192 research outputs found
Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects
No full textParunyou Julayanont,1 Amputch Karukote,2 Doungporn Ruthirago,1 Deepa Panikkath,3 Ragesh Panikkath3 1Department of Neurology, Texas Tech University Health Science Center, Lubbock, TX, USA; 2Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA Abstract: Idiopathic intracranial hypertension (IIH) is an uncommon disorder characterized by increased intracranial pressure without radiological or laboratory evidence of intracranial pathology except empty sella turcica, optic nerve sheath with filled out cerebrospinal fluid spaces, and smooth-walled nonflow-related venous sinus stenosis or collapse. This condition typically affects obese women. The incidence of IIH is increasing with the rising prevalence of obesity. Persistent headache is the most common symptom. Visual impairment is a serious complication that may not be recognized by the patients. This paper reviews clinical manifestations, diagnostic challenges, and current treatments of IIH in adults. Various imaging modalities have been studied on their validity for detection of IIH and papilledema. This review also includes new studies on medical, surgical, and interventional management of this condition. Acetazolamide and topiramate are the only two medications that have been studied in randomized controlled trials about their efficacy in treatment of IIH. In patients who have severe visual impairment or progressive visual deterioration despite medical management, surgical or interventional treatment may be considered. The efficacy and complications of cerebrospinal fluid diversion, optic nerve sheath fenestration, and endovascular venous stenting reported in the last 3 decades have been summarized in this review. Finally, the prospective aspects of biomarkers and treatments are proposed for future research. Keywords: acetazolamide, cerebrospinal fluid shunts, endovascular stenting, optic nerve sheath fenestration, pseudotumor cerebr
Azygos vein cannulation: recognition is vital for preventing complications
No full textInadvertent cannulation of the azygos vein can occur during central vein cannulations,especially from the left side. This can cause several complications, including rupture ofthe azygos vein. This complication is unlikely from the more commonly used right internaljugular vein access, although that approach is not free of complications. An abruptcurve at the tip of the central venous catheter showing venous wave forms and highoxygen saturations suggest azygos vein cannulation. Azygos vein cannulations may bemore common in patients with heart failure in which the vein is dilated
Intrathoracic Manifestations of IgG4-Related Disease
No full textIntrathoracic involvement with IgG4-related disease (IgG4-RD) is frequently overlooked in IgG4-related disease patients. In this article we review the intrathoracic findings of IgG4-RD which are variable and protean. IgG4-related disease has been reported to affect the lung parenchyma, pleura, mediastinal/hilar lymph nodes, vasculature, and pericardium within the thorax. Mediastinal and hilar lymphadenopathy is the most common intrathoracic manifestation of IgG4-RD. Four main patterns of pulmonary disease have been described, including the solid nodular type, the bronchovascular type, the alveolar interstitial type, and the round shaped ground glass type. When feasible, a biopsy should be obtained to confirm the diagnosis. Most lesions show characteristic pathologic findings of IgG4-RD: dense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis. While this helps establish the diagnosis, the interpretation of pathology findings in the clinical context is key in making an accurate diagnosis. Mimickers of IgG4-RD should be ruled out, before making a diagnosis. The intrathoracic findings of IgG4-RD can be treated effectively with prednisone, but may require additional immunosuppressive therapies, including rituximab
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