Obese Women Of Childbearing Age Research Articles

Clinical Characteristics of Idiopathic Intracranial Hypertension in Older Adults.

Idiopathic intracranial hypertension (IIH) is a condition that classically affects obese women of child-bearing age. However, it is sometimes encountered in older patients. The purpose of this study was to help clinicians better understand how this disease can present differently in these age groups. This is a retrospective chart review from a single academic center of baseline characteristics of adult patients diagnosed with IIH based on the modified Dandy criteria. The patients were divided into 2 groups: (1) those 18-44 years old and (2) those older than 45 years at diagnosis. One hundred sixty-seven patients were identified; 135 in the younger group and 32 in the older group. The younger group had a higher rate of headaches (90% vs 63%, P = 0.0004), higher body mass index (38.9 vs 36.1, P = 0.046), higher opening pressure (38 vs 31 cm H2O, P = 0.005), and thicker peripapillary retinal nerve fiber layer average thickness (right eye 178 vs 131 μm, P = 0.02; left eye 184 vs 136 μm, P = 0.045). The older group had higher rates of empty sella (90% vs 62%, P = 0.0039). In addition in the younger group, there was a trend toward higher rates of pulsatile tinnitus (63% vs 45%, P = 0.08), transient visual obscurations (50% vs 32%, P = 0.07), and lower rates of spontaneous cerebrospinal fluid leak (4% vs 13%, P = 0.08). Sex, rates of obesity, other MRI findings typical of elevated intracranial pressure, frequency and Frisen grading of papilledema, and visual field loss were not statistically different between the groups. The older age group had milder signs and symptoms of IIH and a higher prevalence of empty sella than the younger group, but otherwise had typical characteristics. These findings suggest that IIH in the older age group may represent milder chronic disease that was previously undiagnosed.

Idiopathic Intracranial Hypertension With Transcribriform Plate Intranasal Meningocele Without Cerebrospinal Fluid Rhinorrhea: A Case Report

Idiopathic intracranial hypertension (IIH) is a rare disorder of unclear pathogenesis occurring commonly in obese women of childbearing age and characterized by increased intracranial pressure in the absence of intracranial space-occupying lesion or cerebrospinal fluid outflow obstruction. We report a rare case of a middle-aged obese female with intractable headache referred to the department of radiology for neuroimaging on account of suspected dural sinus thrombosis and brain Magnetic Resonance Imaging (MRI) which revealed signs of IIH with asymptomatic transcribriform plate intranasal meningocele with a view to underscore the quiddity of IIH in middleaged obese females and also emphasize the need for radiologists to diligently review previous patient’s images where available for possible finding that could contribute to a suspected diagnosis.

Modelling idiopathic intracranial hypertension in rats: contributions of high fat diet and testosterone to intracranial pressure and cerebrospinal fluid production

BackgroundIdiopathic intracranial hypertension (IIH) is a condition characterized by increased intracranial pressure (ICP), impaired vision, and headache. Most cases of IIH occur in obese women of childbearing age, though age, BMI, and female sex do not encompass all aspects of IIH pathophysiology. Systemic metabolic dysregulation has been identified in IIH with a profile of androgen excess. However, the mechanistic coupling between obesity/hormonal perturbations and cerebrospinal fluid dynamics remains unresolved.MethodsFemale Wistar rats were either fed a high fat diet (HFD) for 21 weeks or exposed to adjuvant testosterone treatment for 28 days to recapitulate IIH causal drivers. Cerebrospinal fluid (CSF) and blood testosterone levels were determined with mass spectrometry, ICP and CSF dynamics with in vivo experimentation, and the choroid plexus function revealed with transcriptomics and ex vivo isotope-based flux assays.ResultsHFD-fed rats presented with increased ICP (65%), which was accompanied by increased CSF outflow resistance (50%) without altered CSF secretion rate or choroid plexus gene expression. Chronic adjuvant testosterone treatment of lean rats caused elevated ICP (55%) and CSF secretion rate (85%), in association with increased activity of the choroid plexus Na+,K+,2Cl− cotransporter, NKCC1.ConclusionsHFD-induced ICP elevation in experimental rats occurred with decreased CSF drainage capacity. Adjuvant testosterone, mimicking the androgen excess observed in female IIH patients, elevated the CSF secretion rate and thus ICP. Obesity-induced androgen dysregulation may thus contribute to the disease mechanism of IIH.

Epidural Labor Analgesia and Epidural Surgical Anesthesia in a Patient with Idiopathic Intracranial Pressure with Lumbo-peritoneal Shunt: a rare case report

Background: Idiopathic Intracranial Hypertension (IIH) is due to an increased intracranial pressure with no secondary cause of intracranial hypertension and normal Cerebrospinal fluid (CSF) composition. IIH’s prevalence is high among obese women of childbearing age and subsequently coincides with pregnancy. Symptoms vary among patients and commonly present headaches and visual impairment. If untreated, it may steer persistent headaches and lasting visual impairment such as diplopia and scotoma or even blindness. Case Report: We hereby present the uncommon case of an epidural anesthesia for cesarean section in a patient with idiopathic intracranial hypertension and Lumbo-peritoneal shunt that presented to our obstetrics department in labor. First, epidural labor anesthesia (ELA) with a catheter placed above the LP shunt scar was the chosen course of action. However, ELA was converted to an epidural surgical anesthesia (ESA) for acute fetal distress secondary to a placental abruption. Conclusion: IIH usually occurs in pregnant women at any trimester. If undiagnosed or poorly managed, it can lead to drastic complications. As uncommon as it may be, all medical practitioners should be familiar with this pathology even though its diagnostic and treatment are exacting. While the optimal anesthetic management is still controversial, epidural anesthesia proved to be very effective.

Neuroimaging in the diagnosis and treatment of intracranial pressure disorders.

To review the clinical features, proposed pathophysiology, and the role of medical imaging in the diagnosis and treatment of idiopathic intracranial hypertension and spontaneous intracranial hypotension. The authors conducted a narrative review of the current literature on intracranial hypertension and hypotension syndromes, with a focus on imaging findings and role of neurointerventional radiology as a therapeutic option for these pathologies. Idiopathic intracranial hypertension commonly presents in obese women of childbearing age, being headache and papilledema the main clinical manifestations. Characteristic radiological findings consist of increased cerebrospinal fluid around the optic nerve, partially empty sella turcica and stenosis of the transverse sinuses. Transverse sinus stenting is a treatment alternative that has proven valuable utility in the recent years. Spontaneous intracranial hypotension in most of cases presents with orthostatic headache and has predilection for female population. The typical radiological features in the brain consist of subdural fluid collections, enhancement of the dura, engorgement of the venous structures, pituitary enlargement, and sagging of the brain. In this pathology, a cerebrospinal fluid leak in the spine associated with a defect in the dura, meningeal diverticulum, or a cerebrospinal fluid-venous leak must be actively ruled out. Neurologic complaints secondary to changes in intracranial pressure exhibit certain clinical features that in combination with fairly specific radiological patterns allow a highly accurate diagnosis. The diverse specialists in neurosciences should be aware of the multiple image modalities in the study of these syndromes as well as the treatment alternatives by neurointerventional radiology.

AML-173 Pseudotumor Cerebri (PTC) in Patients With Acute Leukemia (AL)

Pseudotumor cerebri (PTC) is characterized by headache, vision changes, and fundus papilledema. Primary PTC is often seen in obese women (childbearing age) and secondary with medications such as all-trans retinoic acid (ATRA). We analyze clinical presentation, and outcomes of PTC in patients with acute leukemia (AL) treated at a general hospital. Single-center retrospective study. We reviewed cases of AL patients with PTC at Memorial Hermann Hospital, Texas Medical Center between January 2013 and April 2022. Three (2.3%) of 127 patients (AML=85, APL=29, ALL= 13) had PTC. Fit non-APL patients received induction chemotherapy (IC) with purine analogs-cytarabine-anthracycline. Unfit patients received a hypomethylating agent and venetoclax. APL patients received IC with arsenic trioxide and ATRA. Patients suspected of having APL were started on ATRA, and discontinued with a negative PML-RARA FISH test. We describe the incidence, risk factors, clinical presentation, and outcomes of AL patients with PTC. Mean age was 42 years. Mean BMI was 42. All were white women. Two had AML, and one Philadelphia chromosome-positive ALL. AML patients received 3 doses of ATRA discontinued after negative PML-RARA FISH. One AML patient had PTC at presentation. The other developed PTC 3 months later. One AML patient had PTC 30 years before being treated for 6 months with acetazolamide; PTC recurred 3 months after her diagnosis. All patients had headaches, blurry vision, and papilledema with brain MRI showing optic sheath distension, globe flattening, and papilla cupping, all features suggestive of PTC. In two, the opening lumbar puncture pressures were elevated at 30 and 35 cm H2O. Cerebrospinal fluid cytology and flow cytometry were negative for leukemia. Two patients (AML=1, ALL=1) received intrathecal (IT) chemotherapy for CNS prophylaxis. All patient's symptoms improved with acetazolamide. LP done for IT chemotherapy helped to alleviate symptoms. No patient with APL (29 patients) developed PTC during treatment with ATRA. PTC is a rare diagnosis that can complicate the clinical course of AL patients. In addition to ATRA-induced PTC, clinicians should consider primary PTC, seen most often in morbidly obese women of childbearing age.

Anemia and Idiopathic Intracranial Hypertension: A Case-Control Study.

Idiopathic intracranial hypertension (IIH) is a condition that mostly affects obese women of childbearing age but has been reported to be temporally related to new diagnoses of anemia. Despite these reports, the association between anemia and IIH remains controversial. The present study aimed to understand the strength of association between anemia and IIH through a case-control design. Consecutive IIH patients were recruited from neuro-ophthalmology clinics and matched by age and sex to consecutive patients attending neuro-ophthalmology clinics with diagnoses other than IIH. Complete blood counts (CBCs) were reviewed within 6 months of neuro-ophthalmology presentation, and anemia was diagnosed by hemoglobin of <120 g/L in women and <130 g/L in men. Anemia was classified as microcytic (mean corpuscular volume (MCV) < 80 fL), normocytic (MCV 80-100 fL), and macrocytic (MCV>100 fL) as well as mild (hemoglobin >110 g/L), moderate (hemoglobin 80-109 g/L), and severe (hemoglobin <80 g/L). One hundred twenty-three IIH patients and 113 controls were included in the study. More IIH patients than controls had anemia (22.8%, 28/123 vs 10.6%, 12/113, P = 0.01) with an odds ratio of 2.48 (95% CI: 1.19, 5.16). There were no differences in severity of anemia or MCV between IIH patients and controls, with anemia most often being mild (57.1%, 16/28 vs 75%, 9/12) and normocytic (50.0%, 14/28 vs 50.0%, 6/12). However, 17.9% (5/28) of IIH patients had severe anemia compared with zero in the control group. IIH patients had a higher mean platelet count than controls ( P < 0.001), and there were no differences on leukocyte counts. Idiopathic intracranial hypertension patients have a higher prevalence of anemia compared with non-IIH neuro-ophthalmology patients. The anemia was mostly mild and may be explained by other factors related to worse health status and obesity, including low socioeconomic status, poor nutrition, and polycystic ovary syndrome. However, as a CBC is a widely available test and anemia may influence the IIH disease course, we propose that this test be obtained in all patients with new papilledema.

[CME: Idiopathic Intracranial Hypertension].

CME: Idiopathic Intracranial Hypertension Abstract. Idiopathic intracranial hypertension is a pressure-induced secondary headache disorder and optic neuropathy. It primarily affects obese women of childbearing age and poses an interdisciplinary challenge both diagnostically and therapeutically. The most common symptom of this disorder are headaches frequently accompanied by photo- and/or phonophobia, whose semiology often resembles that of migraine, followed by transient visual obscurations and pulsatile tinnitus. While protection of visual acuity and visual fields are of first therapeutical priority, adequate headache treatment also plays a key role. In the majority of cases, conservative treatment including weight loss and pharmacological therapy is sufficient. In case of a fulminant disease course or loss of visual function, interventional strategies can be applied additionally. Headache treatment is guided by the predominant semiology.

Biochemical indices of blood in women suffering from anovulatory infertility during xenical treatment

Summary. Obesity is a common problem among women of childbearing age. It is known that obesity negatively affects various types of metabolism, many organs and organ systems, and in particular, a woman's fertility. Thus, obese women of childbearing age may experience menstrual irregularities, endometrial pathology, and infertility. The aim of the study – to determine changes in serum biochemical parameters in women with Xenical-induced anovulatory infertility. Materials and Methods. We surveyed 82 obese women who complained of no pregnancy for 2 years or more in the presence of regular sex without the use of contraceptives. Patients were divided into two equal groups: group 1 included 42 women, group 2 – 40 women. Comprehensive treatment of obesity in patients of group 1 was supplemented with the drug Xenical. A laboratory study was performed at the beginning of the experiment, after 3 and 6 months: blood lipid spectrum, ALT, AST, CRP, TSH, adiponectin, insulin, and OGTT. Results. Follow-up of patients in the first stage of the study was carried out for 6 months. Six months later, body weight in patients of group 1 decreased on average to (80.5±0.9) kg, in patients of group 2 – to (94.4±1.1) kg. In group 1, 36 patients became pregnant, in group 2 – 19. During the screening phase of the laboratory study in the experimental and control groups, elevated levels of cholesterol, LDL cholesterol, triglycerides, and decreased levels of HDL cholesterol and adiponectin. After 6 months, differences in the dynamics of lipid metabolism were recorded. Thus, cholesterol in the main group decreased by -0.35 [-0.75; 0.05] mol/l, and the control only -0.05 [-0.15; 0.25] mol/l (p = 0.027). There was a statistically significant difference between the groups in the reduction of atherogenic LDL. In six months of the study, all women who took Xenical showed normalization of cholesterol levels, decreased CRP, and increased adiponectin levels. Conclusions. Xenical is effective in the fight against obesity, improves laboratory blood tests, has a particularly positive effect on lipid metabolism, which resulted in the possibility of pregnancy in most patients who took this drug

New Options (or not) for Treatment of Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is a disorder primarily affecting obese women of childbearing age and, if left untreated, can lead to irreversible vision loss. No consensus exists on the best management strategy for IIH. Weight loss is advocated and few useful medical options exist. There is an unmet need to discover new treatment options for this increasingly prevalent condition. This article reviews the recent advances and research on the treatment of IIH. Venous sinus stenting (VSS) is now performed in many experienced centers, and there is growing interest in bariatric surgery as a treatment modality. Newly approved anti-obesity drugs are showing effectiveness in weight loss, and novel targeted disease-modifying IIH therapies are being explored. Further evaluation of these novel therapeutic strategies as well as studies exploring the use of anti-obesity drugs in IIH is needed. While VSS is gaining popularity due to its efficacy and low complication rate, there is insufficient evidence to support any surgical procedure over another. Bariatric surgery is appealing for patients with non-sight-threatening IIH and needs to be further explored.

CLINICAL FEATURES AND LABORATORY PARAMETERS IN PREGNANT WOMEN WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND OBESITY

Today, non-alcoholic fatty liver disease (NAFLD) is a common pathology and pressing problem in pregnant women, especially among overweight, as the incidence of obese women of childbearing age is rapidly increasing. Disorders of lipid metabolism, which is an integral part of this disease, lead to pathological changes in the functional state of the liver, which in turn have a negative impact on pregnancy and lead to the formation of obstetric and perinatal complications. THE AIM OF OUR STUDY was to evaluate the clinical and laboratory markers of liver disorders in pregnant women with NAFLD depending on body mass index. MATERIALS AND METHODS. We’ve examined 98 pregnant women with NAFLD at the stage of non-alcoholic steatohepatitis (NASH) in combination with obesity. The age of the examined women ranged from 21 to 35 years (mean age 30.5 ± 1.5 years). The control group consisted of 30 almost healthy pregnant women. Depending on the body mass index (BMI), all surveyed women are divided into three groups: Group I - overweight pregnant women, Group II - pregnant women with grade I obesity, Group III - pregnant women with grade II obesity. We evaluated the incidence of major clinical complaints and changes in blood biochemical parameters in pregnant women depending on the increasing of BMI. RESULTS. When comparing the clinical manifestations of NAFLD on the stage of NASH in pregnant, the highest frequency is observed in the group of examined women with severe obesity compared with the group of patients with moderate obesity and overweight: symptoms of asthenic syndrome (increased fatigue, sleep disturbances, emotional lability, decreased and increased appetite) in 91.6.0%, 79.1% and 61.5% of patients (p&lt;0.05), manifestations of dyspepsia  (constipation, nausea, flatulence) - in 87.5%, 54% and 34.6% patients (p &lt;0.05), feeling of heaviness or moderate pain in the right hypochondrium - in 62.5% 50% and 30.7% of patients, respectively (p &lt;0.05). CONCLUSIONS. It has been established that pregnant women with non-alcoholic fatty liver disease on the stage of nonalcoholic steatohepatitits have pronounced clinical picture of the disease, which depends on the increase in BMI. It was found that in pregnant women with NAFLD liver dysfunction occurs on the background of grade I obesity, which can be considered as an early marker of steatohepatitis and risk of obstetric complications.

Is Lumbar Puncture Needed? - Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight impairment. Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. In this study, noninvasively assessed intracranial pressure (nICP) was compared to LP pressure (LPP) in order to clarify its feasibility for the diagnosis of IIH. nICP was calculated using continuous signals of arterial blood pressure and cerebral blood flow velocity in the middle cerebral artery, a method which has been introduced recently. In 26 patients (f = 24, m = 2; age: 33 ± 11 years), nICP was assessed one hour prior to LPP. If LPP was > 20 cmH2O, lumbar drainage was performed, LPP was measured again, and also nICP was reassessed. In total, LPP and nICP correlated with R = 0.85 (p < 0.001; N = 38). The mean difference of nICP-LPP was 0.45 ± 4.93 cmH2O. The capability of nICP to diagnose increased LPP (LPP > 20 cmH2O) was assessed by ROC analysis. The optimal cutoff for nICP was close to 20 cmH2O with both a sensitivity and specificity of 0.92. Presuming 20 cmH2O as a critical threshold for the indication of lumbar drainage, the clinical implications would coincide in both methods in 35 of 38 cases. The TCD-based nICP assessment seems to be suitable for a pre-diagnosis of increased LPP and might eliminated the need for painful lumbar puncture if low nICP is detected.

Динаміка антропометричних показників у жінок фертильного віку з ожирінням при різних схемах терапії

Мета дослідження: вивчити ефективність патогенетичної терапії і динаміку антропометричних показників у жінок з ожирінням фертильного віку при різних ендокринопатіях. Матеріали та методи. За етіологічним чинником пацієнтки з ожирінням були розподілені на три групи: із синдромом полікистозних яєчників (n = 30), із гіпоталамічним ожирінням (n = 21) і з ожирінням при первинному гіпотиреозі (n = 20). Хворим проведені загальноклінічні, біохімічні, гормональні методи дослі­дження, магнітно-резонансна томографія гіпофіза. Результати. У першій і другій групах пацієнток відзначалося вірогідне зниження індексу маси тіла (ІМТ) після 6 міс. лікування, тоді як у пацієнток третьої групи вірогідних змін показника ІМТ через 6 міс. лікування не було досягнуто. У 10 хворих першої групи на тлі лікування настала вагітність. У першій і другій групах пацієнток відзначалося вірогідне поліпшення показників окружності талії і стегон на тлі лікування, тоді як у пацієнток третьої групи вірогідних змін не встановлено. Висновки. Включення метформіну в схему лікування хворих на ожиріння сприяє вірогідному поліпшенню клінічних показників і зниженню ІМТ. Оптимізація лікування ожиріння у жінок репродуктивного віку ґрунтується на складанні індивідуальних програм, вибір яких визначається значеннями антропометричних показників, станом гормонального і метаболічного статусу, особливостями харчової поведінки і особово-емоційної сфери, станом менструальної і репродуктивної функції. Проведення комплексу лікувальних заходів з урахуванням розробленого алгоритму індивідуального підбору терапії ожиріння дозволяє ефективно знижувати і утримувати досягнуту масу тіла, сприяє поліпшенню соматичного і репродуктивного здоров’я у жінок дітородного віку.

Irregular menstrual cycles as a risk factor of type 2 diabetes mellitus in women of childbearing age

Background: Irregular menstrual cycles are a risk factor for developing type 2 diabetes mellitus (DM) in women. Objective: This study aimed to evaluate irregular menstrual cycles as a risk factor of type 2 DM in women of childbearing age with body fat percentage, waist-hip ratio, diet quality, and physical activity as confounding factors. Methods: This was a case-control study. Its subjects were subjects with type 2 diabetes mellitus (n=31) and subjects without any clinical evidence of abnormal glucose regulation (n=31) who attended Puskesmas (Community Health Centre) Rowosari, Tembalang, Semarang with over 30 years of age. Based on their menstrual cycles, they were divided into two groups: women with irregular menstrual cycles, and those with regular menstrual cycles. Cochran Mantel-Haenszel test was used to control their confounding factors. Results: There was an association between irregular menstrual cycles and type 2 DM (p&lt;0.05) with a 7.2 greater risk on women of childbearing age (OR = 7.2, 95% CI=2.18-23.75). By the Cochran Mantel-Haenszel test, the association was still significant; women with over percentage of body fat and central obese with irregular menstrual cycle had 4,85 times and 4,37 times of sequentially greater risk on type 2 DM (OR = 4.85, 95% CI=0.98-23.95 vs OR = 4.37, 95% CI=0.93-20.51). Conclusion: The irregular menstrual cycles was a risk factor of type 2 DM, especially in obese women of childbearing age.

[Professor SHI Yin's experience in treatment of obese polycystic ovary syndrome based on spleen and kidney functions].

Professor SHI Yin's clinical experience in treatment of obese polycystic ovary syndrome (PCOS) accompained with infertility with acupuncture and moxibustion in view of spleen and kidney functions is summarized. Professor SHI believes PCOS is commonly seen in obese women of childbearing age, accompained with infertility, with kidney and spleen involved in terms of the disorder location. In pathogenesis, spleen and kidney deficiency is the primary and obstruction of phlegm (damp) in collateral is the secondary. According to clinical differentiation, the main acupoints are selected from the thoroughfare and conception vessels, the kidney meridian and the spleen/stomach meridian and the corresponding acupoint prescriptions and techniques are used individually, aiming at tonifying kidney, strengthening spleen, benefiting qi, resolving phlegm, eliminating damp, resolving stasis, activating blood circulating and regulating menstruation for successful pregnancy. Professor SHI proposes the theory as "taking syndrome/pattern differentiation as the root, equal consideration of the property of acupoints and that of herbal medicine, similarity of acupoint selection with herbal prescription, as well as determination of reinforcing and reducing techniques of acupuncture and moxibustion". It fully embodies the idea of TCM as "syndrome/pattern differentiation and treatment determination" and displays the curative effect of acupoints and the techniques of acupuncture and moxibustion, being worthy of clinical reference.

Noninvasive Intracranial Pressure Assessment in Patients with Suspected Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight disorders. Besides ophthalmoscopy, lumbar puncture is used for both diagnosis and therapy of IIH. In this study, noninvasively-assessed intracranial pressure (nICP) was compared to lumbar pressure (LP) to clarify its suitability for diagnosis of IIH. nICP was calculated using continuous signals of arterial blood pressure and cerebral blood flow velocity, a method previously introduced by the authors. In thirteen patients (f=11, m=2; age: 36±10years), nICP was assessed 1h prior to LP. If LP was >20cmH2O (~15mmHg), lumbar drainage was performed, LP was measured again, and nICP was reassessed. In six patients, LP and nICP were compared after lumbar drainage. In three patients, assessment of nICP versus LP was repeated. In total, LP and nICP correlated with R=0.82 (p<0.001; N=22). Mean difference of ICP-nICP was 0.8±3.7mmHg. Presuming 15mmHg as critical threshold for indication of lumbar drainage in 20 of 22 cases, the clinical implications would have been the same in both methods. TCD-based ICP assessment seems to be a promising method for pre-diagnosis of increased LP and might prevent the need for lumbar puncture if nICP is low.

Unilateral papilledema in idiopathic intracranial hypertension: A rare entity.

Idiopathic Intracranial Hypertension (IIH), also known as pseudotumor cerebri is a clinical syndrome of unknown etiology, which typically affects young, obese women of childbearing age and is characterized by increased intracranial pressure and bilateral papilledema. Unilateral and highly asymmetrical papilledema is a rare presentation in IIH occurring in less than 4% of patients with definite IIH and can poses a diagnostic challenge for the treating physician as it usually raises the suspicion of localized ocular pathology. As per current consensus, papilledema results in stasis of axoplasmic transport due to mechanical compression, leading to secondary vascular changes of venous dilation and hemorrhage. Given this mechanism, the underlying reasons for unilateral and asymmetrical papilledema remain unclear.

A Case of Pulsatile Tinnitus Related to Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) is a disorder that commonly occurs in obese young women of childbearing age and is characterized by symptoms such as pulsatile tinnitus, dizziness, headache, nausea, vomiting, and visual loss without any structural or vascular abnormalities in the intracranial cavity. We recently experienced a case of a 33-year-old obese woman who presented with right-sided pulsatile tinnitus, which is an early symptom for IIH. The patient was successfully treated with weight reduction and carbonic anhydrase inhibitor (acetazolamide). Pulsatile tinnitus requires thorough diagnosis and examination because it can be cured if the anatomical or functional cause is identified and treated. When obese women of childbearing age present with pulsatile tinnitus at the otorhinolaryngology outpatient department, treatment for IIH should be initiated after appropriate examination and diagnosis as pulsatile tinnitus may be the only symptom for IIH.

Men Are from Mars, Idiopathic Intracranial Hypertension Is from Venous: The Role of Venous Sinus Stenosis and Stenting in Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disease primarily affecting obese women of child-bearing age, typically presenting with positional headaches, diplopia from abducens nerve palsies, pulse-synchronous tinnitus, and visual disturbances related to papilledema, including transient visual obscurations, blurry vision, and visual field defects. Controversy remains regarding the pathophysiology of IIH. Elevated intracranial pressure in IIH is thought to be the result of a dysregulation of cerebrospinal fluid (CSF) dynamics, through excessive secretion, reduced drainage, or both. Passive CSF drainage through the arachnoid granulations depends on a pressure gradient between the subarachnoid space and the cerebral venous system, such that elevations in cerebral venous pressure lead to impaired CSF drainage. Dural venous sinus stenosis (DVSS) at the junction of the transverse and sigmoid sinuses, leading to local venous hypertension and a secondary reduction in CSF drainage through the arachnoid granulations, is increasingly recognized as an important component of the pathophysiology of IIH. A growing number of studies have demonstrated a role for stenting of DVSS as an alternative to CSF shunting and optic nerve sheath fenestration in medically refractory IIH patients with vision loss or debilitating symptoms.

Drug-Induced Intracranial Hypertension: A Systematic Review and Critical Assessment of Drug-Induced Causes.

Idiopathic intracranial hypertension (IIH) is a condition with increased intracranial pressure of unknown etiology. Its presenting symptoms include persistent headache, pulsatile tinnitus, and visual obscuration. It tends to occur in obese women of childbearing age, and its greatest risk is irreversible loss of vision. Some of the commonly used medications in dermatology, especially those for acne vulgaris, have been associated with IIH. However, the creation of specific risk categories for drugs as a guide for clinicians has never been performed. The aim of this study was to critically assess all published cases of IIH and identify high-risk drugs associated with drug-induced intracranial hypertension (DIIH), to assist dermatologists and other physicians with patient education and monitoring of symptoms of secondary intracranial hypertension. MEDLINE, EMBASE, and Cochrane Review Databases were searched for all cases of IIH thought to be drug-related between January 1900 and June 2019. A total of 5117 articles were identified, and 235 articles were found to be relevant. All cases were assessed to satisfy the modified Dandy criteria for diagnosis of IIH, and the likelihood of each case being a 'definite' adverse drug reaction (ADR) was determined using the Koh algorithm for ADR. An association category (from weakly associated [Category I] to strongly associated [Category V]) was assigned based on the number of cases meeting these two criteria. There were 259 verifiable cases of DIIH. Vitamin A derivatives, tetracycline-class antibiotics, recombinant growth hormone, and lithium were found to be most strongly associated with DIIH (Categories IV and V). Corticosteroids were moderately associated with DIIH (Category III). Drugs that were weakly associated with DIIH (Categories I and II) include cyclosporine, progestin-only contraceptives, combined oral contraceptives, second- and third-generation fluoroquinolones, sulfenazone, gonadotropin-releasing hormones and luteinizing hormone-releasing hormone agonist, nalidixic acid, amiodarone, stanozolol, danazol, divalproic acid, sulfasalazine, ketoconazole, and ustekinumab. We suggest using the term 'drug-induced intracranial hypertension' (DIIH) and propose a set of diagnostic criteria for DIIH. Our review attempts to identify DIIH-associated drugs based on a strict diagnostic and drug-causality algorithm, then stratify them into appropriate risks categories. This may ultimately assist physicians in counselling patients about the risk of DIIH when prescribing medications and recognizing this uncommon yet sight-threatening condition.