Sleep Disorders: A Risk Factor for Pseudotumor Cerebri?

Marcus, Dennis M.; Lynn, Julie; Miller, John J.; Chaudhary, Omar; Thomas, Dilip A.; Chaudhary, Bashir A.

doi:10.1097/00041327-200106000-00014

Cited by 66 publications

(44 citation statements)

References 22 publications

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“…Wang et al [13] compared the clinical features of 25 patients with IIHWOP with those exhibiting chronic daily headache (CDH) but with normal CSF pressure, and no difference in headache profile was found. Besides clinical presentation, IIH and CM also share some relevant risk factors such as S24 Neurol Sci (2015) 36 (Suppl 1):S23-S28 female gender, obesity and sleep disturbances [44][45][46] and both show a higher prevalence of allodynic symptoms [47][48][49][50]. Topiramate, a drug with documented efficacy in CM [51,52] that shares with acetazolamide the inhibition of carbonic anhydrase isoenzyme [53], has been found as effective as acetazolamide in IIH treatment [54], suggesting that the topiramate efficacy in CM could be mediated, at least partially, by an acetazolamide-like CSF pressure lowering effect.…”

Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

The role of intracranial hypertension in the chronification of migraine

Simone

Ranieri

2015

Neurol Sci

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Besides a similar clinical presentation, idiopathic intracranial hypertension (IIH) and chronic migraine (CM) also share relevant risk factors, show a higher prevalence of allodynic symptoms and both respond to topiramate. Moreover, sinus stenosis, a radiological marker of IIH, in CM patients is much more prevalent than expected. As a consequence of these striking similarities, IIH without papilledema (IIHWOP) may be easily misdiagnosed as CM. Actually, IIHWOP has been found in up to 14 % of CM clinical series. Considering that, on one hand, an asymptomatic sinus stenosis-associated raised intracranial pressure (ICP) may be highly prevalent in the general population, and on the other, that IIH clinical presentation with chronic headache may require a migraine predisposition, we have proposed that an overlooked IIHWOP could represent a risk factor for migraine progression. This hypothesis prompted us to investigate the prevalence of IIHWOP and its possible role in the process of migraine chronification in a consecutive series of CM patients selected for unresponsiveness to medical treatment and evidence of significant sinus stenosis. The main finding of our study is that the large majority of such patients actually suffer from a chronic headache secondary to IIHWOP. This implies that an IIHWOP mimicking CM is much more prevalent than believed, is commonly misdiagnosed as CM on the basis of ICHD criteria and is strictly predicted by refractoriness to preventive treatments. However, our data fully comply with the alternative hypothesis that an overlooked IIHWOP, although highly prevalent amongst healthy individuals, in migraine-prone subjects is a powerful (and modifiable) risk factor for the progression and the refractoriness of pain. The normalization of ICP by even a single LP with CSF withdrawal may be effective in a significant proportion of patients with a long history of refractory chronic headache, who represent about one-fifth of the patients screened in our study. We suggest that IIHWOP should be considered in all patients with almost daily migraine pain, with evidence of sinus stenosis and unresponsive to medical treatment, referred to specialized headache clinics.

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Section: Idiopathic Intracranial Hypertensionmentioning

confidence: 99%

The role of intracranial hypertension in the chronification of migraine

Simone

Ranieri

2015

Neurol Sci

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“…In children with CND submitted to ABI without associated UR issues, the relatively low pressure normally exerted by the CSF on the dural sutures, coupled with the particular vascularity of the dura allow for robust wound healing, and leading to a successful closure with no CSF collection in the vast majority of cases, even with standard surgical techniques. Conversely, children with significant UR issues and OSA often with secondary intracranial hypertension (SIH) (12)(13)(14)(15)(16), must be considered at higher risk for a CSF leak postoperatively. Indeed, this particular cohort of children need an individualized assessment of their respiratory problems with emphasis on identifying significant comorbidities responsible for idiopathic intracranial hypertension (IIH) or secondary intracranial hypertension (SIH) before the decision for ABI is confirmed.…”

Section: Resultsmentioning

confidence: 99%

Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery

Colletti

Mandalà

Colletti³

et al. 2017

Otology &Amp; Neurotology

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Objective: To present a child with cochlear nerve deficiency (CND) who received simultaneous bilateral simultaneous auditory brainstem implants (BS-ABI) and subsequently presented with bilateral cerebrospinal fluid (CSF) leaks unresponsive to standard treatments. To propose a novel rigid retrosigmoid cranioplasty for treating and preventing CSF leaks in children at high risk for this complication. Patient: A 3.5-year-old child with CND, vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities, coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality, Arnold Chiari malformation, previous treated tracheo-esophageal fistula underwent BS-ABI. Postoperatively, the child had recurrent bilateral retroauricular fluid collections. A standard revision procedure revealed breaches in the dural closure, migration of the auditory brainstem implantation (ABI) receiver stimulator on both sides and was unsuccessful in stopping the leak. Interventions: Bilateral repair with free fat grafting filling the craniectomy space and two absorbable meshes of poly-L-D-lactic (PLDL) acid stabilized with PLDL pins on the surrounding cranium, one to stabilize the fat graft and one to fix the ABI receiver stimulators inside the subperiosteal pockets. Main Outcome Measure: CSF leak recurrence, postoperative computed tomographic (CT) scans, intra-and postoperative simultaneous electrically evoked auditory brainstem responses (EABRs). Subjective and objective assessment of ABI function. Results: No postoperative CSF leaks at 60 days follow-up. EABRs and consistent behavioral responses obtained at initial mapping on both sides. Conclusions: The use of BS-ABI likely contributed to bilateral CSF leaks requiring revision surgeries in this child. Simultaneous bilateral craniotomies can put patients at risk for CSF leak. A novel cranioplasty technique employed finally proved successful in stopping the CSF leak in this case.

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“…[94] Cerebral venous thrombosis has been found in 11.4% of patients who were presumed to have IIH. [95] IIH has been associated with many etiologies such as exposition to a number of drugs (vitamin A, growth hormone, steroids, minocycline and tetracycline, sulphasalazine, etc…), [96][97][98][99][100][101][102] Behçet's Disease, [103] arteriovenous malformations, [104] sleep disturbances including obstructive sleep apnea syndrome (OSAS), [105,106] extracranial venous hypertension secondary to cardiac septal defect, [107] systemic lupus erythematosus, [108] uremia, [109] iron deficiency anemia [110,111] as well as some endocrine changes such as menstrual irregularities, use of oral contraceptives, hyperthyroidism and hypothyroidism. [112,113] It has also been argued that an underlying thrombophilic defect in patients with IIH might play a role in the pathogenesis and some small studies showed abnormalities in prothrombotic factors.…”

Section: New Insights From Neuro-imaging and Bilateral Transverse Sinmentioning

confidence: 99%

An update on the pathophysiology of idiopathic intracranial hypertension alias pseudotumor cerebri

Baykan

Eki̇zoğlu

Uzun

2015

Agri

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İdiyopatik intrakraniyal hipertansiyonun -diğer adıyla psödotümör serebrininpatofizyolojisi üzerine bir güncelleme SummaryIdiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure of unknown cause, leading to severe headache, papilledema and visual disturbances. Its former name, pseudotumor cerebri, has gained popularity recently. The strongest and most consistent risk factors of IIH are obesity and female gender. Infrequently, IIH may present in the absence of papilledema showing a headache profile similar to chronic daily headache with migrainous features. There have been several proposed mechanisms to explain the etiology of this disorder associated with various clinical conditions. In recent years, some inflammatory factors, natriuretic peptides and aquaporins have been proposed as possible contributors of the pathogenesis. On the other hand, some investigators have reported that bilateral transverse sinus stenosis is seen in the majority of IIH patients; therefore, dural sinus stent placement is used in some patients. No single theory has been able to provide a comprehensive answer, and there is no consensus about the exact cause of IIH. The aim of this review was to discuss the new insights on the mysterious pathogenesis of IIH.

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Sleep Disorders: A Risk Factor for Pseudotumor Cerebri?

Cited by 66 publications

References 22 publications

The role of intracranial hypertension in the chronification of migraine

The role of intracranial hypertension in the chronification of migraine

Resorbable Mesh Cranioplasty Repair of Bilateral Cerebrospinal Fluid Leaks Following Pediatric Simultaneous Bilateral Auditory Brainstem Implant Surgery

An update on the pathophysiology of idiopathic intracranial hypertension alias pseudotumor cerebri

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