Article
Effects of Long-Term Elevated Intracranial Pressure on Neurocognitive Functions – What do we know – What should we look for?
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Published: | November 30, 2017 |
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Introduction: Idiopathic intracranial hypertension (IIH) or pseudotumour cerebri, is a disease of to date unknown etiology. It occurs at any age and in males and females, but affects most often young, obese women. The estimated incidence is 1-3 cases /100000 inhabitants/year. Typical symptoms are headache, tinnitus, nausea and multiple visual disturbances, rarely shoulder/arm pain,a.o.. Cerebrospinal fluid (CSF) pressure is usually higher than 25 cm H2O, routine CSF parameters are unremarkable. Pathological magnetic resonance imaging (MRI) findings are the „empty sella“ phenomenon, hydrops of the optical nerv sheath and bilateral papilledema.
Main part: Surprisingly, there are only very few studies on cognition in patients with IIH. International data banks (Pub Med, Cochrane) reveal only 6 studies fulfilling the „Evidence-based Medicine“ (EBM) criteria (prospective, randomised, controlled, at least two confirming studies). One of the first EBM trials is from Soerenson and co-workers 1986, the methodologically best from Yri et al., 2014. The latter is shortly described; 31 patients were included; the authors performed neuropsychological tests (executive function, working- and space memory, information processing speed and simple reaction times, a.o.) after diagnostic lumbar puncture; they used a computerised test battery (Cambridge neuropsychological test automated battery), but also the pencil-paper form of the tests. Patients with IIH performed significantly worse in 4/6 cognitive domains than an age- and sex-matched control group. Most significantly different were the simple reaction times. Despite effective treatment of IIH, neuropsychological control testing after three months showed persistent neurocognitive deficits. This observation has been confirmed by other trials. Kaplan et al. described in their study from 1997 additional mental alteration in IIH patients.
Conclusions: The results of studies on cognitive deficits and mental alteration in IIH patients have not been integrated into clinical routine. The patients are not examined neuropsychologically and only rarely seen by a psychiatrist. These diagnostic steps should be included in the care for this patient group. Because the authors of the relevant studies agree that the interaction between chronically elevated CSF pressure and cognition should be further clarified, long-term trials would make sense, especially to identify risk factors for relapses. Furthermore, neuropsychological, neuroradiological and ophthalmological findings should be correlated.