0:00

With that,

0:01

we can move on to idiopathic intracranial hypertension or pseudotumor cerebra,

0:04

however you wanna say it,

0:05

and that that's along the same spectrum as venous sinus or,

0:09

or venous outflow obstruction, jugular venous obstruction, also like from, uh,

0:12

either cranial cervical instability or, um, uh, uh,

0:16

basically venous eagle syndrome, elongated stylo processes.

0:21

Um, idiopathic intracranial hypertension, though typically affects younger,

0:25

more obese females in kinda the 20 to 40 age range. Um, and again, risk factors,

0:29

obesity, retinoids, like vitamin A, overdose, um, uh, you know,

0:33

things like that, venous obstruction contributes to it. Uh,

0:36

in some cases hyper hypoparathyroidism here in sufficiency,

0:40

Cushings hormone supplementation and tetracycline can also be risk factors for,

0:45

um, idiopathic intracranial hypertension. Um,

0:48

typically there's an increase in intracranial pressure and opening pressure.

0:52

When you do an LP without really an increase in or without a significant

0:55

increase in ventricular volume,

0:57

they typically will present with PAL edema and or double vision palsy.

1:01

A lot of 'em do have tinnitus and headaches as well.

1:04

And the imaging findings typically include sort of slit like ventricles and

1:07

empty cell dilated optic nerve sheaths. Uh,

1:10

and typically there's some degree of diffuse sinus narrowing. Um,

1:14

focal venous sinus narrowing, jugular venous stenosis and or, um,

1:18

cerebral venous sinus thrombosis may potentiate or mimic IH in certain select

1:23

cases. Whether it's a mimic or a potentiator is really more, um, uh,

1:28

a judgment call based upon the patient's phenotype.

1:30

So if you're dealing with a thin person who you know,

1:33

has a very low B M I and they have very severe venous stenosis,

1:36

then it's more mimicking I h.

1:38

Whereas if you're dealing with someone who's closer to the phenotype that you

1:41

expect for i h,

1:42

then a focal venous sinus stenosis may be potentiating it and making it worse,

1:46

and they could benefit from revascularization,

1:48

but typically you'd have to do venous pressure measurements, which I'll,

1:52

I'll go through that in just a minute. But the typical treatments would in,

1:55

in involve weight loss diamox, um, VP shunting or LP shunting. And,

2:00

and they, they both, they respond to both of those. Again,

2:03

VP shunts are easier to control,

2:04

but it's harder to put in a VP shunt on one of these patients because the,

2:07

the ventricles are more slit like, um, you can do venous stenting,

2:10

as I alluded to in select cases.