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Intracranial hypertension
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==Diagnosis== Arachnoiditis, a progressive inflammatory disorder affecting the middle membrane surrounding the spinal cord and brain (arachnoid membrane), epiduritis (involving inflammation of the tough, outer canvas-like covering surrounding the brain and spinal cord) and [[meningitis]] should be ruled out during diagnosis.<ref name="NORD" /> There are many tools that can be used in the diagnosis of intracranial hypertension. The most typical method is a [[lumbar puncture]], during which the opening pressure is measured. Opening pressures of 20 H<sub>2</sub>O or greater are considered abnormal in non-obsese people, 25 H<sub>2</sub>O or greater in obese people. However, as pressure can fluctuate and change with position, a more accurate method is a 24 hour intracranial bolt test. This involves inserting an intracranial pressure monitor directly into the cranium to continuously measure pressure over the course of a day. Normal is 7-15 mm Hg in a supine adult.<ref name="Pickard2004">{{Cite journal | last = Pickard | first = J.D. | last2 = Czosnyka | first2 = M. | date = 2004-06-01 | title = Monitoring and interpretation of intracranial pressure | url = https://jnnp.bmj.com/content/75/6/813|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=75|issue=6 | pages = 813–821|doi=10.1136/jnnp.2003.033126|issn=0022-3050|pmid=15145991}}</ref> An MRI can also aid in diagnosis. While generally considered benign, an empty sella can suggest intracranial hypertension, particularly in patients manifesting the symptoms of intracranial hypertension.<ref name="emptysella">{{Cite web | url = https://rarediseases.org/rare-diseases/empty-sella-syndrome/ | title = Empty Sella Syndrome|website=NORD (National Organization for Rare Disorders)|language=en-US|access-date=2019-06-22}}</ref> An empty sella is when the sella, a bony space which holds the [[pituitary gland]], appears “empty” (dark/black) on an MRI. This is because, due to high pressure, the space has been filled with cerebrospinal fluid, flattening the pituitary gland. Patients can also have excess spinal fluid in their optic nerve sheath, which can cause pain behind the eyes and papilledema. Finally, an MR venogram (a type of MRI that uses contrast to visualizes the veins in the brain) can detect bilateral [[transverse venous sinus]] stenosis (TSS), a narrowing of two veins in the back of the head that drain blood from the brain. TSS is found in 83% of cases of intracranial hypertension (compared to 3% of controls).<ref name="Campeau2017">{{Cite journal | last = Campeau | first = N. | last2 = Port | first2 = J. | last3 = Black | first3 =D.F. | last4 = Morris | first4 = P.P. | date = 2017-03-01 | title = Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension | url =http://www.ajnr.org/content/38/3/471|journal=American Journal of Neuroradiology|language=en|volume=38|issue=3 | pages = 471–477|doi=10.3174/ajnr.A5055|issn=0195-6108|pmid=28104635}}</ref> It is not known whether TSS is cause or effect, but there is growing evidence that stenting one of the transverse sinus veins can improve or resolve intracranial hypertension.<ref name="Higgins2002">{{Cite journal | last = Higgins | first = J Nicholas P | last2 = Owler | first2 = Brian K | last3 = Cousins | first3 = Claire | last4 = Pickard | first4 = John D | date = 2002-01-19 | title = Venous sinus stenting for refractory benign intracranial hypertension | url =http://www.sciencedirect.com/science/article/pii/S0140673602074408|journal=The Lancet|volume=359|issue=9302 | pages = 228–230|doi=10.1016/S0140-6736(02)07440-8|issn=0140-6736}}</ref><ref name="Pickard2003">{{Cite journal | last = Pickard | first = J.D. | last2 = Sarkies | first2 = N. | last3 = Owler | first3 = B.K. | last4 = Cousins | first4 = C. | last5 = Higgins | first5 = J. N.P. | date = 2003-12-01 | title = Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting | url =https://jnnp.bmj.com/content/74/12/1662|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=74|issue=12|pages=1662–1666|doi=10.1136/jnnp.74.12.1662|issn=0022-3050|pmid=14638886}}</ref><ref name="Halmagyi2011">{{Cite journal | last = Halmagyi | first = G.M. | last2 = Owler | first2 = B.K. | last3 = Hanlon | first3 = M. | last4 = Dunne | first4 = V. | last5 = Allan | first5 = R. | last6 = McCluskey | first6 = P.J. | last7 = Macdonald | first7 = J. | last8 = Thurtell | first8 = M.J. | last9 = Parker | first9 = G.D. | date = 2011-09-01 | title = Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions | url = http://www.ajnr.org/content/32/8/1408|journal=American Journal of Neuroradiology|language=en|volume=32|issue=8|pages=1408–1414|doi=10.3174/ajnr.A2575|issn=0195-6108|pmid=21799038}}</ref>
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