| Identifier |
Fulminant_IIH_09_13_20_480p |
| Title |
Fulminant IIH (09-13-20) |
| Creator |
Andrew G. Lee, MD; Jeremy Auerbach |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (JA) Baylor College of Medicine, Houston, Texas |
| Subject |
Idiopathic Intracranial Hypertension (IIH); Pseudotumor; Lumbar Drain |
| Description |
Dr. Lee lectures medical students on the subject of fulminant IIH on September 13, 2020. |
| Transcript |
I want to tell you about what we do in the acute setting for fulminant IIH, and if you watch the video for this you know that this is a surgical disease. So, fulminant means severe and acute. So, we have an acute onset of days or weeks rather than months and severe means either the field or the acuity, and with pseudotumor cerebri as soon as you lose your acuity that's kind of a severe already. So, severe, acute but you're meeting the diagnostic criteria for IIH -bad papilledema, vision loss-we're really going to be doing surgery. The three things that we want to be doing differently in the acute setting is: number one, a lumbar drain, and that we need neurosurgery for. The purpose of the lumbar drain is just a temporizing maneuver. The reason you have to temporize is because we're getting the surgeons ready and sometimes it's not clear whether we should be doing an optic nerve sheath fenestration or a stereotactically placed ventriculoperitoneal shunt. So, it takes time to get the orbit doctor and the neurosurgeon to see the patient, and so while we're waiting to decide who's going to get to do the cutting, a lumbar drain allows us to have temporizing of the ICP and can give us some time before we get to the definitive surgical procedure. In addition, even though there's no real evidence base for this, in addition to the Diamox at max tolerated doses, usually give the patient intravenous steroids at the same time. IV steroids can lower the intracranial pressure and also will reduce the edema component that has neuroprotective as well as genomic and non-genomic steroid effects on the disc head. So, there is a rationale for giving steroids for papilledema and fulminant IIH. There's several papers on this, you can go look at them. But they're all anecdotal, small case series. There's never been a randomized controlled clinical trial. The reason we don't normally give the steroids to the regular pseudotumor as opposed to the fulminant IIH is because steroid withdrawal can cause increased intracranial pressure and is one of the causes of secondary pseudotumor cerebri. However, in the acute setting, it's just another one of these temporizing measures that gives us some time until we can decide who's going to cut on this person-orbit or neurosurgery. So, put the lumbar drain in infulminant IIH while we're figuring out who's going to hold the knife. |
| Date |
2020-09 |
| 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/s63v5gwd |
| Setname |
ehsl_novel_lee |
| ID |
1701567 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s63v5gwd |
