Redefining treatment expectations: exploring mid- and long-term outcomes of venous sinus stenting in idiopathic intracranial hypertension.

BACKGROUND: Venous sinus stenting (VSS) is recognized as a safe and effective intervention for medically-refractory idiopathic intracranial hypertension (IIH). However, its long-term efficacy remains uncertain. METHODS: This retrospective review analyzed a single-center database of adult patients with severe, medically-refractory IIH, who underwent VSS and had minimum 3-month follow-up (FU). Patients were divided into three groups based on post-stenting symptom trajectories: group 1 (sustained improvement without relapse), group 2 (temporary improvement with relapse), and group 3 (no improvement). RESULTS: Of 178 patients undergoing VSS, the majority were female (94%), with a median opening pressure (OP) of 31 cm H2O and trans-stenosis gradient of 14 mm Hg. Of these, 153 (86%) received transverse sinus (TS) stenting, and 19 (11%) underwent concurrent TS and superior sagittal sinus stenting. At a mean FU of 166 days, 53 patients (30%) showed long-term improvement without relapse (group 1). Symptomatic recurrence was noted in 101 patients (57%; group 2) within a mean FU of 390 days. Despite recurrent headache and tinnitus, the average OP reduction was 9.6 cm H2O on repeat lumbar puncture, with 75% showing papilledema improvement or resolution post-VSS. Only 17% required further surgical intervention. CONCLUSIONS: The most common clinical outcome post-VSS in IIH patients is initial symptomatic improvement followed by symptom recurrence in about 60% at a mean of 274 days, despite a consistent intracranial pressure reduction. These findings can guide physicians in setting realistic expectations with patients regarding VSS outcomes.

Vertical transmission of the entomopathogenic soil fungus Scopulariopsis brevicaulis as a contaminant of eggs in the winter tick, Dermacentor albipictus, collected from calf moose (New Hampshire, USA).

Moose naturally acquire soil fungi on their fur that are entomopathogenic to the winter tick, Dermacentor albipictus. Presumed to provide a measure of on-host tick control, it is unknown whether these soil fungi impact subsequent off-host stages of the tick. Eggs and resultant larvae originating from engorged, adult female winter ticks collected from dead calf moose (Alces alces) were used to investigate the presence and extent of fungal infection. Approximately 40% of eggs and larvae were infected, almost exclusively by the fungus Scopulariopsis brevicaulis (teleomorph Microascus brevicaulis: Microascaceae, Ascomycota). Eggs analysed on the day of oviposition and day of hatching had high frequency (40%) of S. brevicaulis, whereas the frequency in eggs harvested in utero was minimal (7%); therefore, exposure occurs pre-oviposition in the female's genital chamber, not by transovarial transmission. At hatching, larvae emerge containing S. brevicaulis indicating transstadial transmission. Artificial infection by topical application of eggs and larvae with a large inoculum of S. brevicaulis spores caused rapid dehydration, marked mortality; pathogenicity was confirmed by Koch's postulates. The high hatching success (>90%) and multi-month survival of larvae imply that S. brevicaulis is maintained as a natural pathobiont in winter ticks.