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Nervenheilkunde 2018; 37(01): 21-28
DOI: 10.1055/s-0038-1631167
Kopfschmerz
Schattauer GmbH

Kopfschmerz bei Liquorüberdruck

Headache in increased intracranial pressure
J. Hoffmann
1   Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Hamburg
,
S. Förderreuther
2   Klinik für Neurologie, Ludwig-Maximilians-Universität München – Innenstadtklinikum, München
› Author Affiliations
Further Information

Publication History

eingegangen am: 01 November 2017

angenommen am: 13 November 2017

Publication Date:
09 February 2018 (online)

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Zusammenfassung

Die idiopathische intrakranielle Hypertension beruht auf einer intrakraniellen Drucksteigerung unklarer Ätiologie. Das daraus resultierende klinische Bild ist in erster Linie durch einen weitgehend unspezifischen Kopfschmerz und progrediente, potenziell irreversible Sehstörungen charakterisiert wobei nicht selten auch Hirnnervenlähmungen, Riechstörungen und kognitive Defizite beobachtet werden. Die Ursache der intrakraniellen Drucksteigerung ist nicht eindeutig geklärt. Das Vorliegen einer venösen Abflussstörung, die aufgrund des häufig bestehenden Übergewichts oder auch aufgrund eines vaskulären Hindernisses in Form einer bilateralen Stenose des Sinus transversus auftreten kann, erscheint am nahe liegendsten. Auch hormonelle Faktoren könnten von wesentlicher Bedeutung sein und erklären warum überwiegend Frauen von der Erkrankung betroffen sind. Die Behandlung besteht in erster Linie aus einer Gewichtsreduktion und der oralen Gabe von Carboanhydrasehemmern, wobei lediglich für Acetazolamid Daten aus einer placebo-kontrollierten Studie vorliegen. Invasive Behandlungsverfahren sollten nur in therapierefraktären oder besonders fulminanten Fällen mit drohendem Verlust des Sehvermögens erwogen werden.

Summary

Idiopathic intracranial hypertension is caused by an increase of intracranial pressure of unknown etiology. The clinical picture is characterized by a rather unspecific headache and progressive and potentially irreversible visual disturbances but cranial nerve palsies, olfactory disturbances and cognitive deficits may also occur. The underlying cause remains largely unknown. The presence of a disturbance in venous outflow either caused by the commonly observed obesity or bilateral stenoses of the sinus transversus are thought to represent a crucial element in the pathobiology of the disorder. The role of hormonal factors is increasingly discussed as these may explain female preponderance. Treatment is mainly based on weight reduction and the use of carboanhydrase inhibitors although data from randomized-controlled trials exist only for acetazolamide. Invasive treatments should only be considered in therapy-resistant cases as well as in those with a fulminant course of the disorder with an acute risk of an irreversible loss of visual function.

Schlüsselwörter

Idiopathische intrakranielle Hypertension - Pseudotumor cerebri - Kopfschmerz - Acetazolamid

Keywords

Idiopathic intracranial hypertension - pseudotumor cerebri - headache - acetazolamide
 

  • Literatur

  • 1 Kesler A, Stolovic N, Bluednikov Y, Shohat T. The incidence of idiopathic intracranial hypertension in Israel from 2005 to 2007: results of a nationwide survey. Eur J Neurol 2014; 21 (08) 1055-9.
    CrossrefPubMedGoogle Scholar
  • 2 Durcan FJ, Corbett JJ, Wall M. The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana. Arch Neurol 1988; 45 (08) 875-7.
    CrossrefPubMedGoogle Scholar
  • 3 Aylward SC, Aronowitz C, Reem R, Rogers D, Roach ES. Intracranial hypertension without headache in children. J Child Neurol 2015; 30 (06) 703-6.
    CrossrefPubMedGoogle Scholar
  • 4 Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 2014; 71 (06) 693-701.
    CrossrefPubMedGoogle Scholar
  • 5 Yri HM, Rönnbäck C, Wegener M, Hamann S, Jensen RH. The course of headache in idiopathic intracranial hypertension: a 12-month prospective follow-up study. European Journal of Neurology 2014; 21 (12) 1458-64.
    CrossrefPubMedGoogle Scholar
  • 6 Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33 (09) 629-808.
    CrossrefPubMedGoogle Scholar
  • 7 Wall M, George D. Idiopathic intracranial hypertension. A prospective Study of 50 patients. Brain 1991; 114: 155-80.
    PubMedGoogle Scholar
  • 8 Hayreh SS. Pathogenesis of optic disc edema in raised intracranial pressure. Progress in Retinal and Eye Research 2016; 50: 108-44.
    CrossrefPubMedGoogle Scholar
  • 9 Digre KB, Nakamoto BK, Warner JE, Langeberg WJ, Baggaley SK, Katz BJ. A comparison of idiopathic intracranial hypertension with and without papilledema. Headache 2009; 49 (02) 185-93.
    CrossrefPubMedGoogle Scholar
  • 10 Becker N, Kronenberg G, Harms L, Wiener E, Kreutz K, Eltiri A. et al. Rapid improvement of olfaction after lumbar puncture in a patient with idiopathic intracranial hypertension. Headache. 2016 Epub 2016/04/05.
    PubMedGoogle Scholar
  • 11 Khoo KF, Kunte H. Olfactory dysfunction in patients with idiopathic intracranial hypertension. Neurology 2014; 82 (02) 189.
    CrossrefPubMedGoogle Scholar
  • 12 Kunte H, Schmidt F, Kronenberg G, Hoffmann J, Schmidt C, Harms L. et al. Olfactory dysfunction in patients with idiopathic intracranial hypertension. Neurology 2013; 81 (04) 379-82.
    CrossrefPubMedGoogle Scholar
  • 13 Schmidt C, Wiener E, Hoffmann J, Klingebiel R, Schmidt F, Hofmann T. et al. Structural olfactory nerve changes in patients suffering from idiopathic intracranial hypertension. PLoS One 2012; 07 (04) e35221.
    CrossrefPubMedGoogle Scholar
  • 14 Yri HM, Fagerlund B, Forchhammer HB, Jensen RH. Cognitive function in idiopathic intracranial hypertension: a prospective case-control study. BMJ Open 2014; 04 (04) e004376.
    CrossrefPubMedGoogle Scholar
  • 15 Sugerman HJ, DeMaria EJ, Felton 3rd WL, Nakatsuka M, Sismanis A. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 1997; 49 (02) 507-11.
    CrossrefPubMedGoogle Scholar
  • 16 Lampl Y, Eshel Y, Kessler A, Fux A, Gilad R, Boaz M. et al. Serum leptin level in women with idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry 2002; 72 (05) 642-3.
    CrossrefPubMedGoogle Scholar
  • 17 Farb RI, Vanek I, Scott JN, Mikulis DJ, Willinsky RA, Tomlinson G. et al. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 2003; 60 (09) 1418-24.
    CrossrefPubMedGoogle Scholar
  • 18 Morris PP, Black DF, Port J, Campeau N. Transverse sinus stenosis is the most sensitive MR imaging correlate of idiopathic intracranial hypertension. American Journal of Neuroradiology. 2017 E-pub.
    PubMedGoogle Scholar
  • 19 Yri HM, Jensen RH. Idiopathic intracranial hypertension: Clinical nosography and field-testing of the ICHD diagnostic criteria. A case-control study. Cephalalgia 2015; 35 (07) 553-62.
    CrossrefPubMedGoogle Scholar
  • 20 Yri H, Wegener M, Sander B, Jensen R. Idiopathic intracranial hypertension is not benign: a longterm outcome study. Journal of Neurology 2012; 259 (05) 886-94.
    CrossrefPubMedGoogle Scholar
  • 21 Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81 (13) 1159-65.
    CrossrefPubMedGoogle Scholar
  • 22 Hoffman KR, Chan SW, Hughes AR, Halcrow SJ. Management of cerebellar tonsillar herniation following lumbar puncture in idiopathic intracranial hypertension. Case Rep Crit Care 2015; 2015: 895035.
    PubMedGoogle Scholar
  • 23 Kaufhold F, Kadas EM, Schmidt C, Kunte H, Hoffmann J, Zimmermann H. et al. Optic nerve head quantification in idiopathic intracranial hypertension by spectral domain OCT. PLoS One 2012; 07 (05) e36965.
    CrossrefPubMedGoogle Scholar
  • 24 OCT Sub-Study Committee for the Nordic Idiopathic Intracranial Hypertension Study. Baseline OCT Measurements in the Idiopathic Intracranial Hypertension Treatment Trial, Part I: Quality Control, Comparisons, and VariabilityBaseline OCT Measurements in IIHTT, Part I. Investigative Ophthalmology & Visual Science 2014; 55 (12) 8180-8.
    CrossrefPubMedGoogle Scholar
  • 25 Lochner P, Brigo F, Zedde ML, Sanguigni S, Coppo L, Nardone R. et al. Feasibility and usefulness of ultrasonography in idiopathic intracranial hypertension or secondary intracranial hypertension. BMC Neurology 2016; 16 (01) 85.
    CrossrefPubMedGoogle Scholar
  • 26 Hoffmann J. Headache Attributed to Intracranial Hypertension and Hypotension. In: Mitsikostas DD, Pameleire K. (eds.) Pharmacological Management of Headaches. London: Springer; 2015: 189-205.
    Google Scholar
  • 27 Hoffmann J, Goadsby PJ. Update on intracranial hypertension and hypotension. Curr Opin Neurol 2013; 26 (03) 240-7.
    CrossrefPubMedGoogle Scholar
  • 28 Hoffmann J, Schmidt C, Kunte H, Klingebiel R, Harms L, Huppertz H-J. et al. Volumetric assessment of optic nerve sheath and hypophysis in idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2014; 35 (03) 513-8.
    CrossrefPubMedGoogle Scholar
  • 29 Hoffmann J, Huppertz HJ, Schmidt C, Kunte H, Harms L, Klingebiel R. et al. Morphometric and volumetric MRI changes in idiopathic intracranial hypertension. Cephalalgia 2013; 33 (13) 1075-84.
    CrossrefPubMedGoogle Scholar
  • 30 Schmidt C, Wiener E, Lüdemann L, Kunte H, Kreutz KM, Becker N. et al. Does IIH Alter Brain Microstructures? – A DTI-Based Approach. Headache: The Journal of Head and Face Pain; 2017. DOI: 10.1111/head.13039.
    Google Scholar
  • 31 Digre KB. Imaging characteristics of IIH: Are they reliable?. Cephalalgia 2013; 33 (13) 1067-9.
    CrossrefPubMedGoogle Scholar
  • 32 Farb RI, Scott JN, Willinsky RA, Montanera WJ, Wright GA, terBrugge KG. Intracranial venous system: gadolinium-enhanced three-dimensional MR venography with auto-triggered elliptic centric-ordered sequence – initial experience. Radiology 2003; 226 (01) 203-9.
    CrossrefPubMedGoogle Scholar
  • 33 Sinclair AJ, Burdon MA, Nightingale PG, Ball AK, Good P, Matthews TD. et al. Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study. BMJ 2010; 341: c2701.
    CrossrefPubMedGoogle Scholar
  • 34 Ko MW, Chang SC, Ridha MA, Ney JJ, Ali TF, Friedman DI. Weight gain and recurrence in idiopathic intracranial hypertension: a case-control study. Neurology 2011; 76 (18) 1564-7.
    CrossrefPubMedGoogle Scholar
  • 35 Committee NIIHSGW. Wall M, McDermott MP, Kieburtz KD, Corbett JJ, Feldon SE. et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 2014; 311 (16) 1641-51.
    CrossrefPubMedGoogle Scholar
  • 36 Wall M, Kupersmith MJ, Thurtell MJ, Moss HE, Moss EA, Auinger P. The longitudinal idiopathic intracranial hypertension trial. Outcomes from months 6–12. American Journal of Ophthalmology. 2017 E-pub.
    PubMedGoogle Scholar
  • 37 Celebisoy N, Gokcay F, Sirin H, Akyurekli O. Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand 2007; 116 (05) 322-7.
    CrossrefPubMedGoogle Scholar
  • 38 Carta F, Supuran CT. Diuretics with carbonic anhydrase inhibitory action: a patent and literature review (2005–2013). Expert Opin Ther Pat 2013; 23 (06) 681-91.
    CrossrefPubMedGoogle Scholar
  • 39 House PM, Stodieck SRG. Octreotide: The IIH therapy beyond weight loss, carbonic anhydrase inhibitors, lumbar punctures and surgical/interventional treatments. Clinical Neurology and Neurosurgery 2016; 150: 181-4.
    CrossrefPubMedGoogle Scholar
  • 40 Kalyvas AV, Hughes M, Koutsarnakis C, Moris D, Liakos F, Sakas DE. et al. Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature. Acta Neurochir 2017; 159 (01) 33-49.
    CrossrefPubMedGoogle Scholar
  • 41 Kelman SE, Heaps R, Wolf A, Elman MJ. Optic nerve decompression surgery improves visual function in patients with pseudotumor cerebri. Neurosurgery 1992; 30 (03) 391-5.
    CrossrefPubMedGoogle Scholar
  • 42 Spoor TC, McHenry JG. Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri. Arch Ophthalmol 1993; 111 (05) 632-5.
    CrossrefPubMedGoogle Scholar
  • 43 Menger RP, Connor Jr. DE, Thakur JD, Sonig A, Smith E, Guthikonda B. et al. A comparison of lumboperitoneal and ventriculoperitoneal shunting for idiopathic intracranial hypertension: an analysis of economic impact and complications using the Nationwide Inpatient Sample. Neurosurg Focus 2014; 37 (05) E4.
    CrossrefPubMedGoogle Scholar
  • 44 Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA, Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia 2011; 31 (16) 1627-33.
    CrossrefPubMedGoogle Scholar
  • 45 Dinkin MJ, Patsalides A. Venous Sinus Stenting in Idiopathic Intracranial Hypertension: Results of a Prospective Trial. Journal of Neuro-Ophthalmology. 2016 DOI: 10.1097/wno.0000000000000426.
    PubMedGoogle Scholar
  • 46 Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ. et al. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol 2011; 32 (08) 1408-14.
    CrossrefPubMedGoogle Scholar