Biomedical subjects
Publications and source records attributed to Deborah I Friedman.
Idiopathic intracranial hypertension is a secondary headache disorder characterized by headaches and visual symptoms. It most frequently occurs in obese women of childbearing age. However, many secondary causes exist, and it may affect children, men, and slim individuals. Prompt recognition, evaluation, and treatment are needed to prevent permanent visual loss.
Increased pressure in the dural venous sinuses has been proposed as the cause of increased intracranial pressure in the condition known as idiopathic intracranial hypertension (IIH). This hypothesis has received further support from manometry of the dural venous sinuses, showing a substantial proximal-to-distal pressure gradient, and from reports of improvement of IIH following stenting of the dural sinuses. Increased intracranial venous pressure has also been proposed as the cause of IIH in morbid obesity through increased abdominal pressure that is transmitted through the thorax to the cerebral draining veins. Although these hypotheses are intriguing, neither has enough scientific support to be endorsed yet. Moreover, dural venous sinus stenting should not be adopted as a therapeutic procedure in IIH until larger clinical trials attest to its safety and efficacy.
Pseudotumor cerebri (PTC) is a syndrome of intracranial hypertension that is idiopathic or from an identified secondary cause. It is characterized by headaches and visual manifestations. The hallmark of PTC is papilledema and the feared consequence is visual loss that may be severe and permanent. The idiopathic form generally occurs in obese women of childbearing age. Various medications may produce PTC in patients at any age, including children. Several medications used in dermatology, particularly those used in the treatment of acne vulgaris, are associated with PTC. There is a strong association with tetracycline usage. Minocycline and doxycycline have also been linked to PTC, although there are relatively few reported cases. PTC has also been described with retinoids, including vitamin A (retinol) and isotretinoin. Although corticosteroids are often used to lower intracranial pressure acutely, corticosteroid withdrawal after long-term administration may induce increased intracranial pressure. A high index of suspicion, early diagnosis and treatment generally yield a good prognosis.
Ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. Although ophthalmic causes are sometimes diagnosed, most eye pain and many types of visual disturbances are neurologic in origin. Afferent and efferent symptoms and signs are associated with headache disorders. This article reviews the primary headache disorders and focuses on their ophthalmic manifestations. The major divisions are migraine and the trigeminal autonomic cephalgias.
Pseudotumor cerebri is a perplexing syndrome of increased intra-cranial pressure without a space-occupying lesion. The terminology for the disorder has changed over the years and the diagnostic criteria revised to reflect advances in diagnostic technology and insights into the disease process. The classification and nomenclature depend on the presence or absence of an underlying cause. When the diagnostic criteria are followed, a secondary etiology is unlikely. When no secondary cause is identified, the syndrome is termed "idiopathic intracranial hypertension."
The syndrome of intracranial hypertension without structural brain or cerebrospinal fluid abnormalities and without identifiable cause, now most appropriately termed idiopathic intracranial hypertension, was described over a century ago. Although the pathogenesis of this condition remains unknown, diagnostic and therapeutic developments during the past two decades have substantially advanced patient management.
The syndrome of increased intracranial pressure without hydrocephalus or mass lesion and with normal CSF composition, previously referred to as pseudotumor cerebri, is a diagnosis of exclusion now termed idiopathic intracranial hypertension (IIH). Diagnostic criteria of this disorder have not been updated since the Modified Dandy Criteria were articulated in 1985. Since then, new developments, including advances in neuroimaging technology and recognition of additional secondary causes of intracranial hypertension, have further enhanced the ability to diagnose conditions that may mimic IIH. These factors are not addressed in the Modified Dandy Criteria. This report describes updated diagnostic criteria for IIH that may be used for routine patient management and for research purposes.
The authors reviewed medical records of 82 patients with idiopathic intracranial hypertension (IIH) to determine the frequency of headaches occurring after initial diagnosis and treatment of IIH, classifiable by the International Headache Society guidelines. Sixty-eight percent of patients had definable headache disorders, including episodic tension type headache (30%) and migraine without aura (20%). Patients with IIH frequently have other types of headaches, not necessarily related to increased intracranial pressure.
Research has demonstrated that men will admit to the perpetration of domestic violence (DV), if questioned, in the medical setting. The opportunity to identify DV perpetrators, however, also depends on the frequency of contact between health care providers and perpetrators. The purpose of this study was to determine health care use among a group of DV perpetrators. A survey was administered to 133 men enrolled in the largest community-based batterer treatment program in a metropolitan region. Of the 133 men surveyed, 56 (42%) indicated they had visited a doctor, hospital, or received some other type of medical care within the preceding 6 months. Of men reporting health care visits, the majority (41%, n = 23) indicated that the Emergency Department was the location where care was provided. These data demonstrate that Emergency Departments are often visited by DV perpetrators in this community and may be important sites for screening and intervention protocols.