tailieunhanh - Chapter 015. Headache (Part 21)

Raised CSF Pressure Headache Raised CSF pressure is well recognized as a cause of headache. Brain imaging can often reveal the cause, such as a space-occupying lesion. NDPH due to raised CSF pressure can be the presenting symptom for patients with idiopathic intracranial hypertension (pseudotumor cerebri) without visual problems, particularly when the fundi are normal. Persistently raised intracranial pressure can trigger chronic migraine. These patients typically present with a history of generalized headache that is present on waking and improves as the day goes on. It is generally worse with recumbency. Visual obscurations are frequent . The diagnosis is relatively straightforward when. | Chapter 015. Headache Part 21 Raised CSF Pressure Headache Raised CSF pressure is well recognized as a cause of headache. Brain imaging can often reveal the cause such as a space-occupying lesion. NDPH due to raised CSF pressure can be the presenting symptom for patients with idiopathic intracranial hypertension pseudotumor cerebri without visual problems particularly when the fundi are normal. Persistently raised intracranial pressure can trigger chronic migraine. These patients typically present with a history of generalized headache that is present on waking and improves as the day goes on. It is generally worse with recumbency. Visual obscurations are frequent . The diagnosis is relatively straightforward when papilledema is present but the possibility must be considered even in patients without fundoscopic changes. Formal visual-field testing should be performed even in the absence of overt ophthalmic involvement. Headache on rising in the morning or nocturnal headache is also characteristic of obstructive sleep apnea or poorly controlled hypertension. Evaluation of patients suspected to have raised CSF pressure requires brain imaging. It is most efficient to obtain an MRI including an MR venogram as the initial study. If there are no contraindications the CSF pressure should be measured by LP this should be done when the patient is symptomatic so that both the pressure and the response to removal of 20-30 mL of CSF can be determined. An elevated opening pressure and improvement in headache following removal of CSF is diagnostic. Initial treatment is with acetazolamide 250-500 mg bid the headache may improve within weeks. If ineffective topiramate is the next treatment of choice it has many actions that may be useful in this setting including carbonic anhydrase inhibition weight loss and neuronal membrane stabilization likely mediated via effects on phosphorylation pathways. Severely disabled patients who do not respond to medical treatment require .