Total improvement after surgery for obstructive sleep apnea syndrome in a patient with concurrent malignant idiopathic intracranial hypertension

Abstract

The association between idiopathic intracranial hypertension (IIH) and obstructive sleep apnea syndrome (OSAS) constitutes an interesting point of discussion regarding clinical approaches as well as the underlying pathophysiological mechanisms. Here, the case of a 42-year-old female with malignant IIH and OSAS is illustrated. Initially, the patient was treated with lumboperitoneal shunt surgery. However, OSAS surgery provided total recovery from the recurrent symptoms developing secondary to lumboperitoneal shunt malfunction. The authors point out the importance of identifying OSAS as a crucial causative agent in some IIH subtypes. Future studies are warranted to clarify this underestimated association.

Diagnosis of idiopathic intracranial hypertension - the importance of excluding secondary causes: A systematic review

“…The distribution was as follows: hematological diseases (N = 16) (90–93,95–104,106,107), rheumatologic diseases (N = 7): Behçet’s disease and systemic lupus erythematosus (SLE) (71,72,83,94,105,108,109), different genetic diseases (N = 5) (73,74,110–112), oncological disorders (N = 3) (75–77). The most common diseases in this group were anemia (N = 42), leukemia (N = 17) (75–77), Behçet’s disease (N = 7) SLE (N = 7) (94,105,108,109), head trauma (N = 7) (78,79), obstructive sleep apnea syndrome (N = 5) (80,81) and sickle cell disease (N = 5) (104,106). Cases related to sIH induced by genetic diseases were distributed as following: cystic fibrosis (N = 2), Gitelman’s syndrome (N = 1), Phosphatase and Tensin Homolog on chromosome TEN (PTEN)mutation (N = 1) Turner syndrome (N = 1) (73,74,110–112).…”

“…We found 42 articles with 105 cases: 48 pediatric and 57 adult (71–112), Table 4. The distribution was as follows: hematological diseases (N = 16) (90–93,95–104,106,107), rheumatologic diseases (N = 7): Behçet’s disease and systemic lupus erythematosus (SLE) (71,72,83,94,105,108,109), different genetic diseases (N = 5) (73,74,…”

Resolution of idiopathic intracranial hypertension symptoms by surgery for obstructive sleep apnea in a pediatric patient

“…[2] Nevertheless, an increasing evidence (at the level of case reports) supporting the role of OSAS as an etiological agent in the pathophysiology of IIH is available. [345] Herein, we present a remarkable patient with IIH, who recovered significantly via the surgery of OSAS. The improvement was shown by the resolution of the OCT measurements as well as LP opening pressure measurements.…”

“…In our previous report, we had shown the recovery of a malignant coursed IIH after surgery for OSAS in detail via serial OCT measurements and fundus examination results. [3] Through the presentation of this report and related literature, we reemphasize the importance of interrogation of OSAS in patients with IIH (also in the pediatric population as in adult patients), as treatment of OSAS may potentially relieve the primary etiology leading to their total cure.…”

<p>Neuro-Ophthalmological Manifestations of Obstructive Sleep Apnea: Current Perspectives</p>

“… The AHI scores of the IIH patients and 1741 randomly sampled individuals had no statistical difference Wardly et al 54 2017 1 Case report PSG Patient with OSA and IIH. Her IIH went away following a clockwise maxillomandibular advancement surgery to treat OSAS Cappuzzo et al 55 2018 18 IIH patients Retrospective Medical history 3/18 (16.7) of IIH patients had OSA Ardissino et al 56 2019 607 IIH patients and 230,792 controls all with BMI>30 Retrospective Medical history 4/607 (0.7%) of IIH patients and 2204/230,792 (1%) of the controls had OSA Radojicic et al 57 2019 219 IIH patients and 67 controls Prospective comparative Medical history 5/219 (2.3%) of IIH patients and 7/67 (10.4%) of the controls had OSA Onder et al 58 2019a 1 Case report Epworth Sleepiness Scale (ESS) Patient with OSA and malignant IIH that was resolved following tonsillectomy to treat OSA Onder et al 59 2019b 1 Case report ESS 10 year-old patient with a BMI of 20, diagnosed with IIH and suspected of OSA Abbreviations: OSA, obstructive sleep apnea; NAION, non-arteritic anterior ischemic optic nerve; PSG, polysomnogram; CPAP, continuous positive air pressure. …”