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Show disorder and anti-aquaporin-4 antibody. Mult Scler. 2011;17:885-887. 4. Wang KC, Lee CL, Chen SY, Lin KH, Tsai CP. Prominent brainstem symptoms/signs in patients with neuromyelitis optica in a Taiwanese population. J Clin Neurosci. 2011;18:1197-1200. 5. Gilmore CP, Jacob A, Evangelou N. A case of neuromyelitis optica with gadolinium-enhancing brain lesions and Parinaud syndrome. Arch Neurol. 2009;66:140- 141. 6. Patel V, Griffith NC, Blackwood E, Dias M, Cordato DJ. Spectrum disorder of neuromyelitis optica in a patient presenting with intractable vomiting and hiccups, transverse myelitis and acute encephalopathy. J Clin Neurosci. 2012;19:1576-1578. 7. Popescu BF, Lennon VA, Parisi JE, Howe CL, Weigand SD, Cabrera-Gómez JA, Newell K, Mandler RN, Pittock SJ, Weinshenker BG, Lucchinetti CF. Neuromyelitis optica unique area postrema lesions: nausea, vomiting, and pathogenic implications. Neurology. 2011;76:1229-1237. Spontaneous Cerebrospinal Fluid Otorrhea and Rhinorrhea in Idiopathic Intracranial Hypertension Patients The article by Rosenfeld et al (1) described cerebro-spinal fluid (CSF) leaks caused by chronically in-creased intracranial pressure (ICP) in 4 patients with idiopathic intracranial hypertension (IIH). The impres-sion given by the authors is that spontaneous CSF leaks occur with equal frequency in the settings of normal and increased ICP. However, evidence indicates that the ma-jority of spontaneous CSF leaks are associated with in-tracranial hypertension. Spontaneous CSF leaks traditionally have had a high recurrence rate after surgical repair (25%-87%), compared to less than 10% for most other etiologies (2-4). Identification of this underlying etiology has led to the widespread use of acetazolamide and, in some cases, permanent CSF diversion to control the ICP. In a prospective evaluation of more than 5 years, 46 patients (average age, 51 years) with a cumulative 56 spontaneous CSF leaks were treated by the senior author (5). The data presented in the study provided concrete evidence that the majority of spontaneous CSF leaks are secondary to intracranial hypertension. Lumbar drain pressure measurements averaged 32.3 6 9.0 cm H2O and demographics mirrored IIH, where a large proportion of the patient cohort consisted of obese middle-aged women. Successful treatment of ele-vated ICP in combination with endoscopic repair can provide high success rates (93% primary and 100% secondary). Michael S. Vaphiades, DO Neel K. Ranganath, BS Bradford A. Woodworth, MD Department of Ophthalmology, Neurology, and Neurosurgery (MSV), University of Alabama at Birmingham, Birmingham, Alabama; and Department of Surgery, Division of Otolaryngology, Head & Neck Surgery (NKR, BAW), University of Alabama at Birmingham, Birmingham, Alabama B. A. Woodworth is a consultant for Gyrus, ArthroCare ENT, and Cook Medical. The other authors report no conflicts of interest. ACKNOWLEDGMENTS This work was supported in part by an unrestricted grant from the Research to Prevent Blindness, Inc, New York, NY. REFERENCES 1. Rosenfeld E, Dotan G, Kimchi TJ, Kesler A. Spontaneous cerebrospinal fluid otorrhea and rhinorrhea in idiopathic intracranial hypertension patients. J Neuroophthalmol. 2013;33:113-116. 2. Woodworth BA, Palmer JN. Spontaneous cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg. 2009;17:59-65. 3. Woodworth B, Prince A, Chiu AG, Cohen NA, Schlosser RJ, Bloger WE, Kennedy DW, Palmer JN. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg. 2008;138:715- 720. 4. Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE. Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol. 2006;115:495-500. 5. Chaaban MR, Illing E, Riley KO, Woodworth BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope. [published ahead of print June 20, 2013] doi: 10.1002/lary.24160. 416 Letters to the Editor: J Neuro-Ophthalmol 2013; 33: 412-423 Letters to the Editor Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
