Talk:Idiopathic intracranial hypertension

Title
This page ought to follow recent terminology, i.e. be under "benign intracranial hypertension". Pseudotumor is a scary oldfashioned term. JFW | T@lk  18:22, 3 May 2004 (UTC)

Number of people w/ IIH
Does anyone know the number of people with IIH? Especially the number of non-overweight males?


 * I do not believe anyone really knows how many people have IIH for certain, the number in the article is a "close guess" based on current research for the continental U.S.

The commonly quoted figure by both the IHRF IIRC and ASBAH (the Association for Spina Bifida and Hydrocephalus (they do some work with BIH/IIH) is 1 in 100,000. Someone on the IIH Support forums worked it out that at that rate there would be "only" around 700 sufferers in the UK. Ecanus fallen angel 20:37, 28 October 2007 (UTC)


 * Figure now cited from reliable sources. JFW | T@lk  22:00, 16 November 2008 (UTC)

nomenclature
Even BIH (benign intracranial hypertension) is an oudated term... BIH is most commonly used in the UK and Europe, and is rather infrequently used in the US. Many experts now discourage use of the term "benign", as it seems to undermine the severity of the disorder in much the same way that "pseudo" does. There is often significant morbidity associated with IH, and to call the disorder false (pseudo) or non-harmful (benign) tends to give the impression that it's not a 'real' health problem.

The consensus in the scientific community today is that "pseudotumor cerebri" (increased intracranial pressure of unknown cause) should be called idiopathic intracranial hypertension, or IIH. Intracranial hypertension of a known cause, such as stroke or trauma, should be called secondary IH, or SIH.

(a quick database search of medical journals will support my comments... also see http://www.ihrfoundation.org)


 * Hmmm. Here in the UK the term BIH is still very common. I've heard it more often than IIH. JFW | T@lk  02:06, 30 May 2005 (UTC)
 * I agree. Enough that I've moved the page and fixed the double redirects. Though not the other links as they may have reasons I'm unaware of for using older terminlogy (NZ) Gible Fog 12:19, 4 February 2006 (UTC)

Title now follows consensus as indicated by recent publications. JFW | T@lk  22:00, 16 November 2008 (UTC)

History
Anyone have a useful reference for the history of this condition? JFW | T@lk  23:24, 3 November 2007 (UTC)


 * Seems this is sorted now. JFW | T@lk  22:00, 16 November 2008 (UTC)

Overlap
Someone who knows something about this should take a look at Pediatric Pseudotumor Cerebri (which, despite the name, is not solely about pediatric cases) and figure out if these should continue being separate pages. WhatamIdoing (talk) 03:02, 10 February 2008 (UTC)


 * Once merged, this paper is a review of the disease in children: http://adc.bmj.com/cgi/content/full/78/1/89 JFW | T@lk  20:40, 26 August 2008 (UTC)

Done. JFW | T@lk  22:00, 16 November 2008 (UTC)

Gotcha
has landed on my desk. Now if I had the time... The following paediatric source is non-free but more recent that the paper I mentioned above: http://pedsinreview.aappublications.org/cgi/content/extract/28/11/e77 JFW | T@lk  22:47, 25 October 2008 (UTC)


 * preserving visual function. JFW | T@lk  00:44, 28 October 2008 (UTC)

Sorted. JFW | T@lk  22:00, 16 November 2008 (UTC)

Stuff to do
I'd meant to work on this article for some time, but I have now finally got copies of the most recent reviews, and with meningitis worked up to GA status I hope to spend the next couple of days to improve this one to at least B class and hopefully GA as well.

Current issues:
 * ✅ Much of the information is currently sourced to primary research studies and minor reviews. Technically, most of the content should be sourced to a source like Binder.
 * ✅ The pathophysiology section can be sourced to Binder.
 * ✅ We need to explain the pros and cons of ONFS versus shunting. This seems to be subject to trends and research studies. Binder and Acheson document these trends pretty well.
 * ✅ How wide is the support for the Friedman/Jacobson criteria? Binder doesn't cite the paper at all, and traces the modified Dandy criteria not to Smith (1985) but to Corbett in 2001. Very puzzling.
 * ✅ There are no useful images. Perhaps I'll draw some graphs for the statistical information.

Anyone keen to help is invited. JFW | T@lk  22:39, 11 November 2008 (UTC)

Criteria
Further to the above, I think we have four different sets of criteria:
 * Dandy's from 1937
 * Smith's from 1985 (modified Dandy), four points
 * Corbett's from 2001 (further modified)
 * Friedman & Jacobson's from 2002 (also modified)

It will be necessary to compare them, and I suspect we'll end up citing Dandy, Corbett and F&J's for completeness, while pointing out the significant differences. JFW | T@lk  07:10, 12 November 2008 (UTC)


 * I have cited all criteria and tracked their development. JFW | T@lk  22:00, 16 November 2008 (UTC)

Associations vs secondary causes
Binder et al distinguish between associated diseases and causes for secondary IH. Frankly, they are not particularly clear on why obstructive sleep apnoea would be an associated condition and cerebral venous thrombosis a secondary cause. I have tried to fudge this as good as I can. JFW | T@lk  08:40, 16 November 2008 (UTC)


 * ✅ Acheson lumps them all together. There are plenty of reasons why OSAS and hypothyroidism could directly lead to increased intracranial pressure, so I have actually eliminated the whole discussion and lumped OSAS with the secondary causes, per Acheson. JFW | T@lk  22:00, 16 November 2008 (UTC)

Three theories as to etiology are presented. What about impair of CSF outflow? Could this be a cause, as seen in hydrocephalus? —Preceding unsigned comment added by 129.177.241.187 (talk) 13:07, 3 November 2009 (UTC)

Pathophysiology
I have rewritten the "pathophysiology" section (now called "mechanism"). The previous version has a number of problems; it mixed up several concepts, and made use of various conflicting primary and secondary sources that could not be unified without significant NOR difficulty. I have now relied on Binder et al as the main supportive source; Binder provides three causative frameworks. JFW | T@lk  11:19, 16 November 2008 (UTC)

Almost done...
As usual, I have kept the "treatment" section for last, as this needs to faithfully reflect the current state of diagnostics and treatment. It seems that currently shunt surgery is more commonly advised than optic nerve fenestration, and Binder gives some good reasons why. Still, we need to make it very clear that most procedures are far from definitive, and that ongoing or recurrent symptoms or worsening visual fields would indicate that the procedure requires revision. JFW | T@lk  14:51, 16 November 2008 (UTC)

The future
Binder already touches on venous stenting, but seems to show that occult venous obstruction underlies many cases - or at least the difficult ones. That's a ten patient case series, so clearly we need to await further developments. JFW | T@lk  22:00, 16 November 2008 (UTC)

Good article!
I've passed the article per the WP:GA? and this. Nothing to worry about here, good work. —Cyclonenim (talk · contribs · email) 22:48, 18 November 2008 (UTC) Hey thats great work here, still waiting for more pseudotumor - Patients to give you finally the best widened optic nerve-sheath MRI's.Shlomo-One —Preceding undated comment added 13:51, 27 May 2010 (UTC).

Cannabis as medicine

 * "Tetrahydrocannabinol, the active ingredient in cannabis, has also proven effective in the treatment of idiopathic intracranial hypertension in at least one case report. "

I see no reason why this statement isn't appropriate for this article. The fact is worded correctly, conclusive, and cited by a reputable source. I'm not going to sit here and defend why it should be included in the article because I feel that it simply belongs. If you wish to continue to retract this fact, then feel free to defend your retraction of my edits. Dmarquard (talk) 16:08, 3 July 2009 (UTC)


 * Both the citation and your personal experience are anecdotal. You wouldn't expect anecdotal experience in a general encyclopedia, so you will not find it here. That's final, really, and I hope you understand. The only situation where anecdotal reports would be suitable is in exceptionally rare and difficult to treat conditions (where every effective treatment would be welcomed) or where the anecdotal report represents a phenomenal breakthrough (e.g. recent findings in rabies). Cannabis for IIH doesn't tick those boxes. JFW | T@lk  11:21, 5 July 2009 (UTC)

Yeah, Mr Wolff is completely right, try to be scientific and systematic Mr Marquard - and smoke your childish pot at home. Many consuming physicians have been recommending exotic Tetrahydrocannabinol - Case Studies to their patients, which is not reaonable and not evidence based. Are we talking about medicine - or what? Greetings from Berlin, Oxford and Frankfurt on the Main to the Neuroradiologist Community Shlomo-One.

Source
Lancet Neurol. JFW | T@lk  23:41, 10 April 2010 (UTC)

Venous outflow obstruction
added. It turns out to be a review from a fairly obscure journal. It discusses a theory that IIH is caused by venous stenoses/outflow obstruction. The more recent secondary sources don't support intervention. The bigger question is whether there is any relationship between the stenoses seen in IIH and those that have been linked with Chronic cerebrospinal venous insufficiency. This is an immensely controversial area that is ripping through the MS research community. Before we say anything about this, we need to think whether the sources are clear enough about the expected benefits and the potential risks. JFW &#124; T@lk  18:32, 11 May 2011 (UTC)

More sources
The Lancet Neurology source above seems useful. There's also the following: (Neurol Sci 2010, more on venous stenosis),  (Curr Opin Neurol 2011, neuroophthalmology emphasis). JFW &#124; T@lk  06:00, 13 May 2011 (UTC)

Space travel concerns
IIH has been observed in astronauts. Koebler J (2012). Note to Newt: Human Body Might Not Be Able to Survive for Long in Space. Jewish World Review.


 * If it's due to space travel it's clearly not "idiopathic". Also, this is not a secondary source that meets the criteria from WP:MEDRS. JFW &#124; T@lk  21:16, 21 March 2012 (UTC)

Verification Requested
In July this article was updated to specify that the headache caused by this condition is &#8220;usually frontal.&#8221; Please provide a citation for this. Bwrs (talk) 20:54, 1 September 2012 (UTC)

Update needed
The sources are a bit rusty, and I clearly need to do a bit of an update here. Sources that might help:
 * 10.1136/jnnp-2011-302029 (JNNP 2012)
 * 10.1212/WNL.0b013e3182a55f17 (Neurology 2013, new criteria)
 * 10.1097/WCO.0b013e328360eccc (Curr Opin Neurol 2013, also covers hypotension)
 * 10.1097/GRF.0b013e31828f2701 (Clin Obstet Gynecol 2013, in pregnancy)
 * 10.1007/s11910-012-0336-x (Clin Neurol Neurosci Rep 2013, children and adolescents)
 * 10.3174/ajnr.A2404 (AJNR 2011, imaging)

Plenty to do, in other words! JFW &#124; T@lk  13:43, 20 January 2014 (UTC)


 * NORDIC trial (10.1001/jama.2014.3312) on acetazolamide in mild visual loss. The conclusions are cautious. Primary source so we'll need to wait for it to appear in secondary sources. JFW &#124; T@lk  09:18, 23 April 2014 (UTC)


 * Another article, free. In Practical Neurology 10.1136/practneurol-2014-000821 JFW &#124; T@lk  19:24, 18 November 2014 (UTC)


 * And another, from Ducros & Biousse in Lancet Neurology 10.1016/S1474-4422(15)00015-0. JFW &#124; T@lk  14:34, 20 May 2015 (UTC)


 * And yet another: 10.1016/S1474-4422(15)00298-7 JFW &#124; T@lk  15:24, 8 December 2015 (UTC)

Stenting
10.1136/neurintsurg-2012-010468 - systematic review showing benefit. Many sources seem to be more doubtful. Methodology? JFW &#124; T@lk  15:05, 29 October 2014 (UTC)

Link to the Humphrey VF analyzer page
(Note this is mostly a copy-paste of Talk:Visual_field_test, which I added a few minutes ago - apologies if duplication is the wrong approach here.)

Hey folks, just writing to say that I added a link to the Humphrey analyzer. I did this because I saw the analyzer page showing "page issues - this page is an orphan" on mobile (confirmed by looking at the "what links here" page) - although I can not see the issue on desktop.

I also previously added a similar link to the Visual field test page - based on a cursory skim of WP:BOLD I figure it's better for Wikipedia's quality to do so in both cases and maybe have it reverted, than to just add sections in the talk pages.

To avoid giving undue focus on the Humphrey brand, I also did an unsuccessful quick web search for a Wiki page on anything Goldmann-related. Some additional resources:

Nclajbiuerb (talk) 08:12, 3 June 2017 (UTC)
 * [] lists both Humphrey and Octopus perimeters, however I didn't find a Wiki article on the latter either.
 * [] describes Humphrey and Goldmann more extensively, and quickly references Octopus.

Guideline
http://jnnp.bmj.com/content/early/2018/06/14/jnnp-2017-317440 (DOI broken). JFW &#124; T@lk  22:04, 18 June 2018 (UTC)