Purpose: To investigate changes in brain water diffusion in patients with idiopathic intracranial hypertension.
Methods: A motion-compensated MR pulse sequence was used to create diffusion maps of the apparent diffusion coefficient (ADC) in 12 patients fulfilling conventional diagnostic criteria for idiopathic intracranial hypertension and in 12 healthy volunteers.
Results: A significantly larger ADC was found within subcortical white matter in the patient group (mean, 1.16 x 10(-9) m2/s) than in the control group (mean, 0.75 x 10(-9) m2/s), whereas no significant differences were found within cortical gray matter, the basal nuclei, the internal capsule, or the corpus callosum. Four of 7 patients with increased ADC in subcortical white matter also had increased ADC within gray matter.
Conclusion: Measurement of diffusion coefficients in vivo demonstrated increased local water mobility within subcortical white matter in 7 patients with idiopathic intracranial hypertension that otherwise appeared normal on conventional MR imaging. Further studies are necessary to assess the clinical significance of these observations.
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Cornea
March 2025
Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL.
Purpose: We present a case of ocular pathology linked to morbid obesity, emphasizing the role of systemic inflammation in ocular disease and clinical impact of weight loss.
Methods: We report the case of a 49-year-old man with morbid obesity and obstructive sleep apnea who underwent bilateral corneal transplants secondary to keratoconus. For 4 years, he had chronic bulbar hyperemia with progressive blood vessel growth across the graft-host junction, which was treated with chronic topical corticosteroids.
J Neurosurg Case Lessons
March 2025
Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts.
Background: Venous sinus injury resulting in thrombosis is a possible complication of skull base surgery and neck dissection. Although usually asymptomatic, sinus thrombosis can obstruct the dominant cranial venous outflow pathways, leading to a cycle of increased intracranial pressure secondary to venous congestion, which further compresses the remaining sinuses in a positive feedback loop. This can present with symptoms resembling idiopathic intracranial hypertension.
View Article and Find Full Text PDFWorld Neurosurg
March 2025
Department of Neurosurgery, Tsukazaki Hospital, 68-1 Waku, Aboshi, Himeji, Hyogo 671-1227, Japan.
The incidence of cerebrospinal fluid (CSF) shunting among older adults is increasing. Ventriculoatrial (VA) shunting is a common shunting method, but research on VA shunting for elderly patients is limited. This retrospective study aimed to investigate the complication rate of VA shunting in older patients.
View Article and Find Full Text PDFNeurosurg Clin N Am
April 2025
Departments of Surgery (Ophthalmology) and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address:
Idiopathic intracranial hypertension (IIH) is becoming an increasingly common health care concern as global obesity rates rise. Physicians need to be familiar with the salient clinical features of this condition to improve the quality of lives of patients, reduce related health care costs, and optimize visual outcomes. The focus of this review is IIH with papilledema, because the potential for vision loss is a dire concern that drives urgency in diagnosis and management.
View Article and Find Full Text PDFNeurosurg Clin N Am
April 2025
Department of Neurological Surgery, Ohio State University College of Medicine, 410 West 10th Avenue, Columbus, OH 43210, USA; Department of Pediatric Neurosurgery, Nationwide Children's Hospital, 4th Floor Faculty Office Building, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address:
This article provides an in-depth review of cerebrospinal fluid (CSF) shunts for managing hydrocephalus and idiopathic intracranial hypertension, with a focus on advanced surgical techniques and strategies to prevent complications. It examines the placement of ventricular, lumbar, peritoneal, atrial, and pleural catheters, highlighting the benefits of neuro-navigation, endoscopic visualization, and laparoscopic-assisted approaches. Evidence-based methods to reduce shunt infections, malfunctions, and overdrainage are discussed, along with a comparative analysis of shunt types tailored to individual patient needs.
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