Intracranial arteriovenous malformation presenting with papilloedema

Authors: Hayton T, Gan P, Sadalage G, Burdon M.

Intracranial arteriovenous malformations (AVM) typically present clinically with haemorrhage, seizures or focal neurological deficit. AVM do not usually have a substantial mass effect or cause raised intracranial pressure. Rarely shunting of arterial blood into the venous system can cause raised venous pressure and consequently raised CSF pressure. The case described here is of a 37 year old man with an AVM who presented with headache and papilloedema secondary to raised CSF pressure. Following partial embolisation, to reduce fistulous flow, and stereotactic radiosurgery (SRS), to reduce the size of the AVM, both the headache and papilloedema resolved.

Prognostic correlation of intracranial pressure monitoring in patients with severe craniocerebral injury

Authors: Huang QB, Zhang Y, Su YH, Zhang ZL, Wang GH, Li XG.

OBJECTIVE: To explore the clinical application of intracranial pressure (ICP) monitoring and its prognostic correlation in patients with severe craniocerebral injury.
METHODS: A total of 216 severe craniocerebral injury patients with scores of Glasgow coma scale 3-8 underwent craniotomy at Affiliated Qilu Hospital, Shandong University.And 168 cases of ICP monitoring were divided into 3 treatment groups and another 48 cases without ICP monitoring selected as the control group.According to ICP, stepwise treatment was administered to control the level of ICP and maintain the cerebral perfusion pressure to analyze the relationship between ICP monitoring and prognosis.
RESULTS: As compared with the control group, there were significant decreases of disability and mortality rate for patients with ICP monitoring (A, B, C group). Especially group C had a better prognosis than the other groups for statistical significance.In addition, the dose and duration of mannitol of group A, B or C were significantly lower than those of the control group (P < 0.05).
CONCLUSION: The application of ICP monitoring is capable of reducing mortality, improving prognosis and enhancing success rate of treating severe craniocerebral injury.

Idiopathic intracranial hypertension: A possible complication in the natural history of advanced prostate cancer

Authors: Valcamonico F, Arcangeli G, Consoli F, Nonnis D, Grisanti S, Gatti E, Berruti A, Ferrari V.

Idiopathic intracranial hypertension is a variety of intracranial hypertension that is extremely rare in men. Obesity and hypogonadism are the most important predictive factors. Etiological hypotheses include increased central venous pressure, and various hormonal and metabolic changes commonly found in obese patients. We described the case of an obese man with prostate cancer who showed a consistent bodyweight increase during treatment with taxanes and prednisone. He was hospitalized because of a severe loss of vision as a consequence of idiopathic intracranial hypertension. A complete symptom remission was obtained after 3 weeks of anti-edema therapies (steroids, acetazolamide). Castration-resistant prostate cancer is a risk factor for idiopathic intracranial hypertension. Long-term androgen deprivation therapy, bodyweight increase, and fluid retention during chronic steroid administration and taxane chemotherapy might favor the disease onset. This severe complication has a good outcome, and should be suspected in the presence of symptoms and signs of intracranial hypertension.

Analysis of intracranial pressure signals recorded during infusion studies using the spectral entropy

Authors: Garcia M, Poza J, Abasolo D, Santamarta D, Hornero R.

Hydrocephalus includes a range of disorders characterized by clinical symptoms, abnormal brain imaging and altered cerebrospinal fluid (CSF) dynamics. Infusion tests can be used to study CSF circulation in patients with hydrocephalus. In them, intracranial pressure (ICP) is deliberately raised and CSF circulation disorders evaluated through measurements of the resulting ICP. In this study, we analyzed 77 ICP signals recorded during infusion tests using the spectral entropy (SE). Each signal was divided into four artifact-free epochs. The mean SE, <SE>, and the standard deviation of SE, SD, were calculated for each epoch. Statistically significant differences were found between phases of the infusion test using <SE> and SD (p<1.7·10-3, Bonferroni-corrected Wilcoxon tests). Furthermore, we found significantly lower <SE> and SD values in the plateau phase than in the basal phase. These findings suggest that the increase in ICP during infusion studies is associated with a significant decrease in irregularity and variability of the spectral content of ICP signals, measured in terms of SE. We conclude that the spectral analysis of ICP signals could be useful for understanding CSF dynamics in hydrocephalus.

Intracranial hypertension presenting with severe visual failure, without concurrent headache, in a child with nephrotic syndrome

Authors: Barnett M, Sinha MD, Morrison D, Lim M.

BACKGROUND: Idiopathic intracranial hypertension is a condition typically characterised by headache, normal level of consciousness, papilloedema and raised cerebrospinal fluid pressure. Children often present with visual loss and atypical features of raised pressure, posing a diagnostic and management challenge. A range of renal disorders can predispose to developing this raised intracranial pressure syndrome. We present a case of severe visual failure in a child with nephrotic syndrome, with no headache when elevated pressure was proven. In nephrotic syndrome, visual failure related to elevated intracranial pressures without concurrent headache symptoms has not been reported previously.

MDCTA diagnosis of cerebral vessel disease among patients with arterial hypertension

Authors: Romanko-Hrushchak N.

BACKGROUND: to study changes involving cerebral vessels in patients with hypertension and various levels of total cardiovascular risk.
MATERIAL/METHODS: One hundred and thirty-four patients underwent CT-angiography of intracranial vessels. Ninety-eight of them were diagnosed with hypertension. Taking into consideration high blood pressure, presence of risk factors and target organ damage subjects were divided into 4 groups: with low, medium, high and very high total cardiovascular risk. Control group included 36 patients. They were not diagnosed with hypertension at the time of examination. One hundred and five patients were examined using a 4-slice CT scanner (Toshiba Asteion 4, Toshiba Medical System, Japan), and 29 patients were examined using a 128-slice scanner (Siemens Definition AS+, Siemens Healthcare, Germany) with an injection system. We used iodine-containing contrast agents such as iodixanol and iopromide for angiography.

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