Abstract
BackgroundIdiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure (ICP) of unknown etiologyAim of the workThe aim of this research is to study the quantitative d-dimer level and the role of anticoagulant therapy in absence of occlusive sinus thrombosis in patients with IIH.MethodologyTwenty-four patients with IIH according to the modified Dandy criteria were enrolled. Headache impact test (HIT6), ophthalmological assessment including Frisen classification for papilledema, visual acuity, visual field, and visual evoked potentials were performed to the patients. Serum quantitative d-dimer level was measured using the enzyme-linked immunosorbent assay (ELISA) technique for the patients and for 24 healthy matched controls. Patients were divided into two groups: group (1) received acetazolamide and low molecular weight heparin (LMWH) in a prophylactic dose for 2 weeks while group (2) received acetazolamide only. Both groups continued on acetazolamide for 6 months. We followed the patients after 1 and 6 months later through the HIT6 test and the ophthalmological assessment.Resultsd-dimer level was statistically higher among the cases compared to the controls. Also, a statistically significant improvement was recorded in the ophthalmological assessment after 6 months among both groups; more evident in group (1).ConclusionThe elevated d-dimer level and the visual improvement in IIH patients receiving LMWH added to acetazolamide suggest the presence of an underlying unrecognized non-occlusive venous cerebral microthrombi impeding the cerebrospinal fluid (CSF) drainage.Trial registrationClinicalTrials,gov on 22/5/2019, NCT03963336.
Highlights
Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure (ICP) in the absence of intracranial disorder, a meningeal process or cerebral venous thrombosis [1]
D-dimer level was statistically higher among the cases compared to the controls
The elevated D-dimer level and the visual improvement in IIH patients receiving low molecular weight heparin (LMWH) added to acetazolamide suggest the presence of an underlying unrecognized non-occlusive venous cerebral microthrombi impeding the cerebrospinal fluid (CSF) drainage
Summary
Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure (ICP) in the absence of intracranial disorder, a meningeal process or cerebral venous thrombosis [1]. The pathophysiology underlying the raised ICP still remains obscure but there are some proposed mechanisms. A prothrombotic state with an elevated Ddimer level has been observed in obese IIH patient [4]. The D-dimer is considered the smallest fibrinolysis-specific degradation product in the circulation and it is an exquisite sensitive test to intravascular thrombosis [5]. The aim of our study was to measure the serum quantitative D-dimer level in IIH patients and to investigate the role of anticoagulation added to the routine treatment as a possible effective therapy. Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure (ICP) of unknown etiology
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