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Andrew I. R. Maas - One of the best experts on this subject based on the ideXlab platform.
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Causes and management of Intracranial Hypertension
Oxford Medicine Online, 2016Co-Authors: Nino Stocchetti, Andrew I. R. MaasAbstract:Intracranial Hypertension may damage the brain in two ways—it causes tissue distortion and herniation, and reduces cerebral perfusion. The many different pathologies that can result in Intracranial Hypertension include subarachnoid haemorrhage, spontaneous intra-parenchymal haemorrhage, malignant cerebral hemispheric infarction, and acute hydrocephalus. The pathophysiology and specific treatment of Intracranial Hypertension may be different and depend on aetiology. In patients with subarachnoid haemorrhage a specific focus is on treating secondary hydrocephalus and maintaining adequate cerebral perfusion pressure (CPP). Indications for surgery in patients with Intracranial Hypertension due to intracerebral haemorrhage (ICH) are not only related to the mass effect, but also to remove the toxic effect of extravasated blood on brain tissue. Decompressive surgery should be considered for patients with a malignant hemispheric infarction, but in order to benefit the patient this surgery should be performed within 48 hours of the onset of the stroke. Hydrocephalus may result from obstruction of cerebrospinal fluid (CSF) flow, from impaired CSF re-absorption and occasionally from overproduction of CSF. Emergency management of acute hydrocephalus can be accomplished by external ventricular drainage of CSF. More definitive treatment may be either by third ventriculostomy or implantation of a CSF shunt diverting CSF to the abdominal cavity (a ventriculoperitoneal shunt) or to the right atrium of the heart (ventriculo-atrial shunt).
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Traumatic Intracranial Hypertension
The New England journal of medicine, 2014Co-Authors: Nino Stocchetti, Andrew I. R. MaasAbstract:This article reviews the methods of monitoring and treating traumatic Intracranial Hypertension in intensive care settings.
Shawn C. Aylward - One of the best experts on this subject based on the ideXlab platform.
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Pediatric Intracranial Hypertension: a Current Literature Review
Current Pain and Headache Reports, 2018Co-Authors: Shawn C. Aylward, Amanda L. WayAbstract:Purpose of Review The purpose of this review is to provide an update on pediatric Intracranial Hypertension. Recent Findings The annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population. Summary Pediatric Intracranial Hypertension is a disorder that if left untreated can lead to poor quality of life and morbidity. There are no current treatment studies in pediatrics, but adult data suggests acetazolamide remains an acceptable first-line medication.
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Incidence and Demographics of Pediatric Intracranial Hypertension
Pediatric neurology, 2017Co-Authors: Natalie Gillson, Charlotte Jones, Rachel E. Reem, David L. Rogers, Nicholas Zumberge, Shawn C. AylwardAbstract:Abstract Objective We analyzed the incidence and demographic features of pediatric Intracranial Hypertension. Methods Inpatient and outpatient encounters of children aged 18 years or younger who were diagnosed with primary (idiopathic) or secondary Intracranial Hypertension between January 2010 and December 2013 were identified. Data were collected from a subspecialty clinic devoted to Intracranial Hypertension and the sole children's hospital in a large Midwestern city of the United States. Estimated incidence rates were calculated based on the number of newly diagnosed patients in our hospital's primary service area, which includes seven central Ohio counties. Sex, race, body mass index, socioeconomic status, and geographic distribution were also noted. Results A total of 74 pediatric patients were diagnosed with Intracranial Hypertension (49 primary/idiopathic and 25 secondary) between January 2010 and December 2013. Using census data, we determined the pediatric population in our service area during the four-year period. The Ohio Hospital Association's database indicated that 92.3% of patients aged 0 to 17 years residing in the region sought care at our institution. By combining these data, we calculated an annual incidence of primary and secondary Intracranial Hypertension of 0.63 and 0.32 per 100,000 children, respectively. Conclusions The estimated annual incidence of pediatric primary Intracranial Hypertension in our seven county service area in central Ohio is similar to previous pediatric reports from other countries and is 67% of that reported in the US adult population.
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Manifestations of Pediatric Intracranial Hypertension From the Intracranial Hypertension Registry
Pediatric neurology, 2016Co-Authors: Shawn C. Aylward, Carin S. Waslo, Emanuel TanneAbstract:Abstract Objective The purpose of this study was to examine the presenting symptoms, demographics, and interventions in pediatric patients enrolled in the Intracranial Hypertension Registry. Methods We analyzed confirmed Intracranial Hypertension patients ≤18 years at the time of initial diagnosis who were enrolled in the registry. Results A total of 203 patients met the criteria for inclusion; 142 (70%) were considered primary Intracranial Hypertension. Females made up 72.5% (103 of 142) and 75.8% (47 of 61) in the primary Intracranial Hypertension and secondary Intracranial Hypertension groups, respectively. There were no clinically significant differences in age, body mass index, or opening pressure between the primary Intracranial Hypertension and secondary Intracranial Hypertension groups. Symptoms most often reported were headache and blurred vision. Bilateral optic disc edema occurred in 89.3% of primary Intracranial Hypertension and 78.7% of secondary Intracranial Hypertension patients. When divided into pre- and postpubertal status, 32.5% of patients were classified prepubertal; 77.3% of these had primary Intracranial Hypertension. This resulted in a female to male ratio of 1:1.04 for prepubertal and 6:1 for postpubertal primary Intracranial Hypertension patients. The body mass index was significantly higher in the postpubertal primary Intracranial Hypertension group ( P = 0.0014). There was no significant difference in opening pressure. Conclusions The common symptoms of Intracranial Hypertension, including headache, optic disc edema, and vision changes, occurred with similar frequencies in our cohort to those reported in the literature. In separate subanalyses, we found significantly higher rates of obesity in postpubertal females with primary Intracranial Hypertension. The female-to-male ratios in the postpubertal primary Intracranial Hypertension and secondary Intracranial Hypertension groups were higher than reported in the literature.
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Intracranial Hypertension without papilledema in children
Journal of Child Neurology, 2016Co-Authors: Shawn C. Aylward, Catherine Aronowitz, Steve E RoachAbstract:This study aims to determine the frequency of Intracranial Hypertension without papilledema in children. Charts of patients evaluated in a pediatric Intracranial Hypertension clinic at our institution were retrospectively reviewed. The patients were divided into 2 groups depending on whether they had presence or absence of optic nerve edema at the time of presentation. Age, body mass index, and opening cerebrospinal fluid pressures were considered continuous variables and compared by Wilcoxon rank sum test because of non-normality. A P-value of 0.05 was considered significant. A total of 228 charts were reviewed; 152 patients met the criteria for Intracranial Hypertension, and 27 patients (17.8%) met the criteria of headache without optic nerve edema. There was no clinically significant difference in age, body mass index, opening pressure, and modified opening pressure between the 2 groups.
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sixth nerve palsy in paediatric Intracranial Hypertension
Neuro-Ophthalmology, 2016Co-Authors: Julia E Reid, Shawn C. Aylward, Rachel E. Reem, David L. RogersAbstract:ABSTRACTThe purpose of this study was to report the incidence and describe the characteristics of sixth cranial nerve (CN VI) palsy in paediatric patients with Intracranial Hypertension (IH). A retrospective chart review of central Ohio children diagnosed with IH over the 3-year period from 2010 to 2013 was conducted. IH without identifiable cause was defined as idiopathic Intracranial Hypertension (IIH), whereas IH with identifiable pathologic aetiology was deemed secondary Intracranial Hypertension (SIH). A subset of patients with CN VI palsy was identified. Data collected included patient age, gender, past medical history, aetiology of SIH, ophthalmic examination, lumbar puncture results, neuroimaging results, and response to treatment. Seventy-eight children with Intracranial Hypertension were included in the study. Nine (11.5%) children (four males, five females; median age 14, range: 3–18) were found to have a unilateral (n = 2) or bilateral (n = 7) CN VI palsy. Five children had IIH; the remaining ...
Amanda L. Way - One of the best experts on this subject based on the ideXlab platform.
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Pediatric Intracranial Hypertension: a Current Literature Review
Current Pain and Headache Reports, 2018Co-Authors: Shawn C. Aylward, Amanda L. WayAbstract:Purpose of Review The purpose of this review is to provide an update on pediatric Intracranial Hypertension. Recent Findings The annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population. Summary Pediatric Intracranial Hypertension is a disorder that if left untreated can lead to poor quality of life and morbidity. There are no current treatment studies in pediatrics, but adult data suggests acetazolamide remains an acceptable first-line medication.
Nino Stocchetti - One of the best experts on this subject based on the ideXlab platform.
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Causes and management of Intracranial Hypertension
Oxford Medicine Online, 2016Co-Authors: Nino Stocchetti, Andrew I. R. MaasAbstract:Intracranial Hypertension may damage the brain in two ways—it causes tissue distortion and herniation, and reduces cerebral perfusion. The many different pathologies that can result in Intracranial Hypertension include subarachnoid haemorrhage, spontaneous intra-parenchymal haemorrhage, malignant cerebral hemispheric infarction, and acute hydrocephalus. The pathophysiology and specific treatment of Intracranial Hypertension may be different and depend on aetiology. In patients with subarachnoid haemorrhage a specific focus is on treating secondary hydrocephalus and maintaining adequate cerebral perfusion pressure (CPP). Indications for surgery in patients with Intracranial Hypertension due to intracerebral haemorrhage (ICH) are not only related to the mass effect, but also to remove the toxic effect of extravasated blood on brain tissue. Decompressive surgery should be considered for patients with a malignant hemispheric infarction, but in order to benefit the patient this surgery should be performed within 48 hours of the onset of the stroke. Hydrocephalus may result from obstruction of cerebrospinal fluid (CSF) flow, from impaired CSF re-absorption and occasionally from overproduction of CSF. Emergency management of acute hydrocephalus can be accomplished by external ventricular drainage of CSF. More definitive treatment may be either by third ventriculostomy or implantation of a CSF shunt diverting CSF to the abdominal cavity (a ventriculoperitoneal shunt) or to the right atrium of the heart (ventriculo-atrial shunt).
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Traumatic Intracranial Hypertension
The New England journal of medicine, 2014Co-Authors: Nino Stocchetti, Andrew I. R. MaasAbstract:This article reviews the methods of monitoring and treating traumatic Intracranial Hypertension in intensive care settings.
Kathleen B. Digre - One of the best experts on this subject based on the ideXlab platform.
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Idiopathic Intracranial Hypertension.
BMJ (Clinical research ed.), 2010Co-Authors: Kathleen B. DigreAbstract:Weight loss may be effective, but confirmation is needed from randomised trials In the linked prospective cohort study (doi:10.1136/bmj.c2701), Sinclair and colleagues observed Intracranial pressure in patients with idiopathic Intracranial Hypertension who follow a low energy diet.1 This condition is often chronic and is characterised by symptoms and signs of Intracranial Hypertension, with no cause found by adequate imaging studies, and normal cerebrospinal fluid.2 Visual loss from papilloedema is the most feared visual complication.2 Headaches (which are difficult to treat) and depression are common, and quality of life is often reduced.3 4 Medical treatment of idiopathic Intracranial Hypertension consists of acetazolamide and other diuretics, which are thought to reduce the formation of cerebrospinal fluid.5 Because most affected people are obese, weight loss has been suggested. When visual loss occurs, surgical cerebrospinal fluid drainage procedures such as lumbar or ventriculo-peritoneal shunting or optic nerve sheath fenestration are performed. A recent systematic review found no randomised or controlled trials of treatment of the condition and called for such evidence.6 The risk of this condition …
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Three Current Controversies in Idiopathic Intracranial Hypertension
Neuro-Ophthalmology, 2009Co-Authors: Kathleen B. DigreAbstract:Idiopathic Intracranial Hypertension (IIH), or pseudotumour cerebri, is a condition of increased Intracranial pressure without space-occupying lesion, cerebrospinal fluid abnormalities or venous sinus thrombosis. This manuscript will discuss three controversies in IIH: (1) its nomenclature; (2) existence without papilloedema; and (3) therapeutic venous stenting. The name pseudotumour cerebri is controversial; idiopathic Intracranial Hypertension, idiopathic Intracranial pressure or primary and secondary Intracranial Hypertension are preferred terms. Some do not believe the condition exists without papilloedema. Our evaluation found idiopathic Intracranial Hypertension without papilloedema (IIHWOP) in ∼6% of cases. IIHWOP patients had more diagnostic lumbar punctures and non-physiological visual field constriction; 93% of IIH patients had venous sinus stenosis. Others suggest treating venous sinus narrowing with stenting, which may be viable in rare cases but should not be first-line treatment.
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A comparison of idiopathic Intracranial Hypertension with and without papilledema.
Headache: The Journal of Head and Face Pain, 2009Co-Authors: Kathleen B. Digre, Beau K. Nakamoto, Judith E. A. Warner, Wendy J. Langeberg, Susan Baggaley, Bradley J. KatzAbstract:Objective.— To compare clinical features, visual characteristics, and treatment of idiopathic Intracranial Hypertension patients with and without papilledema. Background.— Idiopathic Intracranial Hypertension does not often occur without papilledema. This study estimates the prevalence and compares the clinical characteristics of idiopathic Intracranial Hypertension patients with and without papilledema. Methods.— We performed a cross-sectional analysis of all idiopathic Intracranial Hypertension patients diagnosed at the University of Utah Neuro-Ophthalmology Unit between 1990 and 2003. Patient records were reviewed for presence of papilledema and other signs, symptoms, and treatment characteristics. Each patient without papilledema was matched to the patient with papilledema who was closest to his/her age and sex. McNemar's and Wilcoxon-signed rank sum tests were used to compare characteristics between matched pairs. Results.— Among all patients (n = 353), the prevalence of those without papilledema was 5.7% (n = 20). Patients without papilledema reported photopsias (20%), and were found to have spontaneous venous pulsations (75%) and non-physiologic visual field constriction (20%) more often than did those with papilledema. Mean opening pressure, although above normal, was lower in patients without papilledema (mean = 309 mm cerebrospinal fluid) compared with those with papilledema (mean = 373 mm cerebrospinal fluid, P = .031). Idiopathic Intracranial Hypertension patients without papilledema had more frequent diagnostic lumbar punctures than did patients with papilledema. Visual acuities and treatment were similar between groups. Conclusions.— The clinical presentation of idiopathic Intracranial Hypertension without papilledema is only somewhat different from that of idiopathic Intracranial Hypertension with papilledema. The lower opening pressure in patients without papilledema may explain variations in symptoms and signs between the 2 groups. When there are visual field changes in idiopathic Intracranial Hypertension without papilledema, non-physiologic visual loss should be considered.
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Not so benign Intracranial Hypertension
BMJ (Clinical research ed.), 2003Co-Authors: Kathleen B. DigreAbstract:Lesson of the week p 641 That a common antibiotic, doxycycline, used to treat malaria, acne, and other infections could cause increased Intracranial pressure is not a recent revelation.1 Other tetracyclic antibiotics such as minocycline and tetracycline have caused Intracranial Hypertension. Benign Intracranial Hypertension is a syndrome of signs and symptoms of increased Intracranial pressure without causative lesions on images obtained by magnetic resonance imaging or computed tomography.2 The disorder is controversial from its name to its putative pathophysiology, but it should be considered when anyone taking doxycycline begins to complain of a new headache. The first controversy surrounding the disorder is the name—benign Intracranial Hypertension. For over 100 years the condition has been known as pseudotumour cerebri or benign Intracranial Hypertension.3 Corbett and Thompson, following the lead of Buchheit, made a plea to replace “benign” with “idiopathic,”4 to set apart the idiopathic form of increased Intracranial pressure from symptomatic forms, and to dispel the notion that the condition is totally benign. What to call this syndrome is far from settled, but at present we diagnose the primary or idiopathic form in individuals in whom no …
