area (P = 0.0435). CONCLUSION Our findings suggest that CPP elevation induced by norepinephrine is effective in improving contusional rCBF only in selected cases, which are represented by a subset of contusions with critical perfusion, which can be identified by rCBF measurements. Conversely, in contusions with rCBF higher than critical low values, the CPP elevation could probably induce a temporary breakdown of the blood brain barrier, and the norepinephrine leads to a vasoconstriction with a worsening of regional perfusion.
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Affiliation(s)
- Arturo Chieregato
- Neurosurgical and Trauma Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy.
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20
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Martín Rodríguez MM, Ruiz-Cabello Jiménez M, Gómez García M, Vega Villaamil P, González Castillo S. Hipertensión intracraneal benigna y colitis ulcerosa. Rev esp enferm dig 2007; 99:115-6. [PMID: 17417925 DOI: 10.4321/s1130-01082007000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Palma L, Bruni G, Fiaschi AI, Mariottini A. Passage of mannitol into the brain around gliomas: a potential cause of rebound phenomenon. A study on 21 patients. J Neurosurg Sci 2006; 50:63-6. [PMID: 17019386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM Widespread use of mannitol to reduce brain edema and lower elevated ICP in brain tumor patients continues to be afflicted by the so-called rebound phenomenon. Leakage of mannitol into the brain parenchyma through an altered BBB and secondary reversal of osmotic gradient is considered the major cause of rebound . This has only been demonstrated experimentally in animals. As a contribution to this issue we decided to research the possible passage of mannitol into the brain after administration to 21 brain tumor patients. METHODS Mannitol (18% solution; 1 g/kg) was administered as a bolus to patients (ten had malignant glioma, seven brain metastases and four meningioma) about 30 minutes before craniotomy. During resection, a sample of the surrounding edematous white matter was taken at the same time as a 10 ml venous blood sample. Mannitol concentrations were measured in plasma and white matter by a modified version of the enzyme assay of Blonquist et al. RESULTS In most glioma patients, mannitol concentrations in white matter were 2 to 6 times higher than in plasma (mean 3.5 times). In meningioma and metastases patients plasma concentrations of mannitol were higher than white matter concentrations except in three cases with infiltration by neoplastic cells. CONCLUSIONS The results of our study show that even after a single bolus, mannitol may leak through the altered BBB near gliomas, reversing the initial plasma-to-blood osmotic gradient, aggravating peritumoral edema and promoting rebound of ICP.
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Affiliation(s)
- L Palma
- Neurological Clinic, Department of Ophthalmological and Neurosurgical Sciences University of Siena, Siena, Italy.
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Sacco M, Di Giorgio G. Recurrent intracranial hypertension induced by growth hormone therapy. J Pediatr Endocrinol Metab 2006; 19:545. [PMID: 16759042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Sacco M, Di Giorgio G. Recurrent Intracranial Hypertension Induced by Growth Hormone Therapy. J Pediatr Endocrinol Metab 2006; 19:545-546. [PMID: 38742782 DOI: 10.1515/jpem-2006-190414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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Ecoffey M, Merz A, Egli D, Panchard MA, Laubscher B. Rôle du médecin traitant dans les convulsions hyponatrémiques chez l'enfant énurétique traité par desmopressine. Arch Pediatr 2006; 13:262-5. [PMID: 16443352 DOI: 10.1016/j.arcped.2005.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 11/22/2005] [Indexed: 11/23/2022]
Abstract
UNLABELLED Enuresis nocturna is regularly treated by desmopressin, a vasopressin analog. Its side effects, notably neurological, are fortunately rare. We comment on 5 enuretic children on desmopressin who suffered from hyponatremic encephalopathy (natremia 115-127, median 117 mmol/l). RESULTS Side effects appeared at therapeutic doses (10-40 mg/d intranasal). An excessive fluid intake at night was often noted, leading to a dilutional hyponatremia. This may be due to a lack of correct information to the parents. These children presented after a period of warning symptoms, such as headache, vomiting and altered consciousness. Parents could have sought earlier medical attention if they had been informed about these symptoms. CONCLUSION In the absence of fluid restriction, severe hyponatremia can occur in enuretic children on desmopressin. It is therefore mandatory for the prescribing doctor to adequately inform patients and parents to limit fluids at night when desmopressin is used, and seek medical help quickly if any sign of intracranial hypertension appears.
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Affiliation(s)
- M Ecoffey
- Hôpital Pourtalès, 45, rue de la Maladière, 2000 Neuchâtel, Suisse.
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Li F, Zhu G, Lin J, Meng H, Wu N, Du Y, Feng H. Photodynamic therapy increases brain edema and intracranial pressure in a rabbit brain tumor model. Acta Neurochir Suppl 2006; 96:422-5. [PMID: 16671498 DOI: 10.1007/3-211-30714-1_87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The objective of this study was to evaluate the effect of a single photodynamic therapy (PDT) on brain edema and intracranial pressure (ICP) in a rabbit model of brain tumor. A total of 57 adult New Zealand rabbits were assigned to 3 groups: the PDT group, the tumor group, and the tumor plus PDT group. Rabbits in the PDT group (n = 9) received PDT but no tumor implantation; rabbits in the tumor group (n = 18) received VX2 carcinoma implantation but no PDT; rabbits in the tumor plus PDT group (n = 30) received tumor implantation with subsequent PDT 16 days later. Brain edema and ICP levels were then evaluated. We found that ICP in the PDT group was 7.43 +/- 0.50 mmHg. After tumor implantation, ICP increased rapidly (18.43 +/- 1.10 mmHg, 21 days later). PDT alone did not increase ICP, but compared with that in the tumor group, ICP increased significantly in the tumor plus PDT group (9.55 +/- 1.32 vs. 13.31 +/- 1.13 mmHg, p < 0.01) 24 hours after treatment. Brain water content in the tumor group increased rapidly after tumor implantation. PDT again increased perineoplastic brain edema 24 hours after treatment (81.09 +/- 0.97% vs. 78.32 +/- 0.49%, p < 0.01). It should be noted that PDT alone did not induce brain edema. In conclusion, PDT causes transient brain edema and increases ICP in a rabbit brain tumor model.
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Affiliation(s)
- F Li
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Shapingpa, Chongqing, China
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Abstract
BACKGROUND Elevated serum retinol, CSF retinol, and serum retinol binding protein (RBP) levels have been found in some patients with idiopathic intracranial hypertension (IIH), but serum and CSF retinol levels have not been studied in matched serum and CSF samples in patients with IIH. OBJECTIVE To determine whether serum and CSF vitamin A concentrations are associated with IIH. METHODS The serum and CSF retinol concentrations were prospectively assessed in 20 patients with IIH and 20 control subjects. RESULTS CSF retinol concentration was higher in the patient group (median 575.91 nM) vs the control group (median 63.35 nM) (p < 0.05). There was no difference in serum retinol levels between control subjects (median 896.51 nM) and patients (median 1,002.62 nM) (p = 0.10). There was an association between higher vitamin A levels (> 250 nM) and IIH (p = 0.039). There was a correlation between CSF and serum retinol levels in patients (r = 0.82) and control subjects (r = 0.66). CONCLUSION Elevated CSF retinol concentration is associated with idiopathic intracranial hypertension (IIH), but serum retinol level is not associated with IIH.
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Affiliation(s)
- Abdolreza Tabassi
- Neuro-ophthalmology Clinic, School of Public Health, Tehran University of Medical Sciences, Iran
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Boot JP. [Intracranial hypertension with severe and irreversible reduced acuity and impaired visual fields after oral tetracycline]. Ned Tijdschr Geneeskd 2005; 149:2762. [PMID: 16375024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Affiliation(s)
- C J Wenham
- Ophthalmology Wolverhampton and Midland Counties Eye Infirmary, Wolverhampton WV3 9QR
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Santos FXD, Parolin A, Lindoso EMS, Santos FHX, Sousa LBD. Hipertensão intracraniana com manifestações oculares associada ao uso de tetraciclina: relato de caso. Arq Bras Oftalmol 2005; 68:701-3. [PMID: 16322874 DOI: 10.1590/s0004-27492005000500025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
The authors describe a young female patient with intracranial hypertension associated with ocular manifestations, during treatment with tetracycline. This is a rare adverse effect described in the medication warnings, and in a few reported cases in the scientific literature.
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Ramarovavy G, Imbert P, Razaiarinoro J, Langue J, Rasolofoharinoro B, Gerbay A, Randriambelomanana A. Hypertension intracrânienne bénigne chez un nourrisson traité par fluoroquinolones à Madagascar. Arch Pediatr 2005; 12:1527-8. [PMID: 16099146 DOI: 10.1016/j.arcped.2005.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 06/22/2005] [Indexed: 11/18/2022]
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Altinbas A, Hoogstede HALF, Bakker SLM. [Intracranial hypertension with severe and irreversible reduced acuity and impaired visual fields after oral tetracycline]. Ned Tijdschr Geneeskd 2005; 149:1908-12. [PMID: 16136745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A young, non-obese woman aged 24 years with normal blood pressure developed intracranial hypertension after the oral use of tetracycline. Neuro-ophthalmologic examination revealed severely reduced acuity, papilledema, and concentric impaired visual fields. She was treated with acetazolamide and recurrent lumbar punctures and recovered, but without improvement in either acuity or visual fields. Intracranial hypertension is a fairly rare disease characterised by increased intracranial pressure without structural abnormalities in the brain or hydrocephalus, and is termed idiopathic in the absence of an underlying cause. Tetracycline should be considered as a cause of intracranial hypertension if a patient complains of previously unknown headache a few days after its ingestion. Headache and the presence of bilateral papilledema, decreased visual acuity and visual-field defects are indications for urgent referral to a neurologist. Therapy consists of a combination of repetitive lumbar punctures and medication. Surgical interventions include lumboperitoneal shunting and optic nerve fenestration. Intracranial hypertension may lead to irreversible decreased visual acuity and visual-field defects resulting in disability.
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Affiliation(s)
- A Altinbas
- Amphia Ziekenhuis, Molengracht 21, 489rg CK Breda
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Chamberlain CE, Fitzgibbon E, Wassermann EM, Butman JA, Kettl D, Hale D, Kirk AD, Mannon RB. Idiopathic intracranial hypertension following kidney transplantation: a case report and review of the literature. Pediatr Transplant 2005; 9:545-50. [PMID: 16048612 DOI: 10.1111/j.1399-3046.2005.00329.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A pediatric kidney transplant recipient receiving tacrolimus for immunosuppression experienced symptoms consistent with idiopathic intracranial hypertension. The diagnosis of idiopathic intracranial hypertension and possible secondary causes of intracranial hypertension are reviewed in association with the patient's clinical course. Treatment options for the reversal of intracranial hypertension are summarized. Because of the complexity of associated conditions in kidney transplant recipients, symptoms of persistent headaches, visual changes and nausea and vomiting should be promptly investigated by fundoscopic examination in the setting of immunosuppression therapy to prevent vision loss.
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Affiliation(s)
- Christine E Chamberlain
- Pharmacy Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
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Abstract
Several secondary causes are implicated in the etiology of idiopathic intracranial hypertension. Rofecoxib is a selective cyclo-oxygenase (COX)-2 inhibitor, now being increasingly used in place of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). We report a case of intracranial hypertension in a 69-year-old man 3 weeks after the commencement of rofecoxib therapy with reversal of clinical findings on drug withdrawal.
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Affiliation(s)
- Saiju Jacob
- University Hospitals of Leicester, Neurology, Leicester, UK
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Abstract
Pseudotumor cerebri (PTC) is a syndrome of intracranial hypertension that is idiopathic or from an identified secondary cause. It is characterized by headaches and visual manifestations. The hallmark of PTC is papilledema and the feared consequence is visual loss that may be severe and permanent. The idiopathic form generally occurs in obese women of childbearing age. Various medications may produce PTC in patients at any age, including children. Several medications used in dermatology, particularly those used in the treatment of acne vulgaris, are associated with PTC. There is a strong association with tetracycline usage. Minocycline and doxycycline have also been linked to PTC, although there are relatively few reported cases. PTC has also been described with retinoids, including vitamin A (retinol) and isotretinoin. Although corticosteroids are often used to lower intracranial pressure acutely, corticosteroid withdrawal after long-term administration may induce increased intracranial pressure. A high index of suspicion, early diagnosis and treatment generally yield a good prognosis.
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Affiliation(s)
- Deborah I Friedman
- Departments of Ophthalmology and Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Abstract
In neurosurgery, ceftriaxone is a widely used, third generation cephalosporin for the treatment of CNS infections and perioperational prophylaxis. Recent studies have demonstrated that ceftriaxone induces reversible precipitates in the gallbladder. This complication is referred to as "biliary pseudolithiasis", and it has symptoms similar to the raised intracranial pressure (ICP) symptoms of the perioperative period. Symptomatic biliary pseudolithiasis should be kept in mind in all pediatric neurosurgery cases under ceftriaxone therapy in order to prevent unnecessary postoperative investigations and surgery.
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Affiliation(s)
- C Evliyaoglu
- Department of Neurosurgery, Kirikkale University School of Medicine, Kirikkale, Turkey.
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36
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Abstract
A 34-year-old male with a long-standing history of polysubstance abuse and depression was admitted for acute renal failure and hemodialysis secondary to ethylene glycol ingestion that occurred two days prior. The patient was admitted with documented ethylene glycol levels of 41.2 mg/dl, which fell to 25.0 mg/dl after 8 hours and to 6 mg/dl after 12 hours. One week later the patient presented to the outpatient eye clinic complaining of headaches and diplopia. On exam, vision in both eyes was 20/20. No afferent papillary defect was present. The patient had a left abducens palsy. The remainder of the anterior segment exam was normal. On dilated fundus exam the patient was found to have 3+ disc edema with hemorrhages in both eyes. A lumbar puncture revealed elevated intracranial pressure. In our opinion, the patient developed a left abducens nerve palsy and bilateral disc edema secondary to a transient rise in intracranial pressure after ingestion of ethylene glycol.
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Affiliation(s)
- Christina Delany
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Tingvoll SH, Bekkelund SI. [Idiopathic intracranial hypertension]. Tidsskr Nor Laegeforen 2005; 125:578-80. [PMID: 15776030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension is a rare syndrome of increased intracranial pressure without a massive lesion or abnormal cerebrospinal fluid. Common symptoms include headache and visual disturbances such as transient visual obscurations or visual loss. Treatment may alleviate symptoms and prevent serious complications. In this study, we present 10 cases illustrating aspects of the disease including causes and treatment options. We also evaluated the effect of treatment and compared the incidence with other studies. MATERIAL AND METHODS We registered all patients and reviewed the medical notes on patients with intracranial hypertension treated at Tromsø University Hospital over a five-year period (1999-2003). RESULTS AND INTERPRETATION We identified 10 patients with intracranial hypertension; 6 of them fulfilled the criteria of the International Headache Society for idiopathic intracranial hypertension while 4 had secondary intracranial hypertension caused by medication such as oral contraceptives or tetracycline, or by surgical therapy. Idiopathic or secondary intracranial hypertension should be considered in patients with unexplained chronic headache.
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Abstract
The authors report seven patients from six neuro-ophthalmology referral centers who developed pseudo-tumor cerebri during treatment with doxycycline. All four female patients and one of three male patients were obese. Vision was minimally affected in most patients, but two had substantial visual acuity or visual field loss at presentation. Discontinuation of doxycycline, with or without additional intracranial pressure-lowering agents, yielded improvement, but permanent visual acuity or visual field loss occurred in five patients.
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Affiliation(s)
- D I Friedman
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
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Abstract
PURPOSE To report a rare case of neonatal-onset multisystem inflammatory disease with serial photographs to characterize the optic nerve findings. DESIGN Observational case report. METHODS A 6-year-old girl with neonatal-onset multisystem inflammatory disease, who had received systemic corticosteroid therapy for 5 years, had bilateral fibrillar opacities that surrounded the optic disks and extended into the peripapillary nerve fiber layer and vessels. A magnetic resonance imaging examination and lumbar puncture revealed elevated intracranial pressure. RESULTS The elevated intracranial pressure returned to normal following a corticosteroid taper. Optic disk photographs, taken 4 years earlier, were subsequently obtained. The optic disk appearance had remained unchanged over the 4-year period, consistent with a pseudopapilledema. CONCLUSION The optic disk appearance is not consistent with papilledema from increased intracranial pressure. The optic disk findings, in conjunction with the underlying inflammatory syndrome, suggest an infiltrative etiology for the atypical optic nerve findings in neonatal-onset multisystem inflammatory disease.
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Affiliation(s)
- David A Hollander
- Department of Ophthalmology, The University of California, San Francisco, San Francisco, California, USA
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Abstract
With the recognition that vitamin A and isotretinoin may cause intracranial hypertension, the authors reviewed 331 case reports of ocular side effects associated with the three other marketed retinoids: tretinoin, acitretin, and etretinate. The reports were drawn from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization (WHO), the Food and Drug Administration, and medical journals between 1979 and 2003. There were 21 cases of intracranial hypertension associated with these three retinoids, leading to an inference that they are probably causally related to intracranial hypertension by WHO criteria. The lack of positive rechallenge data precludes the inference of a definite causal relationship to intracranial hypertension by WHO criteria. The inference of an independent causal role of these retinoids is further cautioned by the fact that six patients were concurrently using tetracycline or minocycline. Even so, the data suggest that all retinoids may, in rare instances, cause intracranial hypertension.
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Affiliation(s)
- Frederick W Fraunfelder
- Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97201, USA.
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41
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Abstract
Cases of N-acetylcysteine overdose have been reported before. In some cases, these overdoses have led to death if an anaphylactoid reaction was present. A healthy 30-month-old girl allegedly ingested acetaminophen at 418 mg/kg. Because the emergency physician feared the time of ingestion might not be accurate, he decided to start the 20.5-hour intravenous N-acetylcysteine protocol 8 hours after ingestion. He mistakenly prescribed the maximum milliliter-per-kilogram volume of the dextrose 5% diluent for the milliliter-per-kilogram volume of N-acetylcysteine 20% to be administered. Five hours after the error was detected (19.5 hours postingestion), the patient started developing myoclonus on the left side of her body, with left eye deviation. This condition persisted intermittently for 3 hours despite treatment with diazepam, lorazepam, and phenytoin. A first computed tomographic scan result was normal. A few hours later, she sustained shorter recurrences of the myoclonus. At 30 hours after ingestion, she started to have irregular breathing and became unresponsive to pain. A repeated computed tomographic scan showed diffuse cerebral edema. A postmortem examination showed the presence of acute anoxic encephalopathy with marked cerebral edema and the beginning of uncal herniation that confirmed the clinical diagnosis of intracranial hypertension and brain death. A cumulative intravenous dose of 2,450 mg/kg of N -acetylcysteine was associated with status epilepticus, intracranial hypertension, and death in a child.
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Affiliation(s)
- Benoit Bailey
- Section of Emergency Medicine, Department of Pediatrics, Hôpital Ste-Justine, Montréal, Québec, Canada.
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Bala P, McKiernan J, Gardiner C, O'Connor G, Murray A. Turner's syndrome and benign intracranial hypertension with or without growth hormone treatment. J Pediatr Endocrinol Metab 2004; 17:1243-4. [PMID: 15506685 DOI: 10.1515/jpem.2004.17.9.1243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P Bala
- Departments of Paediatrics & Child Health, University College Cork, Cork, Republic of Ireland.
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Abstract
PURPOSE To evaluate the association between intracranial hypertension (IH) and isotretinoin use. DESIGN Observational case series. METHODS In this retrospective study, approximately 1950 case reports of adverse ocular side effects related to isotretinoin were received from spontaneous reporting systems. Reports were evaluated as to the occurrence of IH with isotretinoin use. A survey was mailed to all members of the North American Neuro-ophthalmology Society soliciting their opinions on whether isotretinoin caused IH. RESULTS One hundred seventy-nine reports of IH were associated with isotretinoin use. The mean time from drug exposure to IH diagnosis was 2.3 months. There were 6 cases of positive rechallenge; 5 new cases are reported here, along with 1 previously published report. Of neuro-ophthalmologists surveyed (62% response rate), 6% believed an association between IH and isotretinoin use was certain; 32%, probable; 52%, possible; and 10%, unlikely. Twelve respondents (4%) had personally seen one or more cases of positive rechallenge with isotretinoin causing IH. CONCLUSIONS Based on the number and pattern of rapid IH onsets after isotretinoin exposure and the 6 cases of positive rechallenge, along with the probable similarity in metabolic pathways of this agent and vitamin A (a known cause of IH), it seems certain that there is a direct correlation between IH and isotretinoin use.
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Affiliation(s)
- Frederick W Fraunfelder
- University of Mississippi School of Medicine Neurology Department, Jackson, Mississippi, USA.
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Wolf S, Krammer M, Trost HA, Lumenta CB. Lipofundin®-Induced Intracranial Pressure Rise after Severe Traumatic Brain Injury - A Case Report. ACTA ACUST UNITED AC 2004; 65:81-3. [PMID: 15118922 DOI: 10.1055/s-2004-816270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Early nutrition is a recognized component of neurosurgical intensive care treatment. The authors present the case of a patient suffering from severe traumatic brain injury who responded with reproducible intracranial pressure (ICP) crisis to infusion of Lipofundin, a fatty soybean oil-based emulsion for parenteral nutrition. During the described ICP rise, the patient remained hemodynamically stable, therefore an anaphylactic reaction seems to be unlikely. An increase of brain tissue oxygenation parallel to the ICP rise in this case is suggestive for increased cerebral blood flow as a cause of ICP elevation after application of Lipofundin. Without multimodal monitoring and data storage, the described side effect of Lipofundin in our patient would have been difficult to identify.
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Affiliation(s)
- S Wolf
- Department of Neurosurgery, Academic Hospital Munich-Bogenhausen, Technical University of Munich, Munich.
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Holmström A, Akeson J. Desflurane Increases Intracranial Pressure More and Sevoflurane Less Than Isoflurane in Pigs Subjected to Intracranial Hypertension. J Neurosurg Anesthesiol 2004; 16:136-43. [PMID: 15021282 DOI: 10.1097/00008506-200404000-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Desflurane and sevoflurane may have advantages over isoflurane in neuroanesthesia, but this is still under debate. A porcine model with experimental intracranial hypertension was used for paired comparison of desflurane, sevoflurane, and isoflurane with respect to the effects on cerebral blood flow (CBF), cerebrovascular resistance (CVR), and intracranial pressure (ICP). The agents, given in sequence to each of six pigs, were compared at 0.5 and 1.0 minimal alveolar concentrations (MAC) and three mean arterial blood pressure (MAP) levels (50, 70, and 90 mm Hg) at normocapnia and one MAP level (70 mm Hg) at hypocapnia. MAC for each agent had been previously determined in a standardized manner for comparison reliability. CBF was measured with Xe. MAP was lowered by inflation of a balloon catheter in the inferior caval vein and raised by inflation of a balloon catheter in the descending aorta. ICP was measured intraparenchymally. Two Fogarty catheters positioned extradurally were inflated to a baseline ICP of 20 to 22 mm Hg at 0.2 MAC of each agent. CBF and ICP with the three agents at normocapnia and MAP 70 and 90 mm Hg at both 0.5 and 1.0 MAC were as follows (P < 0.05): desflurane > isoflurane > sevoflurane. None of the agents abolished CO2 reactivity. High-dose desflurane resulted in a higher CBF at hypocapnia than corresponding doses of sevoflurane or isoflurane, but there were no significant differences between the agents in ICP at hypocapnia. The present study showed that desflurane increased ICP more and sevoflurane less than isoflurane during normoventilation, but the differences disappeared with hyperventilation.
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Affiliation(s)
- Anders Holmström
- Department of Anesthesia and Intensive Care, Malmö University Hospital, Lund University, Malmö, Sweden.
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46
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Takeoka Y, Yamamura R, Iwasaki S, Morioka J. [MR imaging provides important clues for the diagnosis of benign intracranial hypertension by all-trans retinoic acid in a patient with acute promyelocytic leukemia]. Rinsho Ketsueki 2004; 45:139-43. [PMID: 15045822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We report a case of benign intracranial hypertension (BIH) caused by all-trans retinoic acid (ATRA) in a patient with acute promyelocytic leukemia. A 21-year-old male was admitted to our hospital with pancytopenia. He was diagnosed as having acute promyelocytic leukemia due to increased promyelocytes, and PML-RAR alpha chimeric mRNA was detected. The administration of ATRA and idarubicin was started immediately. After 26 days of the chemotherapy, he complained of diplopia. Ophthalmologic examination revealed bilateral papilledema and hemorrhage. The cerebrospinal fluid showed an increase in pressure, but no other abnormalities. Computed tomography showed no intracranial abnormalities. The orbital MR imaging showed distension of the perioptic subarachnoid space and flattening of the posterior sclera. A diagnosis of BIH was made. After the discontinuation of ATRA, the symptoms improved and the MR abnormalities disappeared. As far as we know, there have been no reports illustrating MR abnormalities of BIH caused by ATRA, for the diagnosis and monitoring of which orbital MR imaging can provide important clues.
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Affiliation(s)
- Yasunobu Takeoka
- Clinical Hematology and Clinical Diagnostics, Osaka City University, Graduate School of Medicine
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47
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Affiliation(s)
- Medhat F Guirgis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Watts TLP. Significant complications of doxycycline. Br Dent J 2003; 195:65. [PMID: 12881731 DOI: 10.1038/sj.bdj.4810370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVE Recombinant human growth hormone (rhGH) has been used to improve the growth retardation associated with chronic renal insufficiency (CRI) and end-stage renal disease. We determined the incidence of one of four targeted adverse events (AEs): malignancy, slipped capital femoral epiphysis (SCFE), avascular necrosis (AN), and intracranial hypertension (ICH). STUDY DESIGN During a 6.5-year period, we prospectively assessed patients enrolled in the CRI, dialysis, and transplant registries of the North American Renal Transplant Cooperative Study. The availability of an untreated control population facilitated determining whether or not there was the association between the AE and rhGH treatment. RESULTS Of the targeted AE, the only significant relation with rhGH treatment was the presence of ICH in patients with CRI; however, in all 3 instances, ICH occurred 2, 50, and 1131 days after discontinuation of rhGH. Considering that the mechanism of ICH in rhGH-treated patients is thought to be increased CSF production, rhGH probably had no role in the development of ICH in at least 2 of the 3 patients with CRI. A number of nontargeted AE were identified that have been associated with rhGH treatment in patients without renal disease. The incidence of glucose intolerance, pancreatitis, progressive deterioration of renal function, acute allograft rejection, and fluid retention were not more frequent in those receiving rhGH treatment compared with the control population. CONCLUSIONS This report validates the importance of a control population in ascribing AE to any therapeutic intervention. Previously identified AE associated with rhGH treatment are infrequent in patients with CRI and end-stage renal disease.
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Affiliation(s)
- Richard N Fine
- Department of Pediatrics, SUNY Stony Brook, New York 11794, USA.
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50
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Affiliation(s)
- J Lochhead
- Department of Ophthalmology, Oxford Eye Hospital, Radcliffe Infirmary, Oxford OX2 6HE
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