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
Kyle M. Fargen, MD, MPH, FAANS, FACS
Associate Professor of Neurosurgery and Radiology
Wake Forest University
Winston-Salem, NC
USA
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.