Atypical presentations of idiopathic intracranial hypertension

Chen, Benson; Newman, Nancy J.; Biousse, Valérie

doi:10.4103/tjo.tjo_69_20

Cited by 31 publications

(34 citation statements)

References 118 publications

(72 reference statements)

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“…Seizures owing to encephaloceles of the temporal lobe are increasingly recognized as potential rare presentations of IIH. 18,19 Patients with temporal lobe-onset seizures owing to temporal encephaloceles have MRI findings that are similar to those of patients with IIH but do not develop typical manifestations of IH over time. 18,20,21 Tortuous optic nerves and TVSS were found in significantly more patients with papilledema vs without papilledema.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema

et al. 2021

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IMPORTANCE Magnetic resonance imaging (MRI) signs of intracranial hypertension (IH) are traditionally associated with idiopathic intracranial hypertension (IIH), but these signs are also detected among individuals with primary headaches and among asymptomatic individuals without papilledema.OBJECTIVE To examine the prevalence of MRI signs of IH among consecutive outpatients undergoing brain MRI for any clinical indication and to explore their association with papilledema. DESIGN, SETTING, AND PARTICIPANTSThis prospective cross-sectional study of outpatients undergoing brain MRI at 1 outpatient imaging facility was conducted between August 1, 2019, and March 31, 2020, with ocular fundus photographs taken concurrently. Radiographic images from consecutive adult patients who were undergoing brain MRI and able to participate in fundus photography were analyzed for MRI signs of IH. A univariate analysis using either Fisher exact tests or t tests was performed. MAIN OUTCOMES AND MEASURESPrevalence of MRI signs of IH and prevalence of papilledema detected on ocular fundus photographs. Radiographic signs of IH included empty sella, optic nerve head protrusion, posterior scleral flattening, increased perioptic cerebrospinal fluid, optic nerve tortuosity, enlarged Meckel caves, cephaloceles, cerebellar tonsillar descent, and bilateral transverse venous sinus stenosis.RESULTS A total of 388 patients were screened for eligibility; of those, 92 patients were excluded (58 declined participation, 16 were unable to consent, 14 were unable to complete fundus photography, and 4 completed MRI and fundus photography twice, so their second set of findings was removed). Among the 296 patients included in the study, the median age was 49.5 years (interquartile range, 37.8-62.0 years), and 188 patients (63.5%) were female. The most common indication for MRI was surveillance of a brain neoplasm (82 patients [27.7%]). Investigations of headaches (26 patients [8.8%]) and disorders of intracranial pressure (4 patients [1.4%]) were uncommon. At least 1 radiographic sign of IH was present in 145 patients (49.0%). Among 296 total study patients, 98 patients (33.1%) had empty sella, 47 patients (15.9%) had enlarged Meckel caves, 32 patients (10.8%) had increased perioptic cerebrospinal fluid, 23 patients (7.8%) had optic nerve tortuosity, 2 patients (0.7%) had scleral flattening, and 4 patients (1.4%) had cephaloceles. Bilateral transverse venous sinus stenosis was present in 6 of 198 patients (3.0%). Five patients (1.7%) had papilledema. Compared with patients without papilledema, those with papilledema had a significantly higher body mass index and history of IIH, in addition to an increased prevalence of empty sella, optic nerve tortuosity, and transverse venous sinus stenosis detected on MRI. The prevalence of papilledema increased from 2.8% among patients with at least 1 MRI sign of IH to 40.0% among patients with 4 or more MRI signs of IH.CONCLUSIONS AND RELEVANCE Magnetic resonance imaging signs of IH were common among patients undergoin...

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Section: Discussionmentioning

confidence: 99%

Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema

et al. 2021

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“…Studies focusing on neuro-otologic symptoms and evaluations are rare in the literature. [ 2 3 4 5 6 ] Tinnitus, vertigo, and hearing loss were the most common manifestations reported to be in association with IIH. [ 4 8 ] However, they are rarely the initial manifestation of IIH, and no clear association between these symptoms and the disease course has been clarified to highlight these signs as utilizable in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Numerous studies have remarked on the fluid communication between the intracochlear and intracranial spaces through the cochlear aqueduct, and many authors have investigated the potential use of the stapedial reflex arc as a noninvasive test in discrimination increased intracranial pressure. [ 2 3 4 5 6 ] However, its significance in the clinical practice of idiopathic intracranial hypertension (IIH) is unclear. [ 2 4 7 8 ]…”

Section: Introductionmentioning

confidence: 99%

The Potential Significance of Reversed Stapes Reflex in Clinical Practice in Idiopathic Intracranial Hypertension

Önder¹

2022

Annals of Indian Academy of Neurology

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Background: Stapes reflex test is a method of evaluating the involuntary muscle contraction of the stapedius muscle in response to a high-intensity sound stimulus. The formation of this reflex involves the intact function of the 7 th nerve, brain stem, 8 th nerve, and middle ear. Due to ease of administration and information yielded, the stapedial reflex is considered one of the most powerful differential diagnostic audiological procedures. Numerous studies have remarked on the fluid communication between the intracochlear and intracranial spaces through the cochlear aqueduct. Currently, the potential significance of a noninvasive audiological technique in the discrimination of raised intracranial pressure constitutes a crucial topic of interest. Methods: We have performed the pre-LP and post-LP detailed otorhinolaryngological investigations, including the detailed inspection, audiometric testing, tympanometry, and stapedial reflex in a total of four consecutive patients with IIH. Results: We found that the stapedial reflex was bilateral absent initially in two of the patients. However, the second stapedial reflex investigations after LP showed reversal of the reflex responses in both of the patients. Conclusions: We suggest some hypotheses and propose some clinical applications. Future studies focusing on the potential utility of this reflex in the monitorization of IIH may provide crucial perspectives.

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“…This result may be explained by facial nerve dysfunction; however, it is atypical clinical presentation of IIH [10]. Few confirmed case reports of facial nerve abnormalities in association with IIH have been recorded over years [11].…”

Section: Figure (1) Blink Reflex In Iih Patientmentioning

confidence: 96%

Blink reflex in idiopathic intracranial hypertension patients

Hosny

Mabrouk

Gamal

et al. 2022

Egyptian Journal of Medical Research

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The goal of our study was to clarify the possible effect of increased intracranial pressure on electrophysiological blink reflex in idiopathic intracranial hypertension (IIH) pateints . Subjects & Methods: 40 females;20 IIH patients and 20 age matched controls , after through neurological examination , were subjected to electrically elicited blink reflex (BR) . Results: There was a significant delay in ipsilatral R2 (R2i) and contralateral R2 (R2c) latencies with 31.6 (±2.8) msec and 35.2 (±3.3) msec among cases when compared to controls with 29 (±2.6) msec and 32.2 (±2.8) msec respectively with (P-value<0.001), while R1 latencies were 10.4(±1) msec in cases and 10.5(±0.6) in controls with no signifcant difference between the two groups (p-value=0.726) Conclusion: the increased intracranial pressure was proved to increase R2i and R2c latencies of blink reflex studies which may suggest subclinical facial nerve dysfunction in IIH patients whether through peripheral nerve compression or at the level of the reflex centers (lateral medullla)in IIH patients.

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Atypical presentations of idiopathic intracranial hypertension

Cited by 31 publications

References 118 publications

Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema

Prevalence of Incidentally Detected Signs of Intracranial Hypertension on Magnetic Resonance Imaging and Their Association With Papilledema

The Potential Significance of Reversed Stapes Reflex in Clinical Practice in Idiopathic Intracranial Hypertension

Blink reflex in idiopathic intracranial hypertension patients

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