Treatment Of Benign Intracranial Hypertension Research Articles

Benign intracranial hypertension: clinical observations

The complexity of diagnosing benign intracranial hypertension is associated with the low specificity of symptoms. For a timely diagnosis and exclusion of the secondary nature of the disease, it is sometimes necessary to conduct a broad range of additional examinations. The article describes 2 cases of benign intracranial hypertension, representing a diagnostic challenge. In the first case the disease developed in a patient with iron deficiency, hyperprolactinemia and obesity. The patient was treated with diuretics and corticosteroids, therapeutic lumbar punctures were performed. In the second case the disease developed in a patient with recent childbearing, obesity and mastitis. Due to the ineffectiveness of drug therapy surgery was carried out – ventriculoperitoneal shunting was performed with a temporary positive effect. Later breast cancer was diagnosed. The etiology, epidemiology, pathogenesis and symptoms of the disease are discussed. Particular attention is focused on the treatment of benign intracranial hypertension.

Lumboperitoneal shunts: are the complications acceptable?

Lumboperitoneal shunts have long been used in the treatment of benign intracranial hypertension, postoperative pseudomeningocele, CSF leak and communicating hydrocephalus. Although they can provide a rapid and effective resolution of the symptoms there are major disadvantages associated with their use. We retrospectively analyzed the records of 21 patients who underwent LP shunt insertion in our institution during the study period. Eighteen patients (85.7%) underwent at least one shunt revision with a total of 63 revisions. Shunt related infections were observed in 7 cases and 7 patients developed Chiari malformation, 2 (9%) of these requiring further treatment. Despite the symptomatic control achieved with lumboperitoneal shunts we find the complication and revision rates unacceptably high. The technique should be re-evaluated and other treatment strategies considered.

Benign intracranial hypertension and thyreostimulin suppression hormonotherapy

Purpose To report a case of benign intracranial hypertension occurring during thyreostimulin suppression hormonotherapy after thyroidectomy for papillary cancer. Design Interventional case report. Methods A 45-year-old woman underwent total thyroidectomy for a 7-mm papillary cancer. Seventeen years later, she experienced headache, dizziness, irritability, sensation of full head, and blurred vision of the right eye while being treated with a mix of L thyroxin (LT4) and liothyronin (LT3). Ophthalmological data (including the presence of papilledema), cerebroorbital magnetic resonance imaging, and lumbar pressure evaluation confirmed benign intracranial hypertension. Results Substitutive hormonotherapy was decreased under specialized surveillance, permitting remission of benign intracranial hypertension symptoms and papilledema. Conclusions Benign intracranial hypertension is usually difficult to cure, and its association with thyroid hormonotherapy is rare. In our patient, tapering LT4 and withdrawal of LT3 until a euthyroidal state was obtained resulted in successful treatment of benign intracranial hypertension.

Venous sinus stenting for refractory benign intracranial hypertension

Similarities between benign intracranial hypertension and cerebral venous sinus thrombosis are well recognised and the importance of excluding the latter-especially sagittal sinus thrombosis-is understood. Some have suggested that all benign intracranial hypertension is caused by venous hypertension, mostly from stenoses or occlusions of the lateral sinuses. We describe a woman with refractory benign intracranial hypertension. With venography and manometry we showed partial obstruction of both transverse venous sinuses, with raised pressures proximal to the obstructions. Dilation of one of the sinuses with a stent reduced the pressure gradient, with striking symptomatic improvement. Investigation and treatment of benign intracranial hypertension should be revisited in view of these findings.

Medical investigations. 1: Lumbar puncture.

Lumbar puncture (LP) involves the removal of a sample of cerebrospinal fluid (CSF) from the subarachnoid space via a hollow needle which is introduced into the lumbar cisterna through the third or fourth lumbar interspace (Figure 1). (The 4th lumbar vertebra usually lies in the same plane as a line drawn between the iliac crests.) While non-invasive procedures such as computed tomographic (CT) scanning have reduced the need for LP, it remains a valuable tool in the diagnosis of certain disease processes, e.g. subarachnoid haemorrhage (SAR), viral and bacterial meningitis and multiple sclerosis. LP is also performed to facilitate the instillation of drugs such as antibiotics, antirnitoties and contrast media in myelography. Withdrawal of CSF via LP may also be indicated in the treatment of benign intracranial hypertension.

Cerebrospinal fluid diversion in the treatment of benign intracranial hypertension.

Thirty-six patients from a consecutive series of 41 patients with benign intracranial hypertension (BIH) were treated by cerebrospinal fluid shunting. In 12 patients this was selected as the primary treatment due to the severe deterioration of vision or concern regarding the possible adverse effects of steroids; all 12 patients showed rapid and complete resolution of the disease, although eight patients still have a shunt in place. In 24 patients a shunt was inserted when other forms of treatment failed; all of these patients showed rapid resolution of the condition, although 20 patients still have a shunt in place. Three patients had the shunt removed without sequelae, and one patient in whom the shunt was removed because of low-pressure symptoms remains symptomatic with persistent papilledema (over 6 years). The percutaneous lumboperitoneal (LP) shunt was associated with the lowest revision and complication rates. Cisternal shunting to either the atrium or pleural cavity was next most effective, whereas valved LP shunts inserted via a laminectomy were least effective; ventricular shunts were used in only two cases. Shunting is therefore very effective in the treatment of BIH, but the significant complication rate and the possibility of inducing shunt dependence must be recognized.

The treatment of benign intracranial hypertension: A review of 134 cases

The treatment of benign intracranial hypertension in 134 patients is reviewed. No treatment was required in 16 patients, although the diagnosis may have been doubtful in a number of these. Serial lumbar punctures had only a 38.8% success rate when used alone. Steroids were effective as primary treatment in 81.1% of the patients, although recurrence (13.5%) and complications of therapy were significant in this group. Subtemporal decompression was relatively ineffectual, particularly on the measured cerebrospinal fluid (CSF) pressure. CSF shunting, especially lumboperitoneal, was very effective, although complications were important. The basis of treatment in benign intracranial hypertension is reviewed in light of the current theories of its pathogenesis.

Treatment of benign intracranial hypertension

This study is based on 11 cases with pseudotumour cerebri. In each case a high dose of Escin was administered intravenously, and the drug effect during ICP recording was observed. In seven cases the drug manifested a significant hypotensive effect. In these cases the treatment with Escin (20 mg every 8 hours) was continued for 3 days; the control if ICP after this period showed a normal pressure in all cases. Oral treatment was continued at the same dosage for 20-30 days and the patient was then discharged. All patients presented complete remission of the clinical syndrome and fundus normalization. Follow-up after a year showed no recurrence. In three cases the treatment with Escin was unsuccessful; these patients were given dexamethasone, with normalization of the syndrome. Another case that presented with a severe picture of intracranial hypertension and visual impairment was treated with Escin and dexamethasone without positive results. The patient improved with external CSF drainage, and was treated by a shunt procedure that induced remission of the syndrome.

Treatment of benign intracranial hypertension by dehydrating agents with particular reference to the measurement of the blind spot area as a means of recording improvement.

A series of 30 patients (28 females : 2 males) presenting with benign intracranial hypertension is reported. It is shown that the papilloedema may be resolved in as little as six weeks by the use of dehydration therapy. Evidence is presented that this method can restore to normal a visual acuity which is as low as 6/24 or even 6/36. It is concluded that surgery is never required in the management of this condition. It is strongly recommended that serial blind-spot measurements should be used routinely to assess the effectiveness of therapy. Fluorescein angiography has a place in diagnosis among a small proportion of these patients.

The treatment of benign intracranial hypertension with frusemide

The treatment of benign intracranial hypertension with frusemide