Idiopathic Intracranial Hypertension Explained : A Guide for Patients and Families

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. Preface Acknowledgments 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) References 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 References 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 Optic Hydrops or Distention of Optic Nerve Sheath 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) The Basic Principles Who Performs this Procedure? Procedural Location What to Expect: Pre-procedure What to Expect: During the Procedure What to Expect: Post-procedure Complications Lumbar Drain Placement The Basic Principles Who Performs this Procedure? Procedural Location What to Expect: Before the Procedure What to Expect: During the Procedure What to Expect: After the Procedure Complications Intracranial Pressure Monitor (Bolt) Placement The Basic Principles Who Performs this Procedure? Procedural Location What to Expect: Before the Procedure What to Expect: During the Procedure What to Expect: After the Procedure Complications 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 References Chapter 8: Medical Therapies for IIH An Overview of Medications for IIH Acetazolamide (Trade Name: Diamox) Methazolamide (Trade Name: Neptazane) Topiramate (Trade Name: Topamax, Trokendi) Furosemide (Trade Name: Lasix) Opiate (Opioid) Medications Over-the-Counter Medications Reference Chapter 9: Cerebral 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 The Basic Principles Who Performs this Procedure? Procedural Location What to Expect: Pre-procedure What to Expect: During the Procedure What to Expect: Post-procedure Complications References 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 The Basic Principles Who Performs This Procedure? Procedural Location What to Expect: Pre-Procedure What to Expect: During the Procedure What to Expect: Post-Procedure Complications 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 References Chapter 11: Cerebrospinal Fluid Shunting Overview Shunting for Impaired Quality of Life Life Expectancy of Shunts Any of the Three 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 The Basic Principles Who Performs This Procedure? Procedural Location What to Expect: Pre-Procedure What to Expect: During the Procedure What to Expect: Post-Procedure Complications 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 Reference Chapter 12: Other Surgical Treatment Overview Internal Jugular Vein Treatments Optic Nerve Sheath Fenestration Cranio-Cervical (Occipito-Cervical) Fusion Cerebrospinal Fluid Leak Repairs Chiari Decompression Reference Glossary Index