Therapeutic effectiveness of acetazolamide in hindbrain hernia headache

Chalaupka, Flavio Devetag

doi:10.1007/s100720070107

Cited by 9 publications

(1 citation statement)

References 8 publications

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“…Our patient's improvement on high dose acetazolamide provided support for consideration of this medication in other patients with keyhole aqueduct syndrome and mesencephalic cleft and suggested that manipulation of CSF synthesis or dynamics can ameliorate symptoms of keyhole aqueduct syndrome. Acetazolamide, a carbonic anhydrase inhibitor that decreases CSF production and secretion, can help improve symptoms of intracranial hypertension, 13 syringomyelia, 14 hindbrain herniation headache, 15 and Chiari malformation. 16 Furthermore, a majority of patients with keyhole aqueduct syndrome exhibit a progressive clinical course, although some have a static course.…”

Section: Discussionmentioning

confidence: 99%

Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough

Oh¹,

Lanzman²,

Liao³

2018

American Journal of Ophthalmology Case Reports

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PurposeMidline structural defects in the neural axis can give rise to neuro-ophthalmic symptoms. We report a rare case of keyhole aqueduct syndrome presenting after two years of severe cough due to gastroesophageal reflux disease.ObservationsA 58-year-old woman with a 2-year history of daily, severe cough presented to the neuro-ophthalmology clinic with progressive diplopia and oscillopsia. Examination revealed a 1–2 Hz down-beating nystagmus in primary gaze that worsened with left, right, and down gazes. Gaze evoked nystagmus and mild paresis were also seen with up gaze. There was an incomitant left hypertropia due to skew deviation that worsened with right and up gazes and improved with down gaze. She also had a right-sided ptosis and a 3 mm anisocoria not due to cranial nerve 3 paresis or Horner's syndrome. Brain magnetic resonance imaging showed a 1.5 mm × 11.7 mm × 6 mm midline cleft in the ventral midbrain communicating with the cerebral aqueduct, consistent with keyhole aqueduct syndrome. Her nystagmus and diplopia improved with oral acetazolamide treatment, at high doses of 2500–3000 mg per day.Conclusions and importanceWe report the first case of midbrain keyhole aqueduct syndrome with ocular motor and other neuro-ophthalmic manifestations associated with severe cough. Although her cough was effectively treated and intracranial pressure measurement was normal, her ophthalmic symptoms continued to progress, which is common in previous cases reported. Treatment with acetazolamide led to significant improvement, supporting the use of acetazolamide in this rare condition.

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Section: Discussionmentioning

confidence: 99%

Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough

Oh¹,

Lanzman²,

Liao³

2018

American Journal of Ophthalmology Case Reports

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Chiari Malformation Type 1 in Adults

Zisakis

Sun

Pepper

et al. 2023

Advances and Technical Standards in Neurosurgery

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Primary cough headache

Pascual

2005

Current Science Inc

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Primary cough headache is defined as head pain brought on by coughing or other Valsalva maneuvers, but not by prolonged physical exercise, in the absence of any intracranial disorder. Primary cough headache is considered to be a rare condition, accounting for 0.4% of all headaches consulting our Neurology Department. Its pathophysiology remains a mystery. Primary cough headache is a sudden-onset headache that usually lasts from 1 second to 30 minutes, tends to be bilateral and posterior, does not begin earlier than the fifth decade of life, is more frequent in men, is not accompanied by other neurologic manifestations, and responds to indomethacin. These clinical characteristics allow its differential diagnosis from other entities, even though a craniocervical magnetic resonance imaging study is mandatory to rule out posterior fossa lesions, especially Chiari type-I malformation.

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Therapeutic effectiveness of acetazolamide in hindbrain hernia headache

Cited by 9 publications

References 8 publications

Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough

Vertical diplopia and oscillopsia due to midbrain keyhole aqueduct syndrome associated with severe cough

Chiari Malformation Type 1 in Adults

Primary cough headache

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