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1.
Acta Clin Croat ; 59(1): 50-54, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32724274

RESUMEN

Optic nerve sheath diameter (ONSD) enlargement is detectable in traumatic brain injury patients with raised intracranial pressure (ICP). The aim was to assess its value in neurological patients suspected to have increased ICP. Patient clinical imaging data and hospitalization outcome were analyzed. Patients were divided into groups according to brain pathology and level of consciousness with Glasgow Coma Score (GCS). Poor hospitalization outcome was assessed by modified Rankin scale (mRS) >3. Data obtained by ocular sonography performed in acute setting were compared with data of 100 control subjects. Data were expressed as mean ± SD. Intergroup comparison was performed by Student's t-test. Data of 34 patients (63+16 years) were suitable for analysis, including 8 primary intracerebral hemorrhage (PICH), 8 subarachnoid hemorrhage (SAH), 12 PICH or SAH and intraventricular hemorrhage (IVH), 4 tumors and 2 ischemic strokes. The mean ONSD was 5.86+0.69 mm in patients versus 4.38+0.41 mm in controls (p<0.01). ONSD was 6.28+0.61 mm in patients with GCS <8 and 5.77+0.55 mm in other patients (p<0.05). ONSD was 5.72+0.59 mm in PICH versus 6.20+0.65 mm in PICH/SAH with IVH (p=0.1). ONSD was 5.73+0.38 mm in SAH in comparison to PICH/SAH with IVH (p=0.05). There was no statistically significant difference in optic nerve diameter between patients and controls (2.48+0.28 mm vs. 2.39+0.33 mm; p>0.05). Pronounced enlargement of ONSD was observed in patients with ICH or SAH with IVH, and in patients with GCS <8. Enlarged ONSD was associated with poor neurological outcome (mRS >3).


Asunto(s)
Hipertensión Intracraneal , Presión Intracraneal , Nervio Óptico , Anciano , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/etiología , Masculino , Persona de Mediana Edad , Nervio Óptico/diagnóstico por imagen , Ultrasonografía
6.
Cerebrovasc Dis ; 49(2): 160-169, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32316014

RESUMEN

OBJECTIVE: This study aimed to control blood pressure (BP) under transcranial Doppler (TCD) guidance in patients with anterior circulation acute ischemic stroke after endovascular treatment (EVT) to reduce the incidence of early neurological deterioration (END) and improve neurological prognosis. METHODS: This prospective randomized controlled study included 95 patients who were randomly divided into a TCD-guided BP control (TBC) group and a non-TCD-guided BP control (NBC) group. The patients were monitored by TCD within 72 h after EVT. In the TBC group, BP decreased, BP increased, or intracranial pressure decreased when TCD showed blood flow acceleration, deceleration, or intracranial hypertension respectively. The BP of the NBC group was controlled according to the guidelines. The incidence of END and the prognosis was compared between the 2 groups. RESULTS: TCD identified 18 patients with blood flow acceleration, but the prognosis of the 2 groups was not significantly different. TCD identified 23 patients with blood flow deceleration, and the poor prognosis rate at discharge was lower in the TBC group than in the NBC group (45.5 vs. 91.7%, p = 0.027). TCD identified 34 patients with intracranial hypertension, and the 3-month mortality rate of the TBC group was lower than that of the NBC group (0 vs. 36.8%, p = 0.011). The incidence rates of END and 3-month mortality in the TBC group were lower than those in the NBC group (13.8 vs. 37.5%, p = 0.036; 0 vs. 25.0%, p = 0.012) when TCD parameters were abnormal. Multivariable logistic regression analysis showed that the TBC group (adjusted OR 0.267, 95% CI 0.074-0.955; p = 0.042) was an independent protective factor against the incidence of END when TCD parameters were abnormal. CONCLUSION: These findings indicated that TCD-guided BP and intracranial pressure control improved the prognosis of patients with blood flow deceleration and intracranial hypertension.


Asunto(s)
Presión Sanguínea , Isquemia Encefálica/terapia , Procedimientos Endovasculares/efectos adversos , Hipertensión Intracraneal/diagnóstico por imagen , Presión Intracraneal , Accidente Cerebrovascular/terapia , Ultrasonografía Doppler Transcraneal , Anciano , Beijing , Velocidad del Flujo Sanguíneo , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/mortalidad , Isquemia Encefálica/fisiopatología , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/mortalidad , Hipertensión Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
7.
J Neurol Surg A Cent Eur Neurosurg ; 81(4): 324-329, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32176924

RESUMEN

OBJECTIVE: To present our experience in the diagnosis and management protocol of 13 patients with a depressed skull fracture over the superior sagittal sinus (SSS) who developed delayed neurologic deterioration. PATIENTS AND METHODS: This retrospective study was conducted in the Neurosurgical Department, Assiut University Hospitals, between May 2012 and May 2017. All patients with a depressed skull fracture over the SSS were reviewed. Only those patients who were neurologically intact after trauma but suffered delayed neurologic deterioration were included in this study. Preoperative characteristics of age, sex, cause of trauma, type and site of the depressed skull fracture, and clinical presentation were reviewed and evaluated. Neuroimaging including brain computed tomography and computed tomography venography were evaluated. RESULTS: Of 612 patients with depressed skull fractures admitted to our department, 63 had the fracture segment on the SSS. Thirteen patients, nine males and four females, met the inclusion criteria (age range: 5-42 years). The most common cause of trauma was assault from others (seven patients). Eight patients had a compound depressed fracture; the other five fractures were simple. Interval between trauma and neurologic deterioration ranged between 4 days and 3 weeks. Clinical deterioration included decrease of consciousness, headache, blurred vision, and repeated vomiting. Deterioration of consciousness was seen in four patients. Eight patients had sixth cranial nerve palsy. Visual deterioration was seen in four patients. All the included patients were operated on for elevation of the depressed segment. Eleven patients improved; two patients who presented initially with visual deterioration did not improve. Their visual deterioration persisted after surgery. For both these patients, lumbar puncture revealed high cerebrospinal fluid (CSF) pressure. Clinical improvement followed the insertion of a thecoperitoneal shunt. CONCLUSION: Increased intracranial pressure (ICP) may follow a depressed fracture over the SSS. It may occur immediately after trauma or later. Surgical decompression with elevation of the depressed segment is indicated. Persistence of manifestations of raised ICP despite elevation of the depressed segment indicates the occurrence of an SSS thrombosis. CSF pressure should be measured to confirm the diagnosis and consider a thecoperitoneal shunt.


Asunto(s)
Hipertensión Intracraneal/etiología , Fractura Craneal Deprimida/cirugía , Seno Sagital Superior/cirugía , Adolescente , Adulto , Niño , Preescolar , Angiografía por Tomografía Computarizada , Descompresión Quirúrgica , Femenino , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/cirugía , Masculino , Estudios Retrospectivos , Fractura Craneal Deprimida/complicaciones , Fractura Craneal Deprimida/diagnóstico por imagen , Seno Sagital Superior/diagnóstico por imagen , Seno Sagital Superior/fisiopatología , Adulto Joven
8.
Curr Opin Crit Care ; 26(2): 115-121, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32068580

RESUMEN

PURPOSE OF REVIEW: Multimodal monitoring has emerged as a novel paradigm of care in acute brain injury, and in this context the value of noninvasive devices is increasingly under scrutiny. This narrative review summarizes recent clinical investigation focused on the role of automated infrared pupillometry (AIP) and optic nerve sheath diameter (ONSD) ultrasound as novel techniques to monitor and manage neurocritical care patients. RECENT FINDINGS: AIP provides a quantitative measurement of the pupillary light reflex that is more precise and reliable than the traditional examination of the pupillary light reflex using manual flashlight lamps. AIP helps detect raised intracranial pressure (ICP) and brain herniation in patients with intracranial mass lesions. Using an automatically computed scalar index - the neurological pupil index - AIP has great accuracy to predict poor neurological outcome in patients in coma after cardiac arrest. Recent data indicate that ONSD may diagnose intracranial hypertension with better accuracy than other ultrasound-based methods. SUMMARY: Noninvasive AIP and ONSD appear useful complements to multimodality monitoring of acute brain injury, in particular in patients at risk of elevated ICP and for early neuroprognostication following cardiac arrest.


Asunto(s)
Hipertensión Intracraneal , Presión Intracraneal , Nervio Óptico , Encéfalo/diagnóstico por imagen , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Estudios Prospectivos , Pupila , Ultrasonografía
10.
Am Fam Physician ; 101(5): 275-285, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-32109031

RESUMEN

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.


Asunto(s)
Sistemas de Atención de Punto , Ultrasonografía , Absceso/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Apendicitis/diagnóstico por imagen , Celulitis (Flemón)/diagnóstico por imagen , Competencia Clínica , Cólico/diagnóstico por imagen , Femenino , Fracturas Óseas/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Humanos , Perforación Intestinal/diagnóstico por imagen , Hipertensión Intracraneal/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Masculino , Derrame Pericárdico/diagnóstico por imagen , Embarazo , Atención Prenatal , Desprendimiento de Retina/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Infecciones de los Tejidos Blandos/diagnóstico por imagen , Torsión del Cordón Espermático/diagnóstico por imagen , Volumen Sistólico , Ultrasonografía Intervencional , Trombosis de la Vena/diagnóstico por imagen
11.
Rev Paul Pediatr ; 38: e2019123, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31939519

RESUMEN

OBJECTIVE: To determine the events associated with the occurrence of intracranial hypertension (ICH) in pediatric patients with severe cranioencephalic trauma. METHODS: This was a prospective cohort study of patients 18 years old and younger with cranioencephalic trauma, scores below nine on the Glasgow Coma Scale, and intracranial pressure monitoring. They were admitted between September, 2005 and March, 2014 into a Pediatric Intensive Care Unit. ICH was defined as an episode of intracranial pressure above 20 mmHg for more than five minutes that needed treatment. RESULTS: A total of 198 children and adolescents were included in the study, of which 70.2% were males and there was a median age of nine years old. ICH occurred in 135 (68.2%) patients and maximum intracranial pressure was 36.3 mmHg, with a median of 34 mmHg. A total of 133 (97.8%) patients with ICH received sedation and analgesia for treatment of the condition, 108 (79.4%) received neuromuscular blockers, 7 (5.2%) had cerebrospinal fluid drainage, 105 (77.2%) received mannitol, 96 (70.6%) received hyperventilation, 64 (47.1%) received 3% saline solution, 20 (14.7%) received barbiturates, and 43 (31.9%) underwent a decompressive craniectomy. The events associated with the occurrence of ICH were tomographic findings at the time of admission of diffuse or hemispheric swelling (edema plus engorgement). The odds ratio for ICH in patients with Marshall III (diffuse swelling) tomography was 14 (95%CI 2.8-113; p<0.003), and for those with Marshall IV (hemispherical swelling) was 24.9 (95%CI 2.4-676, p<0.018). Mortality was 22.2%. CONCLUSIONS: Pediatric patients with severe cranioencephalic trauma and tomographic alterations of Marshall III and IV presented a high chance of developing ICH.


Asunto(s)
Traumatismos Craneocerebrales/complicaciones , Hipertensión Intracraneal/epidemiología , Hipertensión Intracraneal/terapia , Presión Intracraneal/fisiología , Adolescente , Pérdida de Líquido Cefalorraquídeo , Niño , Preescolar , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/mortalidad , Craniectomía Descompresiva/métodos , Femenino , Escala de Coma de Glasgow , Humanos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Hipertensión Intracraneal/diagnóstico por imagen , Masculino , Bloqueantes Neuromusculares/uso terapéutico , Prevalencia , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos
12.
J Clin Ultrasound ; 48(1): 59-63, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31774180

RESUMEN

We report and discuss a case that illustrate the clinical utility of transcranial Doppler (TCD) ultrasound in a patient with cirrhosis. A 43-year-old female presented with acute decompensation of cirrhosis with hepatic encephalopathy, requiring mechanical ventilation. TCD showed low diastolic flow velocities and high pulsatility index (PI) consistent with increased cerebrovascular resistance (CVR). The flow velocities and PI normalized over a period of few days and correlated well with neurological improvement after treatment. Subsequently, the patient developed a large intracerebral hemorrhage with mass effect. The TCD measurements in intracranial hypertension were similar to those with cirrhosis and hepatic encephalopathy. However, the windkessel notch in the systolic phase of TCD waveform, related to the distensibility of arterial wall, was absent during raised intracranial pressure (ICP). The absence of a windkessel notch may help to differentiate a high downstream resistance due to raised ICP from increased CVR.


Asunto(s)
Hipertensión Intracraneal/diagnóstico por imagen , Presión Intracraneal , Cirrosis Hepática/fisiopatología , Ultrasonografía Doppler Transcraneal , Resistencia Vascular , Adulto , Circulación Cerebrovascular , Femenino , Humanos , Hipertensión Intracraneal/etiología
14.
Pract Neurol ; 20(1): 39-49, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31649103

RESUMEN

The skull base is the major bony and soft tissue interface for the intracranial and extracranial compartments. Its anatomy is complex, containing multiple traversing foramina that act as conduits for various neurovascular structures. The optimum imaging modality depends on the specific diagnostic question and area of interest; both CT and MR have complementary roles. This article focuses on the applied compartmental anatomy of the skull base and specific imaging protocols, and discusses the range of pathologies that neurologists will encounter.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Base del Cráneo/anatomía & histología , Base del Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/patología , Base del Cráneo/patología , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Neoplasias de la Base del Cráneo/patología , Acúfeno/diagnóstico por imagen , Acúfeno/patología
15.
Neurosurgery ; 86(2): 221-230, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30877299

RESUMEN

BACKGROUND: Hypertonic saline (HTS) and mannitol are effective in reducing intracranial pressure (ICP) after severe traumatic brain injury (TBI). However, their simultaneous effect on the cerebral perfusion pressure (CPP) and ICP has not been studied rigorously. OBJECTIVE: To determine the difference in effects of HTS and mannitol on the combined burden of high ICP and low CPP in patients with severe TBI. METHODS: We performed a case-control study using prospectively collected data from the New York State TBI-trac® database (Brain Trauma Foundation, New York, New York). Patients who received only 1 hyperosmotic agent, either mannitol or HTS for raised ICP, were included. Patients in the 2 groups were matched (1:1 and 1:2) for factors associated with 2-wk mortality: age, Glasgow Coma Scale score, pupillary reactivity, hypotension, abnormal computed tomography scans, and craniotomy. Primary endpoint was the combined burden of ICPhigh (> 25 mm Hg) and CPPlow (< 60 mm Hg). RESULTS: There were 25 matched pairs for 1:1 comparison and 24 HTS patients matched to 48 mannitol patients in 1:2 comparisons. Cumulative median osmolar doses in the 2 groups were similar. In patients treated with HTS compared to mannitol, total number of days (0.6 ± 0.8 vs 2.4 ± 2.3 d, P < .01), percentage of days with (8.8 ± 10.6 vs 28.1 ± 26.9%, P < .01), and the total duration of ICPhigh + CPPlow (11.12 ± 14.11 vs 30.56 ± 31.89 h, P = .01) were significantly lower. These results were replicated in the 1:2 match comparisons. CONCLUSION: HTS bolus therapy appears to be superior to mannitol in reduction of the combined burden of intracranial hypertension and associated hypoperfusion in severe TBI patients.


Asunto(s)
Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Lesiones Traumáticas del Encéfalo/tratamiento farmacológico , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/tratamiento farmacológico , Presión Intracraneal/efectos de los fármacos , Manitol/administración & dosificación , Solución Salina Hipertónica/administración & dosificación , Adolescente , Adulto , Lesiones Traumáticas del Encéfalo/complicaciones , Estudios de Casos y Controles , Circulación Cerebrovascular/efectos de los fármacos , Circulación Cerebrovascular/fisiología , Diuréticos Osmóticos/administración & dosificación , Femenino , Escala de Coma de Glasgow , Humanos , Hipertensión Intracraneal/etiología , Presión Intracraneal/fisiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
16.
Curr Neurol Neurosci Rep ; 19(12): 99, 2019 11 26.
Artículo en Inglés | MEDLINE | ID: mdl-31773291

RESUMEN

PURPOSE OF REVIEW: Principles of intracranial pressure (ICP) management continue to be an essential part of the neurointensivist's skillset as appropriate treatment decisions can prevent secondary injury to the central nervous system. This review of the literature aims to: discuss commonly encountered pathologies associated with increased ICP, summarize diagnostic approaches used in evaluating ICP, and present evidence-based treatment paradigms that drive clinical care in intensive care units. RECENT FINDINGS: Recent topics of discussion include invasive and non-invasive modalities of diagnosis and monitoring, recent developments in hypothermia, hyperosmolar therapy, pharmacological interventions, and surgical therapies. The authors also present an example of an algorithm used within our system of hospitals for managing patients with elevated ICP. Recent advances have shown the mortality benefits in appropriately recognizing and treating increased ICP. Multiple modalities of treatment have been explored, and evidence has shown benefit in some. Further work continues to provide clarity in the appropriate management of intracranial hypertension.


Asunto(s)
Manejo de la Enfermedad , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/terapia , Nervio Óptico/diagnóstico por imagen , Electroencefalografía/métodos , Humanos , Unidades de Cuidados Intensivos/tendencias , Hipertensión Intracraneal/fisiopatología , Presión Intracraneal/fisiología , Nervio Óptico/patología
17.
Ann Intern Med ; 171(12): 896-905, 2019 12 17.
Artículo en Inglés | MEDLINE | ID: mdl-31739316

RESUMEN

Background: Optic nerve ultrasonography (optic nerve sheath diameter sonography) has been proposed as a noninvasive, quick method for diagnosing increased intracranial pressure. Purpose: To examine the accuracy of optic nerve ultrasonography for diagnosing increased intracranial pressure in children and adults. Data Sources: 13 databases from inception through May 2019, reference lists, and meeting proceedings. Study Selection: Prospective optic nerve ultrasonography diagnostic accuracy studies, published in any language, involving any age group or reference standard. Data Extraction: 3 reviewers independently abstracted data and performed quality assessment. Data Synthesis: Of 71 eligible studies involving 4551 patients, 61 included adults, and 35 were rated as having low risk of bias. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of optic nerve ultrasonography in patients with traumatic brain injury were 97% (95% CI, 92% to 99%), 86% (CI, 74% to 93%), 6.93 (CI, 3.55 to 13.54), and 0.04 (CI, 0.02 to 0.10), respectively. Respective estimates in patients with nontraumatic brain injury were 92% (CI, 86% to 96%), 86% (CI, 77% to 92%), 6.39 (CI, 3.77 to 10.84), and 0.09 (CI, 0.05 to 0.17). Accuracy estimates were similar among studies stratified by patient age, operator specialty and training level, reference standard, sonographer blinding status, and cutoff value. The optimal cutoff for optic nerve sheath dilatation on ultrasonography was 5.0 mm. Limitation: Small studies, imprecise summary estimates, possible publication bias, and no evaluation of effect on clinical outcomes. Conclusion: Optic nerve ultrasonography can help diagnose increased intracranial pressure. A normal sheath diameter measurement has high sensitivity and a low negative likelihood ratio that may rule out increased intracranial pressure, whereas an elevated measurement, characterized by a high specificity and positive likelihood ratio, may indicate increased intracranial pressure and the need for additional confirmatory tests. Primary Funding Source: None. (PROSPERO: CRD42017055485).


Asunto(s)
Hipertensión Intracraneal/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Pruebas en el Punto de Atención , Ultrasonografía , Adulto , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/diagnóstico por imagen , Niño , Interpretación Estadística de Datos , Humanos , Hipertensión Intracraneal/diagnóstico , Hipertensión Intracraneal/etiología , Presión Intracraneal , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Ultrasonografía/métodos
18.
PLoS One ; 14(10): e0223484, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31596889

RESUMEN

BACKGROUND: Postural orthostatic tachycardia syndrome is a disorder of the autonomic nervous system. Approximately 30% of patients experience orthostatic headaches. Orthostatic headaches also are a hallmark symptom in spontaneous intracranial hypotension. While the cause of orthostatic headaches in spontaneous intracranial hypotension can be linked to the cerebrospinal fluid loss at the spinal level and consecutively reduced intracranial pressure in the upright position, the cause of orthostatic headaches in postural orthostatic tachycardia syndrome still remains unknown. The present study examined orthostatic changes of intracranial pressure using dynamic ultrasound of the optic nerve and optic nerve sheath diameter in postural orthostatic tachycardia syndrome, spontaneous intracranial hypotension and healthy subjects. METHODS: Data was obtained from postural orthostatic tachycardia syndrome patients with (n = 7) and without orthostatic headaches (n = 7), spontaneous intracranial hypotension patients (n = 5) and healthy subjects (n = 8). All participants underwent high-resolution transorbital ultrasound in the supine and upright position to assess optic nerve and optic nerve sheath diameter. RESULTS: Group differences were found in percentage deviations when changing position of optic nerve sheath diameter (p < 0.01), but not regarding the optic nerve diameter. Pairwise comparisons indicated differences in optic nerve sheath diameter only between spontaneous intracranial hypotension and the other groups. No differences were found between postural orthostatic tachycardia syndrome patients with and without orthostatic headaches. CONCLUSION: This study shows that the size of the optic nerve sheath diameter dynamically decreases during orthostatic stress in spontaneous intracranial hypotension, but not in postural orthostatic tachycardia syndrome with or without orthostatic headaches, which indicates different underlying causes.


Asunto(s)
Hipertensión Intracraneal/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Síndrome de Taquicardia Postural Ortostática/diagnóstico por imagen , Adolescente , Adulto , Femenino , Humanos , Hipertensión Intracraneal/complicaciones , Masculino , Persona de Mediana Edad , Síndrome de Taquicardia Postural Ortostática/complicaciones , Postura , Ultrasonografía
19.
Clin Neurol Neurosurg ; 186: 105527, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31586855

RESUMEN

OBJECTIVE: Idiopathic intracranial hypertension (IIH) is aetiologically unknown disorder that associates with endocrinological disturbances, including dysfunction of hypothalamic-pituitary-adrenal-axis. Neuroendocrinological dysfunctions have also been characterized in psychiatric disorders, and therefore we investigated the presence of psychiatric disorders of patients with IIH in a well-defined cohort. PATIENTS AND METHODS: A total of 51 patients with IIH were included. Patient demographics, symptoms, imaging data, ophthalmological and clinical findings were collected. RESULTS: At the time of diagnosis the mean age was 32.5years (SD 10.7), the body mass index was 37.1 kg/m2 (SD 7.4), and the opening pressure 29.1 mmHg (SD 6.2). A total of 88.2% of patients were female and 45.1% were diagnosed with a psychiatric co-morbidity prior to IIH diagnosis. The mean follow-up time was 4.4 years (SD 5.4). The overall treatment outcome was significantly poorer on a group of patients with psychiatric diagnosis when compared to individuals without such history (p = 0.001), but there were no differences in the resolution of papilledema (p = 0.405). Patients with IIH and psychiatric disorders had more often empty sella on their imaging at diagnosis when compared to patients without psychiatric co-morbidity (p = 0.044). CONCLUSION: Psychiatric disorders are highly prevalent in patients with IIH and associate with worse subjective outcomes. These findings advocate for monitoring the mental health of patients with IIH and warrant further multidisciplinary research to understand the potentially underlying psychosocial and neuroendocrinological mechanisms.


Asunto(s)
Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/psicología , Trastornos Mentales/diagnóstico por imagen , Trastornos Mentales/psicología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Hipertensión Intracraneal/epidemiología , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento
20.
World Neurosurg ; 132: 129-133, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31491574

RESUMEN

BACKGROUND: Magnetic resonance imaging plays an important role in identification of any underlying structural cause in spontaneous cerebrospinal fluid (CSF) leaks-either rhinorrhea or otorrhea. Sphenoid bone defects have been reported in those presenting as idiopathic intracranial hypertension with or without CSF rhinorrhea. Sphenoid lateral recess defect with intrasphenoidal encephalocele is one of the uncommon causes of spontaneous CSF leakage. Many classifications of basal encephaloceles have been used along with associated predisposing anatomic factors for the CSF leak. CASE DESCRIPTION: We report 2 cases of spontaneous CSF rhinorrhea in 2 middle-aged females and had intrasphenoidal encephalocele on imaging using 3-dimensional magnetic resonance cisternography and computed tomography. CONCLUSIONS: We discuss the various classification systems of sphenoidal encephaloceles and review the terminology and comprehensive imaging details to be included in reporting such cases for appropriate treatment planning.


Asunto(s)
Rinorrea de Líquido Cefalorraquídeo/diagnóstico por imagen , Encefalocele/diagnóstico por imagen , Hipertensión Intracraneal/complicaciones , Hipertensión Intracraneal/diagnóstico por imagen , Hueso Esfenoides/diagnóstico por imagen , Terminología como Asunto , Adulto , Pérdida de Líquido Cefalorraquídeo/clasificación , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/clasificación , Rinorrea de Líquido Cefalorraquídeo/etiología , Encefalocele/clasificación , Encefalocele/etiología , Femenino , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Persona de Mediana Edad , Seno Esfenoidal/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
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