Idiopathic Intracranial Hypertension Explained: A Guide for Patients and Families

ISBN-13: 9783030800413 / Angielski / Miękka / 2021 / 247 str.

Kyle M. Fargen

Spis treści

Table of Contents

Chapter 1. Introduction 

Chapter 2. Basic Brain Anatomy and Physiology

The Brain and Its Fluid

The Flow of Brain Fluid

The Reabsorption of Brain Fluid is Into Veins

Brain Veins

Blood Pressure – Arteries vs. Veins

Cerebrospinal Fluid Reabsorption is Dependent on Venous Sinus Pressures

What are Normal Venous Sinus Pressures?

Venous Sinus Pressures Are Not Uniform Throughout the Brain

IIH is Due to High Venous Sinus Pressures

Hydrocephalus is NOT the Same as IIH

Intracranial Pressure and CSF Pressure

Normal Intracranial Pressures (ICP)

Chapter 3. Idiopathic Intracranial Hypertension (IIH)

Diagnosis

Presentation

Common Symptoms

Headache

Visual Symptoms

Papilledema and Visual Loss

Light Sensitivity

Pulsatile Tinnitus

‘Brain Fog’

Cerebrospinal Fluid Leak (Rhinorrhea or Otorrhea)

Other symptoms

Symptoms Are Worsened By Weather Changes

Symptoms Are Often Related to Intracranial Pressure

Distinguishing ICP That is Too High (Hyper) vs Too Low (Hypo)

Ehlers-Danlos Syndrome

Chapter 4. The Fundamental Reasons Patients get IIH

IIH is Actually Not Idiopathic

Venous Pressures In the Body and the Brain

Normal Venous Pressures in the Body and Brain

Venous Pressures in the Body and Brain when CVP is High

Venous Narrowing (“Stenosis”)

Why Does Venous Sinus Stenosis Occur?

What Triggers the Positive Feedback Loop to Start?

Vein Narrowing May Occur at More Than One Site

The Pressure Gradient

Venous Congestion and Collaterals

Venous Sinus Thrombosis

Confusion Between Thrombosis and Aplasia

Other Causes of High Venous Pressures

Not All IIH Patients are the Same

IIH Links to Medications or Surgeries

General Treatment Strategies

IIH is a Chronic Condition

Chapter 5. Understanding Your Brain Imaging

Imaging in IIH

CT Scan

MRI Scan

MRV and CTV

Brain Imaging Findings You May See in Your Report

“Empty Sella”

“Venous Sinus Stenosis”

“Venous Sinus Thrombosis”

“Chiari Malformation”

“Collapsed ventricle”

“Pneumocephalus”

“Cerebral Edema”

“Bone Dehiscence”

“Metal Artifact”

Chapter 6. Measuring Intracranial Pressure

Obtaining Intracranial Pressure Measurements

Lumbar Puncture (Spinal Tap)

Lumbar Drain Placement

Intracranial Pressure Monitor (Bolt) Placement 

Chapter 7. Lifestyle Modification and Weight Loss

The Link Between IIH and Being Overweight

How We Measure Normal Weight Versus Overweight

Is Being Overweight Dangerous?

The Relationship Between Body Mass Index and Central Venous Pressure

Weight Loss is an Effective Treatment for IIH in Most Patients

Lifestyle Modification

Tips for Being Successful with Lifestyle Modification

Weight Loss Surgeries

The Importance of Weight Loss After Surgical Treatment of IIH

Chapter 8. Medical Therapies for IIH

An Overview of Medications for IIH

Acetazolamide (trade name: Diamox

Methazolamide (trade name: Neptazane)

Topiramate (trade name: Topamax)

Furosemide (trade name: Lasix)

Opiate medications

Over the counter medications

Chapter 9. Catheter Angiography

Overview

Timing of the Procedure is Important

Anesthesia Affects Pressure Measurements

Angiograms in Patients Who Have Shunts

Contrast Dye, Allergies and Kidney Problems

Cerebral Angiogram Procedure

Chapter 10. Venous Sinus Stenting

Reasons to Have a Surgical Procedure Performed for IIH

Venous Sinus Stenting Overview

Stents Reduce Intracranial Venous and CSF Pressures and Relieve the Pressure Gradient

Candidacy for Stenting

Usually The Larger Transverse Sinus is Treated

Timing of the Procedure is Less Important Than the Angiogram

Venous Sinus Stenting Symptom Improvement Rates

Defining Success With Stenting

Sudden Visual Loss

Venous Sinus Stenting in Children or Mentally Handicapped Individuals

Blood Thinners

Venous Stenting Procedure

Stent Pain

Stopping IIH Medications After Stenting

Evaluation of Patients with Persistent Symptoms After Stenting

Reasons For Stent Failures

New Vein Narrowing Can Develop After Stenting

Using Spinal Tap Opening Pressure After Stenting

Repeat Cerebral Angiography After Stenting

Repeat Stenting 

Re-Equilibration Phenomenon

Some Final Comments About Stents

Chapter 11. Cerebrospinal Fluid Shunting

Overview

Shunting For Impaired Quality of Life

Life Expectancy of Shunts

Any of the 3 Parts Can Stop Working and Cause the Shunt to Fail

Ventriculo-peritoneal (VP) Shunts

Ventriculo-atrial (VA) Shunts

Lumbo-peritoneal (LP) Shunts 

Other Shunts

Shunt Valves 

Blood Thinners

Shunt Surgical Procedure

Pain, Swelling and Numbness at Shunt Site

Cerebrospinal Fluid Leak From Incision

Evaluating Patients With IIH Symptoms After Shunting

Shunt Series

CT Brain

Nuclear Medicine Shuntogram

Ventricular Collapse

Shunt Tap

Shunt Re-programming

VP Shunt Peritoneal Catheter, Catheter Migration and Pelvic Pain 

Shunt Infection

Re-equilibration Phenomenon After Shunting

Shunt Revision Surgery

Some Final Comments About Shunts

Chapter 12. Other Surgical Treatments

Internal Jugular Vein Treatments

Optic Nerve Sheath Fenestration

Cranio-cervical (Occipito-cervical Fusion)

Cerebrospinal Fluid Leak Repairs

Chiari Decompression

O autorze

Kyle M. Fargen, MD, MPH, FAANS, FACS

Associate Professor of Neurosurgery and Radiology

Wake Forest University

Winston-Salem, NC

USA

Blurb

This book provides a valuable guide to understanding idiopathic intracranial hypertension (IIH), which is a very complex and painful disease. It is a chronic, often disabling condition resulting in headaches, visual loss, and ringing in the ears. This condition was thought to be rare but is becoming much more common, especially as the population becomes more overweight. Patients with this condition often suffer from intractable headaches with poor quality of life.  Very few physicians specialize in this condition, and as a result, there is almost no information or resources available to those trying to understand this condition. The text is designed to take very complex neurosurgical anatomy, principles, and treatments and reduce them down into simple principles. The book contains 12 chapters, each organized into distinct sections. All chapters also contain key points from those paragraphs to summarize useful take home messages.

Written by an expert specializing in this debilitating condition, Idiopathic Intracranial Hypertension Explained serves as a valuable guide towards understanding and treating IIH. The ultimate goal is to empower patients and families with knowledge about the disease.