Investigation of Venous Aetiology in Pseudotumor Cerebri Syndrome

The high proportion of patients with venous sinus obstruction coupled with the ability to treat such obstruction should be an indication to investigate all patients with PTS for the existence of venous sinus obstruction. In performing these investigations one should be cognisant of the location and morphology of the venous obstruction that is sought. The most important distinction in the investigation of venous sinus obstruction in PTS is that between thrombosis and stenosis. Until recently,...

Peri Infarct Depolarisations PIDS

In their 1977 paper Branston et al. 45 referred to spontaneous, transient increases in extracellular potassium ion concentration (Ke) which occurred in the ischaemic penumbra following experimental MCAO. Similar, spontaneous events were later reported in another MCAO preparation, also in a gyrencephalic species 90 . It was suggested then that such events, PIDs 3 or HSDs 1 , were ''not necessarily benign'' 91 , and specific studies have confirmed this page 24 Evolution of PID Patterns with Time...

Historical Perspective

The association between cranial venous outflow obstruction and PTS dates back to the earliest descriptions of the latter condition, indeed even prior to the reports of Quincke 138, 139 and Nonne 123 which are generally taken to represent the first recognition of a specific condition initially called either meningitis serosa (Quincke, 1893) or pseudotumor cerebri (Nonne, 1904). Thus Taylor wrote in the 1890 edition of The Practice of Medicine ''It is important to remember what has now been...

Cost of Sacral Neuromodulation

General Issues in Urge Incontinence Costs Urinary incontinence and urinary retention are a costly illness that affect personal resources, medical treatment and quality of life. The overall prevalence of overactive bladder is similar between men (16.0 ) and women (16.9 ), but sex specific prevalence differed substantially by severity of symptomes 150 . Anatomic differences increase the frequency of urge incontinence linked to bladder overactivity among women compared with men. In women,...

Complications of Sacral Neuromodulation

Complications of Peripheral Nerve Evaluation (PNE) Siegel et al. 143 noted 18.2 of adverse effects in 914 test stimulation procedures. The most common adverse events are lead migration from 11.8 143 to 18.6 143 , technical problems (2.6 ) and pain (2.1 ). One surgical intervention (0.1 ) was required to remove a test lead electrode that became dislodged during lead removal. Local infection and subcutaneous hematoma are rare 143 . Complications of Sacral Nerve Neuromodulation For chronic sacral...

Therapeutic Alternatives and Developping Treatments in Refractory Urge Incontinence and Idiopathic Bladder Overactivity

Conservative therapies such as pelvic floor exercises, bladder retraining, electrical stimulation of the pelvic floor and pharmacotherapy involving anticholinergics, antispasmodics and tricyclic antidepressants are primary discussed. The use of pelvic floor muscle training with or without biofeedback for overactive bladder is suggested to inhibit detrusor muscle contraction by voluntary contraction of the pelvic floor at the same time, and to prevent sudden falls in urethral pressure by change...

Clinical Application of Sacral Neuromodulation

Neuromodulation of the sacral nerves is a therapeutic option for voiding dysfunction in patients who do not respond to the common non-invasive therapies and in whom disturbance in reflex coordination between the bladder, sphincter and pelvic floor is suspected. The rationale for using electrical stimulation techniques for the treatment of such voiding dysfunction is that this stimulation turns the neurological control mechanism back towards a more functional status. The main indications are...

Treatment of Olfactory Disorders

The effect of surgery on quantitative olfactory disorders has already been mentioned above. Beside the routine surgery indicated in advanced and medication resistant nasal polyposis, ESS has also been proposed in very particular cases of qualitative olfactory disorders 221, 222 . Leopold was the first to describe the selective excision of the olfactory epithelium in patients suffering from very handicapping phantosmias. These cases, less than two dozen so far, have been carefully selected, and...

Treatment of Venous Sinus Obstruction

In most cases of PTS spontaneous resolution of the condition will occur. In these cases, removal of any offending agent such as tetracyclines, conventional medical therapy including acetazolamide and or steroids, and intermittent lumbar punctures will enable sufficient control of the condition until spontaneous resolution occurs. However, consideration should be considered to more aggressive intervention when the condition is refractory to medical therapy, it does not undergo spontaneous...

The Overactive Bladder

Pathophysiology Oab

Until the most recent definition of the International Continence Society (ICS), the term of bladder overactivity referred to urodynamic status. The bladder was considered as overactive when objectively shown to contract, spontaneously or on stimulation, during the filling phase of a cystometro-gram while the patient is attempting to inhibit micturition 2 . Furthermore, in the first standardization report, the threshold of 15cmH20 was necessary to conclude that an uninhibited bladder was related...

Interaction Between Venous Sinus Hypertension and CSF Pressure

The aforementioned recent observations demonstrating a much greater prevalence of venous sinus obstruction in patients with PTS raise the question of what role venous sinus obstruction occupies in the aetiology of PTS. Clearly, in cases of cerebral venous sinus thrombosis the role has been defined. However, the nature of venous sinus obstruction in PTS is different. Both intrinsic and extrinsic lesions have been identified and both characteristically are found in the region of the junction of...

Causes and Symptoms of Smell Disorders

Since olfactory disorders or even total olfactory loss are far less of a handicap than blindness or deafness for the person concerned, there have not been many attempts to estimate the percentage of people with olfactory problems. Initial surveys were done with questionnaires and rapid smell tests. They revealed that approximately 1-3 of the population has an olfactory problem 117, 118 . Since most of the decrease in olfactory function, like any other sensory function, is due to aging 119 ,...

Venous Sinus Obstruction in Pseudotumor Cerebri Syndrome Cause or Effect

Whether venous sinus obstruction in PTS is cause or effect remains unresolved. The experimental and clinical evidence discussed above indicates that there is potential for primary venous sinus pathology to cause PTS and there is also potential for secondary venous sinus obstruction due to raised intracranial pressure. We discuss below the available evidence and also present a unifying theory based on the establishment of a disordered positive feedback cycle. The discussion will centre on the...

Surgical Risks to the Olfactory System

Chronic rhinosinusitis is the most common chronic inflammatory disease and is frequently associated with impaired sense of smell 198, 199 . When symptomatic patients do not improve on medical treatment, endoscopic sinus surgery (ESS) may be proposed. Nasal polyposis is considered as the ultimate stage of chronic rhinosinusitis for which the mainstay of treatment is medical, but in which ESS plays a part in the majority of cases resistant to medication. Assessment of preoperative olfactory...