Pseudotumour cerebri syndrome

Pseudotumour cerebri syndrome, previously known as benign intracranial hypertension and more recently termed idiopathic intracranial hypertension, is characterized by headaches, raised intracranial pressure, and the risk of sudden irreversible visual loss. The pathophysiology of the condition is not fully understood but reduced cerebrospinal fluid absorption secondary to venous outflow obstruction seems to be an important factor. Treatment of patients with this condition is generally with lumbar punctures, weight loss, and lumboperitoneal shunts but ventriculoperitoneal shunts, subtemporal decompression, venous sinus stenting, and acetazolamide may also be used. Prognosis in pseudotumour cerebri syndrome is variable—some patients stabilize after a single lumbar puncture, while others have persistent symptoms for many years. A patient’s symptoms may improve and then recur years later, especially if weight has been lost and then regained again.

Papilledema

Papilledema is the cardinal clinical sign of increased intracranial pressure. In this chapter, we begin by reviewing the symptoms and signs of increased intracranial pressure. We next review potential causes of increased intracranial pressure, which include intracranial masses, obstruction of the ventricular system, obstruction of cerebral venous outflow, decrease in cerebrospinal fluid absorption, increase in cerebrospinal fluid secretion, cerebral edema, medications, and idiopathic intracranial hypertension. We then review the approach to the diagnostic evaluation of increased intracranial pressure, including the recommended neuroimaging studies and cerebrospinal fluid evaluation. Lastly, we discuss the basic management approach for the patient with symptoms and signs of increased intracranial pressure.

Shunt Dependency Syndrome after Cyst-Peritoneal Shunt Resolved by Keyhole Microsurgical Cyst Resection: Two Case Reports and Literature Review

Objective Shunt dependency syndrome after cyst-peritoneal (CP) shunt is a rare but serious complication which leads to increased intracranial pressure and neurological deficit. The possible mechanism still remains in controversy. We present our experience on the treatment of the complication and attempt to find a better therapy strategy for the complication. Methods Two children with middle fossa arachnoid cysts underwent CP shunt with fixed pressure catheters at an opening pressure of 7 cmH2O and then developed dependency syndrome. Both patients were effectively treated by mini-invasive cyst wall excision with the shunts reserved. The clinical manifestation, radiological findings, treatment methods, and therapeutic outcomes were reviewed retrospectively. Results The time from shunt surgery to shunt dependency syndrome occurrence was 4 and 2 years, respectively. Computed tomography/magnetic resonance findings of the brain showed remarkably collapsed cysts with normal or small ventricles. Both patients underwent secondary mini-invasive cyst wall excision and shunt catheters were reserved. After the operations, their symptoms were resolved except one case with marginally improved visual impairment. Conclusion Shunt dependency syndrome is a rare but dangerous complication of CP shunt and should be treated in time. Collapsed and thickened cyst wall intermittent covering the catheter head end, decreased brain compliance due to chronic fibrosis, as well as regression of cerebrospinal fluid absorption could be the pathogenesis. We suggest keyhole resection of the residual cyst wall as an effective and mini-invasive treatment option.

Ventriculosternal Shunting for the Management of Hydrocephalus: Case Report of A Novel Technique

BACKGROUND Conventional cerebrospinal fluid diversion such as ventriculoperitoneal or ventriculoatrial shunting for the management of hydrocephalus is one of the commonest neurosurgical procedures. However, in selected patients, surgical options are limited when relative contraindications for these operations exist. A patient who underwent ventriculosternal shunting, a novel procedure, is presented with durable and successful outcomes. OBJECTIVE To demonstrate the feasibility, durability, and safety of ventriculosternal shunting for the management of hydrocephalus. METHODS A patient with end-stage renal failure and heart failure with recurrent pleural effusion suffered from post–subarachnoid hemorrhage communicating hydrocephalus. Because of the need for continuous ambulatory peritoneal dialysis and the risk of introducing excessive cardiac preloading, conventional shunting was relatively contraindicated. Ventriculosternal shunting was performed by adopting the cancellous matrix of the sternum as the anatomic receptacle for intraosseous cerebrospinal fluid absorption. After placement of the ventricular catheter in the usual manner, the distal end was inserted into the sternum. RESULTS There was demonstrable clinical and radiological improvement in hydrocephalus by ventriculosternal shunting. Cerebrospinal fluid intraosseous absorption by this novel procedure translated into both physical and cognitive recovery. The procedure was tolerable, effective, and durable, with the patient suffering no complications 3 years after the procedure. CONCLUSION Ventriculosternal shunting for the management of hydrocephalus is a feasible, safe, and durable surgical treatment option for selected patients when conventional procedures are contraindicated.

The role of lumbar puncture and pressure.lowering therapy for transverse dural sinus thrombosis

ABSTRACTTransverse (lateral) sinus thrombosis is a well-known complication of acute otitis media and mastoiditis in the pediatric and adult population. Thrombosis involving the transverse sinus can ultimately cause elevation of intracranial pressure (ICP) as a result of decreased cerebrospinal fluid absorption. If treatment to lower ICP is not undertaken, it can lead to ophthalmological complications including irreversible vision loss. The following case report describes an 11-year-old girl who was diagnosed with AOM by her pediatrician and subsequently presented to the emergency department complaining of nausea, vomiting, headache, and diplopia.

Idiopathic intracranial hypertension

Case History—A 40 yr old man presenting with headache and visual disturbance. Idiopathic intracranial hypertension is a syndrome of raised intracranial pressure in the absence of an intracranial mass lesion, enlargement of the cerebral ventricles due to hydrocephalus, or venous thrombosis in the dural sinuses. Impaired cerebrospinal fluid absorption and raised cerebral venous pressure have both been implicated. Obese females of childbearing age are predominantly affected. Rarely, provocative factors include tetracycline, vitamin A derivatives, hypervitaminosis A, and vitamin A excess....