Intracranial pressure and glaucoma

Authors: Berdahl, John Pa; Allingham, R Randb

Current Opinion in Ophthalmology: March 2010 - Volume 21 - Issue 2 - p 106–111 doi: 10.1097/ICU.0b013e32833651d8 Glaucoma: Edited by Donald L. Budenz

Purpose of review: Glaucoma remains a disease with an unclear basic pathophysiology. The optic nerve travels through two pressurized regions: the intraocular space and the intracranial space. Some authors have suggested that the relationship between intraocular pressure and intracranial pressure may play a fundamental role in the development of glaucoma.

Recent findings: Recent studies have shown that intracranial pressure is lower in patients with glaucoma and normal-tension glaucoma. Conversely, intracranial pressure appears to be elevated in patients with ocular hypertension. Early mathematical modeling studies have suggested that the counterbalance provided by intracranial pressure would be an important factor in the development of glaucoma.

Summary: The relationship between intraocular pressure and intracranial pressure may play an important role in the development of glaucoma.

Headaches caused by decreased intracranial pressure: diagnosis and management

Authors: Mokri, Bahram 

Current Opinion in Neurology: June 2003 - Volume 16 - Issue 3 - pp 319-326 Headache

Purpose of review: More patients with spontaneous intracranial hypotension are now being diagnosed, and it is realized that most cases result from spontaneous cerebrospinal fluid leaks. A broader clinical and imaging spectrum of the disorder is recognized. This paper reviews new insights into the variability of clinical manifestations, imaging features, etiological factors, anatomy of leaks, and implications of these in patient management.

Recent findings: Spontaneous intracranial hypotension should not be equated with post-lumbar puncture headaches. In a substantial minority of patients, headaches are not orthostatic and may mimic other types of headache. Additional diverse neurological manifestations may dominate the clinical picture and patients may occasionally have no headache at all. Reports on unusual presentations of the disorder continue to appear in the literature. Furthermore, additional imaging features of cerebrospinal fluid leaks are recognized. High-flow and slow-flow leaks may present diagnostic challenges, and require modification of diagnostic studies aimed at locating the site of the leak. Stigmata of connective tissue abnormality, especially abnormalities of fibrillin and elastin, are seen in a notable minority of patients, pointing to weakness of the dural sac as one of the etiological factors. After treatment of spontaneous intracranial hypotension, surgically or by epidural blood patch, a rebound and self-limiting intracranial hypertension may sometimes develop.

Summary: In the past decade, interest in spontaneous intracranial hypotension has been rekindled, with a substantial growth of knowledge on various aspects of the disorder. We are in the learning phase, and new information will probably appear in the future, with notable diagnostic and therapeutic implications.

Mild Traumatic Brain Injury: Neuroimaging of Sports-Related Concussion

Authors: Cecilia V. Mendez, M.D., Robin A. Hurley, M.D., FANPA, Maryse Lassonde, Ph.D., Liying Zhang, Ph.D. and Katherine H. Taber, Ph.D., FANPA

J Neuropsychiatry Clin Neurosci 17:297-303, August 2005
doi: 10.1176/appi.neuropsych.17.3.297
© 2005 American Neuropsychiatric Association

Today, multiple sports are associated with concussive events. In excess of 1.5 million people participate in football (i.e. recreational, high school, collegiate, and professional) annually. The estimated annual incidence of MTBI’s in football is 4–20%.5 A systematic review of the literature from 1985 to 2000 found ice hockey and rugby to have the highest incidence of concussion for high school, college, and amateur athletes, while soccer had the lowest.10 At the recreational level, female taekwondo participants and male boxers had the highest frequency of concussion.10 Of the injuries, 6.2% were concussive in a three-year prospective study among intercollegiate athletes.11 According to a survey of 1,659 children participating in contact sports, 3% suffered concussions.12 In addition, an epidemiologic study of collegiate and high school football players found that players who sustain one concussion are three times more likely to sustain a second one in the same season.13

Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

Authors: Charles W. Hoge, M.D., Dennis McGurk, Ph.D., Jeffrey L. Thomas, Ph.D., Anthony L. Cox, M.S.W., Charles C. Engel, M.D., M.P.H., and Carl A. Castro, Ph.D.
N Engl J Med 2008; 358:453-463January 31, 2008

BACKGROUND

An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumatic brain injury is poorly understood.

METHODS

We surveyed 2525 U.S. Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq. Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), with soldiers who reported other injuries. 

RESULTS

Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache.

CONCLUSIONS

Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.

 

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