Idiopathic Intracranial Hypertension

Shah, Vinay; Fung, S.; Shahbaz, Reza; Taktakishvili, Otar; Wall, Michael; Lee, Andrew G.

doi:10.1016/j.ophtha.2006.08.034

Cited by 13 publications

(4 citation statements)

References 3 publications

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“…19 If patients cannot tolerate acetazolamide, we have used topiramate as an alternative because it also demonstrates carbonic anhydrase inhibitory effect and has been studied as an alternative to acetazolamide in cases of idiopathic intracranial hypertension. 20,21 Acetazolamide should be used cautiously in patients with sulfa allergy, though our experience is that it is well tolerated by most patients with a history of reaction to other sulfa drugs, a finding that agrees with previous reports of the use of acetazolamide in sulfa-allergic patients. 22 Other reported strategies for the treatment of RIH include the use of IV glycerol and the need for CSF shunting.…”

supporting

confidence: 86%

Rebound Intracranial Hypertension: A Complication of Epidural Blood Patching for Intracranial Hypotension

Kranz

Amrhein

Gray

2014

American Journal of Neuroradiology

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SUMMARY:Rebound intracranial hypertension is a complication of epidural blood patching for treatment of intracranial hypotension characterized by increased intracranial pressure, resulting in potentially severe headache, nausea, and vomiting. Because the symptoms of rebound intracranial hypertension may bear some similarity to those of intracranial hypotension and literature reports of rebound intracranial hypertension are limited, it may be mistaken for refractory intracranial hypotension, leading to inappropriate management. This clinical report of 9 patients with confirmed rebound intracranial hypertension reviews the clinical characteristics of patients with this condition, emphasizing factors that can be helpful in discriminating rebound intracranial hypertension from refractory spontaneous intracranial hypotension, and discusses treatment.ABBREVIATIONS: SIH ϭ spontaneous intracranial hypotension; RIH ϭ rebound intracranial hypertension; EBP ϭ epidural blood patching; LP ϭ lumbar puncture

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supporting

confidence: 86%

Rebound Intracranial Hypertension: A Complication of Epidural Blood Patching for Intracranial Hypotension

Kranz

Amrhein

Gray

2014

American Journal of Neuroradiology

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“…Bislang existieren jedoch keine randomisierten, placebo-kontrollierten Studien zum Nachweis der Wirksamkeit. Lediglich einige offene Studien ohne Placebogruppe deuten auf eine Wirksamkeit bei der IIH hin [80,86]. Zu den häufigsten Nebenwirkungen zählen Parästhesien, Stimmungsschwankungen und kognitive Nebenwirkungen [87].…”

Section: Medikamentöse Behandlungunclassified

Neues beim Pseudotumor cerebri (Idiopathische intrakranielle Hypertension)

Hoffmann

May

2017

Akt Neurol

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ZusammenfassungDie idiopathische intrakranielle Hypertension (IIH) ist charakterisiert durch eine Liquordruckerhöhung unklarer Ätiologie. Klinisch äußert sich diese in Form von progredienten Sehstörungen, in der Regel als Folge eines Papillenödems, Kopfschmerzen und nicht selten Hirnnervenausfällen. In den letzten Jahren haben klinische Studien zunehmend zeigen können, dass das Syndrom häufig auch mit weiteren Symptomen wie Riechstörungen, kognitiven Defiziten und einem pulsierenden Tinnitus einhergehen kann. Pathophysiologisch liegt der Erkrankung vermutlich eine venöse Abflussstörung zugrunde, die zu einer verminderten Liquorresorption und einem Anstieg des Liquordrucks führt, wobei unklar ist, ob die Abflussstörung auf einer übergewichtsbedingten Zunahme des intrathorakalen Drucks, dem Vorliegen von Stenosen im Sinus transversus oder beidem beruht. Seit einigen Jahren werden auch hormonelle Faktoren diskutiert, wobei deren Auswirkungen bislang weitgehend unklar sind. Die Behandlung der IIH beruht vorwiegend auf einer effizienten Gewichtsreduktion sowie einer medikamentösen Behandlung mit Karboanhydrasehemmern, die sowohl die Liquorproduktion als auch das Körpergewicht reduzieren. Für den Karboanhydrasehemmer Azetazolamid liegen nun die Ergebnisse der ersten randomisierten, placebo-kontrollierten Studie einschließlich einer 12-monatigen Follow-up Phase vor, die zeigen, dass sich unter der Therapie sowohl das Papillenödem und die Sehstörungen als auch die Kopfschmerzen signifikant bessern. Für die Karboanhydrasehemmer Topiramat und Furosemid gibt es weiterhin nur offene, jedoch keine doppelblinden, placebo-kontrollierten Studien zur Wirksamkeit bei der IIH. Neben der Behandlung mit Karboanhydrasehemmern mehren sich inzwischen die Hinweise, dass das Somatostatinanalogon Octreotid wirksam in der Behandlung der IIH sein könnte, wobei für diese Substanz bislang keine randomisierten, doppelblinden, placebo-kontrollierten Studien vorliegen.

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“…In cases where acetazolamide is not effective, tolerated, or contraindicated, topiramate can be given as an alternative at a dose between 50-200 mg. To date, however, there have been no randomized, placebo-controlled studies to verify its efficacy. Only a few open studies without a placebo group suggest its efficacy in IIH [80,86]. Paresthesias, mood swings, and cognitive deficits are among the most frequent side effects [87].…”

Section: Pharmaceutical Treatmentmentioning

confidence: 99%

Update on Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

Hoffmann

May

2017

Neurology International Open

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Idiopathic intracranial hypertension is characterized by an increase of intracranial pressure of unknown etiology. The clinical presentation is dominated by progressive visual disturbances, which are commonly the result of a papilledema, headache and cranial nerve palsies. Clinical studies have revealed over the past years that the syndrome may also be associated with olfactory disturbances, cognitive deficits and a pulsatile tinnitus.The underlying pathomechanism is probably based on a disturbance of venous outflow, which causes a reduced absorption of cerebrospinal fluid that results in an increase of cerebrospinal fluid pressure. It remains unclear if the venous outflow disturbance results from the overweight-induced increase of intrathoracic pressure, the presence of sinus vein stenoses or both conditions. Recently hormonal factors have also been discussed, but the mechanisms behind a potential influence on intracranial pressure remain unclear.Treatment of idiopathic intracranial hypertension relies mainly on an effective body weight reduction and medication with carboanhydrase inhibitors, which can reduce the production of cerebrospinal fluid and body weight. Results of the first randomized, placebo-controlled trial as well as a 12-month follow-up show that acetazolamide effectively reduces papilledema, visual disturbances and headache in idiopathic intracranial hypertension. In contrast, the evidence for the carboanhydrase inhibitors topiramate and furosemide still relies on open-label trials, because double-blind, placebo-controlled trials for their efficacy in idiopathic intracranial hypertension do not exist. In addition to the treatment with carboanhydrase inhibitors, increasing evidence suggests that the somatostatin analog octreotide may be effective in the treatment of idiopathic intracranial hypertension, but to date no randomized, double-blind, placebo-controlled trials exist to confirm this observation.

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Idiopathic Intracranial Hypertension

Cited by 13 publications

References 3 publications

Rebound Intracranial Hypertension: A Complication of Epidural Blood Patching for Intracranial Hypotension

Rebound Intracranial Hypertension: A Complication of Epidural Blood Patching for Intracranial Hypotension

Neues beim Pseudotumor cerebri (Idiopathische intrakranielle Hypertension)

Update on Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)

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