Showing posts with label IIH. Show all posts
Showing posts with label IIH. Show all posts

Wednesday, January 15, 2020

IDIOPATHIC INTRACRANIAL HYPERTENSION


IDIOPATHIC INTRACRANIAL HYPERTENSION

What is Idiopathic intracranial hypertension (IIH)?
IIH is a condition characterized by raised intracranial pressure (ICP) of unknown etiology. It is also known as benign intracranial hypertension or pseudotumor cerebri.
What are the common symptoms of IIH?
The commonest symptom of IIH is headache. In some cases, visual blurring or double vision may occur.
What is the dreaded complication in patients with IIH?
If IIH is left untreated, there is a threat to vision. Partial or complete loss of vision may occur. In many of these cases, vision may not revert to normal even after treatment.
How is the diagnosis of IIH confirmed?
The diagnostic criteria for IIH, including those of the Dandy criteria as described by Dandy in 1937 and later modified, are as follows (source: Medscape)
·       There are symptoms and signs of increased intracranial pressure
·       There are no localizing neurologic signs (with the exception of a unilateral or bilateral sixth nerve paresis)
·       Cerebrospinal fluid (CSF) may show increased pressure, but there are no cytologic or chemical abnormalities
·       Neuroimaging reveals no structural cause or hydrocephalus
·       No other causes of increased intracranial pressure found through workup
Subsequent additions to these criteria include the following
·       The diagnostic lumbar puncture should be performed with the patient in the lateral decubitus position
·       Magnetic resonance venography should be included to rule out intracranial venous sinus thromboses
What are the common abnormalities of IIH on MRI/MR Venogram brain?
Brain MRI with gadolinium contrast venogram is the imaging modality of choice, as it can effectively rule out meningitis/meningeal infiltrates, hydrocephalus, mass lesions, cerebral venous sinus thrombosis, etc. In addition, there are certain abnormalities, which are typically seen in patients with IIH:
·      Partial empty sella
·      Flattening of posterior globe
·      Distension of perioptic subarachnoid space
·      Vertical tortuosity of orbital optic nerve
What is the role of lumbar puncture in the diagnosis of IIH?
Lumbar puncture should be done in left lateral decubitus. It confirms the elevated ICP, opening pressure >200 mm water. Lumbar puncture also helps in excluding meningitis.
What is the mainstay of treatment?
Medical treatment with diamox (acetazolamide) is the primary treatment to be started in patients with IIH. Starting dose should be 500-1000 mg per day and a maximum dose of 4 grams per day can be used. Common side effects include paresthesia and tingling.
Diamox to lower intracranial pressure is indicated when there is 
1) visual field loss on automated perimetry, 
2) transient visual obscurations, 
3) binocular diplopia, or 
4) pulsatile tinnitus.
Does weight loss help in patients with IIH?
Yes, a weight loss of 5-10% can lead to substantial reduction in reducing symptoms of IIH and papilledema.
Do patients with IIH need surgery?
There are a group of patients that need surgery. Patients with severe papilledema with impending threat to visual loss or those presenting with loss of vision require an early surgery. Another group of patients who may need surgery are those that continue to worsen despite being on adequate doses of acetazolamide.
What are the surgical options in IIH?
1.     Optic nerve sheath fenestration
2.     CSF diversion procedures such as theco-peritoneal or ventriculo-peritoneal shunt surgery.

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com


Wednesday, August 23, 2017

FLUOROQUINOLONE ANTIBIOTICS CAN INCREASE THE RISK OF BENIGN INTRACRANIAL HYPERTENSION

FLUOROQUINOLONES CAN INCREASE THE RISK OF BIH

Antibiotics are commonly prescribed for treating infections. Although they are generally safe, sometimes, rare and serious adverse effects can occur.
In a recent research study, fluoroquinolones and tetracycline group of antibiotics were found to increase the risk of developing benign intracranial hypertension (BIH). Fluoroquinolones include some commonly used antibiotics such as ciprofloxacin, levofloxacin, norfloxacin, ofloxacin and moxifloxacin.
The adverse event of BIH was noted within 15 day and 30 day period of starting fluroquinolones. The risk of developing BIH was about five times more than non-users. 

Patients with BIH present with headache, double vision and tinnitus (ringing sound in ears). If left untreated, there is a risk of vision loss.
Fluoroquinolones can also increase the risk of seizures and confusion, especially in older people.
The research study was published in the August 22, 2017 issue of Neurology Journal and can be accessed at the following link:

http://www.neurology.org/content/89/8/792.full

Conclusions
1. Fluoroquinolones can increase the risk of BIH, and hence caution is needed while prescribing them.
2. Patients who are taking fluoroquinolone antibiotics, and develop headache, double vision or tinnitus, should consult a neurologist.
3. Patients who have suffered from BIH in the past should avoid using fluoroquinolones, as much as possible.

DR SUDHIR KUMAR MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com
04023607777/04060601066