Total improvement after surgery for obstructive sleep apnea syndrome in a patient with concurrent malignant idiopathic intracranial hypertension

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The association between idiopathic intracranial hypertension (IIH) and obstructive sleep apnea syndrome (OSAS) constitutes an interesting point of discussion regarding clinical approaches as well as the underlying pathophysiological mechanisms. Here, the case of a 42-year-old female with malignant IIH and OSAS is illustrated. Initially, the patient was treated with lumboperitoneal shunt surgery. However, OSAS surgery provided total recovery from the recurrent symptoms developing secondary to lumboperitoneal shunt malfunction. The authors point out the importance of identifying OSAS as a crucial causative agent in some IIH subtypes. Future studies are warranted to clarify this underestimated association.

ABBREVIATIONS CC-MMA = counterclockwise maxillomandibular advancement; CPAP = continuous positive airway pressure; EES = Epworth Sleepiness Scale; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; LP = lumbar puncture; OCT = optical coherence tomography; OSAS = obstructive sleep apnea syndrome.

Article Information

Correspondence Halil Onder: Yozgat State Hospital, Yozgat, Turkey. halilnder@yahoo.com.

INCLUDE WHEN CITING Published online August 17, 2018; DOI: 10.3171/2018.3.JNS171663.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graphic representation of the temporal evolution of LP opening pressures and papilledema grading during the patient’s clinical course. Green line indicates the time of lumboperitoneal shunt surgery; light blue line, the time of OSAS surgery; dark blue line and dot, the LP measurements; and red line, the papilledema stage. The x-axis represents the number of days. Figure is available in color online only.

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    Perimetry tests performed preoperatively and postoperatively (8th day) showing near-total recovery from the bilateral visual field defects, which occurred in the form of global constriction. Upper: Right eye. Lower: Left eye.

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    Graphic representation of retinal nerve fiber layer (RNFL) measurements revealing gradual decrements in both the right eye and the left eye soon after the tonsillectomy operation. The x-axis represents the number of days and the y-axis the average thickness measurements in micrometers. Figure is available in color online only.

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