O LÍQUOR (LCR) E A HIPERTENSÃO INTRACRANIANA IDIOPÁTICA (HII): REVISÃO CRÍTICA
DOI:
https://doi.org/10.48208/HeadacheMed.2022.16Palavras-chave:
Cefaleia, Pseudotumor cerebral, hipertensão intracraniana idiopática, cefaleia, líquor, sistema glinfáticoResumo
Pseudotumor cerebral é uma síndrome que resulta do aumento da pressão intracraniana e que causa cefaleia, distúrbios visuais e tinnitus pulsátil. O diagnóstico definitivo requer a presença de sinais clínicos e/ou radiológicos de hipertensão intracraniana, pressão de abertura elevada na punção lombar (PL) e constituição normal do líquor (LCR). Diversos estudos têm avaliado novas contribuições do LCR no diagnóstico e no entendimento acerca da fisiopatologia do pseudotumor cerebral. Tais estudos têm incluído a análise de biomarcadores inflamatórios, adipocinas, análise proteômica e estudos de fluxo liquórico. Nesta revisão apresentamos os principais resultados até aqui obtidos e discutimos criticamente as contribuições das pesquisas envolvendo o LCR no entendimento desta condição. Com base nos conhecimentos até aqui obtidos é possível concluir que que a pesquisa com novos biomarcadores liquóricos ainda não possibilitou a incorporação de informações com impactos na prática clínica. Contudo, um melhor entendimento da constituição e da dinâmica da circulação liquórica em pacientes com pseudotumor cerebral vem trazendo algumas informações sobre a fisiopatologia do pseudotumor cerebral e pode vir a aprimorar o conhecimento acerca dessa condição.
Downloads
Referências
Friedman DI, Liu GT and Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013;81(13):1159-1165 Doi:10.1212/WNL.0b013e3182a55f17 DOI: https://doi.org/10.1212/WNL.0b013e3182a55f17
Toscano S, Lo Fermo S, Reggio E, Chisari CG, Patti F and Zappia M. An update on idiopathic intracranial hypertension in adults: a look at pathophysiology, diagnostic approach and management. J Neurol 2020;268(9):3249-3268 Doi:10.1007/s00415-020-09943-9 DOI: https://doi.org/10.1007/s00415-020-09943-9
Wall M. Update on Idiopathic Intracranial Hypertension. Neurol Clin 2017;35(1):45-57 Doi:10.1016/j.ncl.2016.08.004 DOI: https://doi.org/10.1016/j.ncl.2016.08.004
Barkatullah AF, Leishangthem L and Moss HE. MRI findings as markers of idiopathic intracranial hypertension. Curr Opin Neurol 2021;34(1):75-83 Doi:10.1097/wco.0000000000000885 DOI: https://doi.org/10.1097/WCO.0000000000000885
Raoof N and Hoffmann J. Diagnosis and treatment of idiopathic intracranial hypertension. Cephalalgia 2021;41(4):472-478 Doi:10.1177/0333102421997093 DOI: https://doi.org/10.1177/0333102421997093
Westgate CSJ, Botfield HF, Alimajstorovic Z, Yiangou A, Walsh M, Smith G, . . . Sinclair AJ. Systemic and adipocyte transcriptional and metabolic dysregulation in idiopathic intracranial hypertension. JCI Insight 2021;6(10):Doi:10.1172/jci.insight.145346 DOI: https://doi.org/10.1172/jci.insight.145346
Friedman DI. Papilledema and idiopathic intracranial hypertension. Ophtalmol Clin North 2014;20(4):857-876 Doi:10.1212/01.Con.0000453314.75261.66 DOI: https://doi.org/10.1212/01.CON.0000453314.75261.66
Avery RA, Shah SS, Licht DJ, Seiden JA, Huh JW, Boswinkel J, . . . Liu GT. Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 2010;363(9):891-893 Doi:10.1056/NEJMc1004957 DOI: https://doi.org/10.1056/NEJMc1004957
Friedman DI and Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002;59(10):1492-1495 Doi:10.1212/01.Wnl.0000029570.69134.1b DOI: https://doi.org/10.1212/01.WNL.0000029570.69134.1B
Whiteley W, Al-Shahi R, Warlow CP, Zeidler M and Lueck CJ. CSF opening pressure: Reference interval and the effect of body mass index. Neurology 2006;67(9):1690-1691 Doi:10.1212/01.wnl.0000242704.60275.e9 DOI: https://doi.org/10.1212/01.wnl.0000242704.60275.e9
Bono F, Quattrone A, Whiteley WN, Salman RAS, Lueck C and Warlow C. Csf Opening Pressure: Reference Interval and the Effect of Body Mass Index. Neurology 2007;68(17):1439-1440 Doi:10.1212/01.wnl.0000265411.84472.61 DOI: https://doi.org/10.1212/01.wnl.0000265411.84472.61
Avery RA, Licht DJ, Shah SS, Huh JW, Seiden JA, Boswinkel J, . . . Liu GT. CSF opening pressure in children with optic nerve head edema. Neurology 2011;76(19):1658-1661 Doi:10.1212/WNL.0b013e318219fb80 DOI: https://doi.org/10.1212/WNL.0b013e318219fb80
Aylward SC. Pediatric Idiopathic Intracranial Hypertension: A Need for Clarification. Pediatr Neurology 2013;49(5):303-304 Doi:10.1016/j.pediatrneurol.2013.05.019 DOI: https://doi.org/10.1016/j.pediatrneurol.2013.05.019
Berezovsky DE, Bruce BB, Vasseneix C, Peragallo JH, Newman NJ and Biousse V. Cerebrospinal fluid total protein in idiopathic intracranial hypertension. J Neurol Sci 2017;381:226-229 Doi:10.1016/j.jns.2017.08.3264 DOI: https://doi.org/10.1016/j.jns.2017.08.3264
Wall M, McDermott MP, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, . . . Kupersmith MJ. Effect of Acetazolamide on Visual Function in Patients With Idiopathic Intracranial Hypertension and Mild Visual Loss. Jama 2014;311(16):Doi:10.1001/jama.2014.3312 DOI: https://doi.org/10.1001/jama.2014.3312
Friedman DI. Contemporary management of the pseudotumor cerebri syndrome. Exp Rev Neurother 2019;19(9):881-893 Doi:10.1080/14737175.2019.1660163 DOI: https://doi.org/10.1080/14737175.2019.1660163
Kaufman DI and Friedman DI. Should Acetazolamide Be the First-Line Treatment for Patients With Idiopathic Intracranial Hypertension? J Neuro-Ophthalmol 2017;37(2):182-186 Doi:10.1097/wno.0000000000000513 DOI: https://doi.org/10.1097/WNO.0000000000000513
Ceylan OM, Yılmaz M, Yilmaz H, Çelikay O, Köylü MT and Turan A. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammation markers in patients with papilledema due to idiopathic intracranial hypertension. Indian J Ophthalmol 2021;69(6):1499-1505 Doi:10.4103/ijo.IJO_2030_20 DOI: https://doi.org/10.4103/ijo.IJO_2030_20
Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J and Gupta A. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Resp Rev 2021;38:51-57 Doi:10.1016/j.prrv.2020.08.001 DOI: https://doi.org/10.1016/j.prrv.2020.08.001
Divya K, Indumathi C, Vikrant K and Padmanaban S. Pseudotumor cerebri complicating multisystem inflammatory syndrome in a child. J Curr Ophthalmol 2021;33(3):Doi:10.4103/joco.joco_241_20 DOI: https://doi.org/10.4103/joco.joco_241_20
Bilen NM, Sahbudak Bal Z, Yildirim Arslan S, Kanmaz S, Kurugol Z and Ozkinay F. Multisystem Inflammatory Syndrome in Children Presenting With Pseudotumor Cerebri and a Review of the Literature. Pediatr Infect Dis J 2021;40(12):e497-e500 Doi:10.1097/inf.0000000000003327 DOI: https://doi.org/10.1097/INF.0000000000003327
Sofuoğlu Aİ, Akçay N, Şevketoğlu E and Bektaş G. Pseudotumor Cerebri Syndrome as a Neurologic Involvement of Multisystem Inflammatory Syndrome in Children: A Case Report. J Trop Pediatr 2021;67(4):Doi:10.1093/tropej/fmab075 DOI: https://doi.org/10.1093/tropej/fmab075
Altıokka-Uzun G, Tüzün E, Ekizoğlu E, Ulusoy C, Yentür S, Kürtüncü M, . . . Baykan B. Oligoclonal bands and increased cytokine levels in idiopathic intracranial hypertension. Cephalalgia 2015;35(13):1153-1161 Doi:10.1177/0333102415570762 DOI: https://doi.org/10.1177/0333102415570762
Edwards LJ, Sharrack B, Ismail A, Tench CR, Gran B, Dhungana S, . . . Constantinescu CS. Increased levels of interleukins 2 and 17 in the cerebrospinal fluid of patients with idiopathic intracranial hypertension. Am J Clin Exp Immunol 2013;2(3):234-244
Dhungana S, Sharrack B and Woodroofe N. IL-1β, TNF and IP-10 in the cerebrospinal fluid and serum are not altered in patients with idiopathic intracranial hypertension compared to controls. Clin Endocrinol 2009;71(6):896-897 Doi:10.1111/j.1365-2265.2009.03593.x DOI: https://doi.org/10.1111/j.1365-2265.2009.03593.x
Fahmy EM, Rashed LA, Mostafa RH and Ismail RS. Role of tumor necrosis factor-alpha in the pathophysiology of idiopathic intracranial hypertension. Acta Neurol Scand 2021;144(5):509-516 Doi:10.1111/ane.13482 DOI: https://doi.org/10.1111/ane.13482
Zanello SB, Tadigotla V, Hurley J, Skog J, Stevens B, Calvillo E and Bershad E. Inflammatory gene expression signatures in idiopathic intracranial hypertension: possible implications in microgravity-induced ICP elevation. NPJ Microgravity 2018;4:1 Doi:10.1038/s41526-017-0036-6 DOI: https://doi.org/10.1038/s41526-017-0036-6
Mancuso P. The role of adipokines in chronic inflammation. ImmunoTargets Ther 2016; Doi:10.2147/itt.S73223 DOI: https://doi.org/10.2147/ITT.S73223
Kawai T, Autieri MV and Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Cell 2021;320(3):C375-C391 Doi:10.1152/ajpcell.00379.2020 DOI: https://doi.org/10.1152/ajpcell.00379.2020
Obradovic M, Sudar-Milovanovic E, Soskic S, Essack M, Arya S, Stewart AJ, . . . Isenovic ER. Leptin and Obesity: Role and Clinical Implication. Front Endocrinol 2021;12:Doi:10.3389/fendo.2021.585887 DOI: https://doi.org/10.3389/fendo.2021.585887
Lu SC and Akanji AO. Leptin, Obesity, and Hypertension: A Review of Pathogenetic Mechanisms. Metab Synd Relat Disord 2020;18(9):399-405 Doi:10.1089/met.2020.0065 DOI: https://doi.org/10.1089/met.2020.0065
Ball AK, Sinclair AJ, Curnow SJ, Tomlinson JW, Burdon MA, Walker EA, . . . Rauz S. Elevated cerebrospinal fluid (CSF) leptin in idiopathic intracranial hypertension (IIH): evidence for hypothalamic leptin resistance? Clin Endocrinol (Oxf) 2009;70(6):863-869 Doi:10.1111/j.1365-2265.2008.03401.x DOI: https://doi.org/10.1111/j.1365-2265.2008.03401.x
Behbehani R, Mabrook A, Abbas JMK, Al-Rammah T, Mojiminiyi O and Doi SAR. Is cerebrospinal fluid leptin altered in idiopathic intracranial hypertension? Clin Endocrinol 2009;72(6):851-852 Doi:10.1111/j.1365-2265.2009.03722.x DOI: https://doi.org/10.1111/j.1365-2265.2009.03722.x
Samancı B, Samancı Y, Tüzün E, Altıokka-Uzun G, Ekizoğlu E, İçöz S, . . . Baykan B. Evidence for potential involvement of pro-inflammatory adipokines in the pathogenesis of idiopathic intracranial hypertension. Cephalalgia 2016;37(6):525-531 Doi:10.1177/0333102416650705 DOI: https://doi.org/10.1177/0333102416650705
Aslam B, Basit M, Nisar MA, Khurshid M and Rasool MH. Proteomics: Technologies
and Their Applications. J Chromatogr Science 2017;55(2):182-196 Doi:10.1093/chromsci/bmw167 DOI: https://doi.org/10.1093/chromsci/bmw167
Lecube A, Poca MA, Colomé N, Bech-Serra JJ, Hernández C, García-Ramírez M, . . . Simó R. Proteomic Analysis of Cerebrospinal Fluid from Obese Women with Idiopathic Intracranial Hypertension: A New Approach for Identifying New Candidates in the Pathogenesis of Obesity. J Neuroendocrinol 2012;24(6):944-952 Doi:10.1111/j.1365-2826.2012.02288.x DOI: https://doi.org/10.1111/j.1365-2826.2012.02288.x
Brettschneider J, Hartmann N, Lehmensiek V, Mogel H, Ludolph AC and Tumani H. Cerebrospinal fluid markers of idiopathic intracranial hypertension: Is the renin- angiotensinogen system involved? Cephalalgia 2010;31(1):116-121 Doi:10.1177/0333102410375726 DOI: https://doi.org/10.1177/0333102410375726
Jessen NA, Munk ASF, Lundgaard I and Nedergaard M. The Glymphatic System: A Beginner’s Guide. Neurochemical Res 2015;40(12):2583-2599 Doi:10.1007/s11064-015-1581-6 DOI: https://doi.org/10.1007/s11064-015-1581-6
Mestre H, Mori Y and Nedergaard M. The Brain’s Glymphatic System: Current Controversies. Trend Neurosci 2020;43(7):458-466 Doi:10.1016/j.tins.2020.04.003 DOI: https://doi.org/10.1016/j.tins.2020.04.003
Lenck S, Radovanovic I, Nicholson P, Hodaie M, Krings T and Mendes-Pereira V. Idiopathic intracranial hypertension. Neurology 2018;91(11):515-522 Doi:10.1212/wnl.0000000000006166 DOI: https://doi.org/10.1212/WNL.0000000000006166
Tuță S. Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment. Life 2022;12(6):Doi:10.3390/life12060854 DOI: https://doi.org/10.3390/life12060854
Bezerra MLS, Ferreira ACA and de Oliveira-Souza R. Pseudotumor Cerebri and Glymphatic Dysfunction. Front Neurol 2018;8 Doi:10.3389/fneur.2017.00734 DOI: https://doi.org/10.3389/fneur.2017.00734
Mondejar V and Patsalides A. The Role of Arachnoid Granulations and the Glymphatic System in the Pathophysiology of Idiopathic Intracranial Hypertension. Curr Neurol Neurosci Rep 2020;20(7):Doi:10.1007/s11910-020-01044-4 DOI: https://doi.org/10.1007/s11910-020-01044-4
Nicholson P, Kedra A, Shotar E, Bonnin S, Boch A-L, Shor N, . . . Lenck S. Idiopathic Intracranial Hypertension: Glymphedema of the Brain. J Neuro-Ophthalmol 2021;41(1):93-97 Doi:10.1097/wno.0000000000001000 DOI: https://doi.org/10.1097/WNO.0000000000001000
Jones O, Cutsforth-Gregory J, Chen J, Bhatti MT, Huston J and Brinjikji W. Idiopathic Intracranial Hypertension is Associated with a Higher Burden of Visible Cerebral Perivascular Spaces: The Glymphatic Connection. Am J Neuroradiol 2021;42(12):2160-2164 Doi:10.3174/ajnr.A7326 DOI: https://doi.org/10.3174/ajnr.A7326
Bošnjak R and Kordaš M. Circulatory effects of internal jugular vein compression: A computer simulation study. Med Biol Eng Comp 2002;40(4):423-431 Doi:10.1007/bf02345075 DOI: https://doi.org/10.1007/BF02345075
Eide PK, Hasan‐Olive MM, Hansson HA and Enger R. Increased occurrence of pathological mitochondria in astrocytic perivascular endfoot processes and neurons of idiopathic intracranial hypertension. J Neurosci Res 2020;99(2):467-480 Doi:10.1002/jnr.24743 DOI: https://doi.org/10.1002/jnr.24743
Taoka T and Naganawa S. Neurofluid Dynamics and the Glymphatic System: A Neuroimaging Perspective. Korean J Radiol 2020;21(11):Doi:10.3348/kjr.2020.0042 DOI: https://doi.org/10.3348/kjr.2020.0042
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2022 Renan Domingues, Márcio Vega, Fernando Brunale, Carlos Giafferi, Carlos Senne
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
