| Identifier |
Fulminant_Idiopathic_Intracranial_Hypertension |
| Title |
Fulminant Idiopathic Intracranial Hypertension (IIH) |
| Creator |
Andrew G. Lee, MD; Sugi Panneerselvam |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (SP) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Cerebral; Intracranial; Hypertension; Medical Condition |
| Description |
Dr. Lee lectures medical students on Fulminant Idiopathic Intracranial Hypertension (IIH). |
| Transcript |
So today we're going to be talking about fulminant IIH, and as you know most cases of IIH are in obese, young females. They usually have a slowly progressive or subacute course over months of the symptoms of increased intracranial pressure, which are headache, pulse synchronous tinnitus, double vision from non-localizing sixth nerve palsy, and transient visual obscurations from the papilledema. They can only have signs of increased intracranial pressure, which is papilledema, the sixth enlargement of blind spot, and some type of nerve fiber layer defect, and their MRI and MRV with contrast should be negative except for this radiographic signs of increased intracranial pressure, which is fluid in the sheath, flattening of the globe, empty sella, and venous sinus stenosis, but not thrombosis. And of course, the lumbar; puncture can only show elevated intracranial pressure, but the CSF contents have to be normal. So, the difference between regular IIH and fulminant IIH is fulminant IIH is more acute and more severe, so it is the combination of acute plus severe that defines fulminant IIH. And so normally, when we're dealing with regular IIH we have plenty of time to the imaging study, they have plenty of time to do the lumbar puncture because the person is not going to go blind while we're working it up; however, in acute and fulminant IIH, especially if we have loss of acuity or severe loss of visual field (the patient) needs to be admitted to the hospital. And the reason you're admitting to the hospital is 1) to expedite the workup, but; 2) to put a lumbar drain in, so that we can have a temperizing measures on the elevated intracranial pressure while we're waiting for a definitive surgical procedure, which is either optic nerve sheath fenestration, a shunting procedure like a stereotactically placed ventriculoperitoneal shunt or a venous; sinus stem, or some combination of these surgical procedures. So in patients who present acutely, defined as less than a few weeks or who have severe visual field or severe central loss, acuity loss, we should work it up faster and we could do a lumbar drain and we should do surgery. So even though you're going to give the patient Diamox, might even give them intravenous steroids while we're waiting, you really shouldn't be waiting very long before we do surgery. So fulminant IIH is a different type of IIH that means aggressive, rapid surgical treatment and it's especially bad if they're African American or if they have concomitant hypertension. Those two comorbidities make it even worse. So don't fool around with fulminant IIH. Admit that to the hospital and do surgery. |
| Date |
2020-05-27 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6g504c5 |
| Setname |
ehsl_novel_lee |
| ID |
1561504 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6g504c5 |
