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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Idiopathic intracranial hypertension and low cerebrospinal pressure are 2 conditions that are thought to be on opposite ends of the cerebrospinal pressure spectrum. Headache is the prominent component of both conditions. We describe a patient whose evaluation for idiopathic intracranial hypertension resulted in a postlumbar puncture headache. Although not entirely intuitive, we suggest that the 2 conditions can be present in the same patient.
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PMID:Idiopathic intracranial hypertension and postlumbar puncture headache. 1475 57

Pseudotumor cerebri (PTC) is a syndrome of increased intracranial pressure without hydrocephalus or mass lesion and with normal cerebrospinal fluid (CSF) composition. Although often considered to be "idiopathic," detailed investigation has revealed a high incidence of venous outflow abnormalities in PTC syndrome patients. The thought that elevated intracranial venous sinus pressure is a "universal mechanism" for PTC syndrome of varying etiologies has been called into question by a study indicating that the increased venous pressure in idiopathic PTC patients is caused by the elevated intracranial pressure and not the reverse, suggesting that "the chicken is the CSF pressure elevation and the egg is the venous sinus pressure elevation." Vitamin A toxicity may play a role in the pathogenesis of idiopathic PTC. The treatment of PTC has two major goals: the alleviation of symptoms and preservation of visual function. When medical therapy fails or when visual dysfunction deteriorates, surgical therapies for PTC should be considered. The two main procedures performed include lumboperitoneal shunt and optic nerve sheath fenestration. Because of the association of PTC with venous sinus hypertension, some authors are considering venous sinus stenting for refractory cases of PTC. It is still unclear if primary treatment of the observed venous stenosis benefits patients with idiopathic PTC. This should be no surprise, as it is not certain whether the stenoses are the cause or the result of idiopathic PTC.
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PMID:Pseudotumor cerebri. 1498 82

An 11-year-old boy with recurrent nephritis due to tubulointerstitial nephritis associated with uveitis (TINU syndrome) was treated with cyclosporin A (CSA) to induce sustained remission. CSA was introduced as a steroid-sparing drug because of extreme obesity (body mass index 32 kg/m(2)). Although the boy did not complain of any clinical symptoms, eye inspection after 7 months revealed bilateral disk edema with retinal bleeding and the patient developed cerebrospinal hypertension. Pseudotumor cerebri was diagnosed by measuring the intracranial pressure (31 cm H(2)O) and normal computer tomography and brain magnetic resonance imaging. Cessation of CSA therapy and treatment with mycophenolate mofetil led to resolution within 12 weeks.
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PMID:Pseudotumor cerebri following cyclosporine A treatment in a boy with tubulointerstitial nephritis associated with uveitis. 1501 64

Pseudotumor cerebri is a perplexing syndrome of increased intra-cranial pressure without a space-occupying lesion. The terminology for the disorder has changed over the years and the diagnostic criteria revised to reflect advances in diagnostic technology and insights into the disease process. The classification and nomenclature depend on the presence or absence of an underlying cause. When the diagnostic criteria are followed, a secondary etiology is unlikely. When no secondary cause is identified, the syndrome is termed "idiopathic intracranial hypertension."
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PMID:Pseudotumor cerebri. 1506 30

Idiopathic intracranial hypertension, characterized by headache, visual disturbance, papilledema, and increased intracranial pressure in the absence of space-occupying lesions, has been reported in pediatric recipients several months to years following kidney transplantation (KTx). We describe the development of idiopathic intracranial hypertension in a 10-year-old girl in the first few hours after KTx. We hypothesize that this event was associated with thymoglobulin administration, perhaps on the background of growth hormone therapy. Awareness of this possibility could lead to earlier diagnosis and treatment of children with similar risk factors.
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PMID:Idiopathic intracranial hypertension immediately after kidney transplantation in a pediatric recipient. 1537 20

Idiopathic intracranial hypertension is a disease with a predilection for young obese women. The most common symptoms are headache, transient visual obscuration and pulsatile tinnitus. The only focal neurologic finding is false-localizing 6th cranial nerve palsy. Papilledema is usually present and this can lead to optic atrophy with progressive permanent visual loss. The earliest visual loss is constriction of peripheral visual field, usually starting with the inferior nasal quadrant. Numerous theories have been entertained as to the pathogenesis but this still remains an open controversy. The most prevalent current theories involve increased resistance to cerebrospinal fluid reabsorption at the arachnoid granulations, either from intrinsic disease in the granulations or secondary to elevated pressure in the dural venous sinuses into which the cerebrospinal fluid is absorbed across the granulations. The syndrome of idiopathic intracranial hypertension was long ago recognized as a complication of recurrent otitis media with resultant thrombosis of the transverse and sigmoid dural venous sinuses. Cases secondary to dural venous sinus thrombosis are seldom encountered today because the incidence of chronic otitis is much less than in the past. The prevalent concept has been that the idiopathic cases in obese young women were not associated with pathology in the dural venous sinuses. A recent study using ATECO MR venography, which the authors claim to be more reliable than even conventional catheter venography, has demonstrated stenosis of the transverse and sigmoid dural venous sinuses distinguishes cases of idiopathic intracranial hypertension from controls with a high degree of sensitivity and specificity. The authors believe the stenosis is secondary to intracranial hypertension but that it may further aggravate the hypertension when it occurs.
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PMID:Recent developments in idiopathic intracranial hypertension (IIH). 1551 4

Pseudotumor cerebri (PTC) is a syndrome of intracranial hypertension that is idiopathic or from an identified secondary cause. It is characterized by headaches and visual manifestations. The hallmark of PTC is papilledema and the feared consequence is visual loss that may be severe and permanent. The idiopathic form generally occurs in obese women of childbearing age. Various medications may produce PTC in patients at any age, including children. Several medications used in dermatology, particularly those used in the treatment of acne vulgaris, are associated with PTC. There is a strong association with tetracycline usage. Minocycline and doxycycline have also been linked to PTC, although there are relatively few reported cases. PTC has also been described with retinoids, including vitamin A (retinol) and isotretinoin. Although corticosteroids are often used to lower intracranial pressure acutely, corticosteroid withdrawal after long-term administration may induce increased intracranial pressure. A high index of suspicion, early diagnosis and treatment generally yield a good prognosis.
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PMID:Medication-induced intracranial hypertension in dermatology. 1567 88

The purpose of this report is to describe successful surgical treatment of benign intracranial hypertension (BIH) in two patients presenting with depressed skull fractures over the superior sagittal sinus (SSS). The first case involved a 22-year-old patient who presented with depressed skull fracture overlying the posterior third of the SSS. Symptoms of BIH developed within 48 h. The second case involved a 33-year-old patient who presented with depressed skull fracture overlying the junction between the middle and posterior thirds of the SSS. Symptoms of BIH developed 1 month after. Although this patient presented with bilateral papilloedema, the less straightforward nature of his BIH symptoms prompted us to undertake further neuroradiological assessment by angiography with retrograde venous catheterization. A high-pressure gradient was found between venous flow upstream and downstream from the compressed zone. Both patients underwent surgical decompression in the lateral decubital position. Continuous monitoring of intracranial pressure was begun upon induction of general anaesthesia. High preoperative pressure declined immediately after elevation of the depressed zone. Bleeding was not a problem at any time during the procedure. Follow-up MRI and angio-MRI demonstrated total restoration of SSS patency. Benign intracranial hypertension is an uncommon complication of depressed skull fracture. Retrograde venous catheterization with pressure measurement can be a useful diagnostic adjunct. Surgical treatment is indicated in symptomatic patients. Based on the two cases reported, we now propose MRI venography in all patients presenting with symptoms of BIH and arteriography with retrograde venous catheterization when venous sinus stenosis exists.
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PMID:Depressed skull fracture overlying the superior sagittal sinus causing benign intracranial hypertension. Description of two cases and review of the literature. 1645 69

Idiopathic intracranial hypertension results from cerebral oedema. The symptoms and signs of the condition are reviewed, especially the risks of visual failure if the condition is prolonged without adequate treatment. The most significant symptom in childhood is headache, and the most important sign is papilloedema. The difficulties of diagnosis are discussed, especially the cerebral oedema that can occur on the withdrawal of steroid therapy, and the increased intracranial pressure that may develop with minimal forms of craniostenosis. The causes of intracranial hypertension are many, and include ear infections, venous sinus thrombosis, the use of certain drugs, and as a complication of acute disseminated encephalomyelitis and Cushing's disease, and impaired renal function. The condition may remit spontaneously, but even so a careful watch must be kept on visual acuity. If treatment is needed various drugs can be tried, and if the response is unsatisfactory repeated lumbar punctures will be indicated. It is rarely necessary to consider surgical intervention such as cerebral decompression.
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PMID:Idiopathic intracranial hypertension. 1650 Jan 24

Benign intracranial hypertension (BIH) or idiopathic intracranial hypertension (IIH) is a rare disorder of unknown etiology that is most often seen in obese women of reproductive age (19.3/100,000) and is reported only occasionally during pregnancy. Both pregnancy and exogenous estrogens are thought to promote IIH or worsen it. It can occur in any trimester during pregnancy, and the visual outcome is the same as for nonpregnant patients with IIH. There is no increase in fetal wastage; therapeutic abortion to limit its progression is not indicated, and subsequent pregnancies do not increase the risk of recurrence. Most therapies used during the nonpregnant state can also be used during pregnancy. The aim of treatment is to preserve vision and improve symptoms. Treatments include analgesics, diuretics, steroids, and serial lumbar punctures. When medical therapy fails, surgical procedures need to be considered. Although this condition has been reviewed often, the issue of mode of delivery, especially when papilledema has not resolved, is unclear. We report on 3 women with IIH during pregnancy and review the choice of therapy and mode of delivery.
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PMID:Choice of therapy and mode of delivery in idiopathic intracranial hypertension during pregnancy. 1661 63


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