Resolution of pseudotumor cerebri after bariatric surgery for related obesity

Nadkarni, Trimurti; Rekate, Harold L.; Wallace, Donna

doi:10.3171/jns.2004.101.5.0878

Cited by 67 publications

(57 citation statements)

References 7 publications

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“…Another case report demonstrated a reduction of dural venous sinus pressure in 2 patients following bariatric surgery. 46,47 Medications to treat and prevent recurrence of PTC typi- cally have activity against carbonic anhydrase, which has been found to decrease the rate of CSF production, and thus address 1 of the proposed mechanisms of PTC. 22 Acetazolamide is historically the most commonly used medication to treat PTC, but topiramate has been shown to have equal effect as a result of partial carbonic anhydraseϪinhibition activity augmented by beneficial analgesic action against headaches and weight loss as a fortuitous side effect.…”

mentioning

confidence: 99%

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

Degnan

Levy

2011

AJNR Am J Neuroradiol

239

179

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SUMMARY: PTC is a clinical entity of uncertain etiology characterized by intracranial hypertension. The syndrome classically manifests with headaches and visual changes in women with obesity. Traditionally, imaging ruled out secondary causes of elevated CSF pressure but now may reveal findings frequently seen in patients with PTC, including the following: flattening of the globe, an empty sella, an enlarged ONS, protrusion and enhancement of the optic nerve head, and increased tortuosity of the optic nerve. Novel imaging methods, including MR venography, have additionally identified sinovenous stenosis as a potential indicator of PTC.ABBREVIATIONS: BMI ϭ body-mass index; CN ϭ cranial nerve; HIV ϭ human immunodeficiency virus; ICP ϭ intracranial pressure; IIH ϭ idiopathic intracranial hypertension; ISF ϭ interstitial fluid; MRI ϭ MR imaging; ONS ϭ optic nerve sheath; ONSF ϭ optic nerve sheath fenestration; IOP ϭ intraocular pressure; PCOS ϭ polycystic ovary syndrome; PTC ϭ pseudotumor cerebri syndrome

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mentioning

confidence: 99%

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

Degnan

Levy

2011

AJNR Am J Neuroradiol

239

179

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“…This is reflected in our cohort of patients, all of whom are female with an average age of 32 and mean body mass index of 46.05 kg/m 2 at initial presentation. IIH is a poorly understood entity, with several postulated causes or predisposing factor [7][8][9][10]. All patients in our cohort had been investigated and When considered as a whole, our group of patients had suffered with a rather refractory form of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Nadkarni et al have stated that the increased intracranial pressure is caused by high right atrial pressure, which itself is a direct result of obesity [7]. This has complemented other such work which has identified intra-abdominal pressure increases in obesity as the primary contributory factor in IHH [8,9].…”

Section: Introductionmentioning

confidence: 93%

The Effects of Laparoscopic Adjustable Gastric Banding on Idiopathic Intracranial Hypertension

et al. 2010

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The purpose of this study was to determine whether laparoscopic adjustable gastric banding has a role in the treatment of idiopathic intracranial hypertension. This pilot study was undertaken in a single, tertiary referral centre. Data on all patients with idiopathic intracranial hypertension that have undergone laparoscopic adjustable gastric banding in our unit were collected from our prospectively maintained bariatric database. Additional information was obtained via telephone questionnaires and review of medical records. Four female patient with a mean age of 32 years (range 29-39 years) and mean pre-operative body mass index of 46.1 kg/m(2) (range 38.2-54.0 kg/m(2)) underwent laparoscopic adjustable gastric banding between June 2006 and July 2009. At a mean follow-up of 19.8 months all four patients reported either total resolution of headache or significant improvement in headache, with a mean improvement in pain score of 76.3/100 (range 55-95) on a analogue pain score. Mean excess weight loss at follow-up was 64.1% (range 50.1-88.2%). There were no complications or mortality in this cohort. This study suggests that laparoscopic adjustable gastric banding represents an effective and safe treatment for idiopathic intracranial hypertension associated with morbid obesity. We have shown good results both in terms of symptom resolution and weight loss, whilst avoiding alimentary tract diversion procedures in these young female patients. A randomized, controlled trial can be justified on the basis of this initial pilot study.

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“…The first case was reported by Fontes et al, 21 who observed that complete resolution of PC-related symptoms was achieved in a 37-yearold female after RYGB. Nadkarni et al 20 reported on two cases of obese women, both aged 42 years, who underwent gastric bypass and gastric stapling. Complete resolution of PC was observed at the one-year reevaluation.…”

Section: Case Reportmentioning

confidence: 99%

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

et al. 2017

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CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of childbearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH 2 O. She presented a body mass index of 39.5 kg/m 2 , also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH 2 O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm. RESUMOCONTEXTO: O pseudotumor cerebri ocorre quando há aumento na pressão intracraniana sem causa subjacente, comumente levando a perda visual. É mais comum em mulheres obesas em idade fértil. RELATO DE CASO: Mulher de 46 anos, foi admitida com hipertensão intracraniana idiopática diagnosticada há dois anos, que levou a cefaleia refratária crônica e perda estimada de 30% da acuidade visual, associada a papiledema bilateral. Apresentou melhora parcial da cefaleia com acetazolamida, mas a perda visual persistiu. A pressão intracraniana era de 34 cmH 2 O. Apresentava índice de massa corpórea de 39,5 kg/m 2 , associado a hipertensão arterial. Tomografia computadorizada com contraste endovenoso de crânio não apresentou anormalidades. Foi submetida ao bypass gástrico em Y de Roux, com evolução pós-operatória sem intercorrências. Um mês após a cirurgia, apresentou perda de peso em excesso de 24%. Um exame oftalmológico demonstrou ausência de perda visual e remissão do papiledema; não houve novos episódios de cefaleia após a cirurgia. Houve também resolução completa da hipertensão arterial. A pressão intracraniana caiu para 24 cmH 2 O após seis meses da cirurgia. CONCLUSÃO: Embora a condição seja usualmente associada à obesidade, há escassos relatos de cirurgia bariátrica em indivíduos com pseudotumor cerebri. Nos casos previamente estudados, há alta pre...

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Resolution of pseudotumor cerebri after bariatric surgery for related obesity

Cited by 67 publications

References 7 publications

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

The Effects of Laparoscopic Adjustable Gastric Banding on Idiopathic Intracranial Hypertension

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

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