Thread by @UHBNeurosurgery

1. 👉 #TWEETORIAL 👈 join us to discuss Idiopathic Intracranial Hypertension (#IIH) - a rare disease of unknown cause characterised by high pressure around the brain - it is a debilitating condition which affects mainly young women
#IIH #headaches #tweetorial #MedTwitter @IIHUK

2. Women of childbearing age with obesity are mainly affected, though men can be affected too. Though rare, the incidence is rising in line with the global obesity epidemic

3. What does IIH feel like? Throbbing headaches are a very common symptom in IIH. They are usually the worst in the morning but can be made worse by coughing, straining, or lying down. Sometimes, headaches are associated with nausea or vomiting

4.‼️ If a person who has IIH experiences visual symptoms loss, this is an emergency and they need to seek urgent medical advice. Often, they may not have any changes to their vision, but it can be picked up at the opticians when the pressure behind the eyes is checked 👀

5. Your doctors 👨‍⚕️👩‍⚕️will need to do a some tests such as blood tests, a CT or MRI scan. You may need a lumbar puncture to check the pressure of the fluid around the brain. The name ‘idiopathic’ means that no cause of the raised fluid pressure is found

6.Weight loss 🏋️ is the treatment of choice; in some cases bariatric surgery is required [See Ref 1] Medications, such as acetazolamide may also help.This drug reduces production of cerebrospinal fluid(CSF) which surrounds the brain, thus reducing the pressure within the skull

7. Fewer than 10% of patients develop rapidly progressive visual loss and require urgent surgery to reduce the pressure around the brain and preserve vision

8. The most common operation is insertion of a shunt; a thin silicon tube that drains fluid from the brain or the lower spine to abdomen. @UHBNeurosurgery @uhbtrust #MrGeorgeTsermoulas and team have developed a protocol for shunting with very good surgical results. [See Ref 2]

9. 💡We are setting up a study called IIH Intervention Trial that will compare two interventions in patients with IIH that are at risk of permanent visual loss: shunting and stenting with @unibirmingham @NIHRresearch @DrMollan @IIHDrBirmingham @IMSR_UoB

10. The shunt is described in [8] above. The stent is a metallic mesh tube that is inserted in a narrow part of a brain vessel. Both shunting and stenting reduce pressure around the brain, but we don’t yet know which intervention is better.
birmingham.ac.uk/research/bctu/…

11. 🙂☺️ Thank-you for reading our #tweetorial on IIH! Special thanks to #MrGeorgeTsermoulas. Always consult your doctor for more information. Do check out our other #tweetorials!
#UHBNeurosurgery #IIH #tweetorial

Ref 1: Susan P. Mollan et al. Effectiveness of Bariatric Surgery vs Community Weight Management Intervention for the Treatment of Idiopathic Intracranial Hypertension
A Randomized Clinical Trial @DrMollan pubmed.ncbi.nlm.nih.gov/33900360/

Ref 2: Galloway et al. CSF shunting protocol for idiopathic intracranial hypertension for an improved revision rate. J Neurosurg. 2021 Oct 8:1-6. doi: 10.3171/2021.5.JNS21821. Epub ahead of print. PMID: 34624853. pubmed.ncbi.nlm.nih.gov/34624853/

@RobBryce17