What is it about?
This work attempts to bridge otology, neurology, vestibular medicine, and intracranial pressure physiology by describing a subgroup of patients who are often labeled as migraine or functional dizziness, but who may actually improve with treatment directed at abnormal CSF and venous pressure dynamics.Many patients seen in otology and dizziness clinics complain of chronic head pressure, dizziness, pulsatile tinnitus, ear fullness, and migraine-like symptoms, yet they do not meet the classic criteria for idiopathic intracranial hypertension (IIH) because papilledema is absent.
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Why is it important?
In this review, we propose the concept of mildly elevated intracranial pressure (MeICP) as a clinically important but underrecognized disorder frequently encountered in otology and neurotology practice. We discuss how subtle elevations in cerebrospinal fluid pressure may affect inner ear mechanics and vestibular function, particularly in patients with additional otologic vulnerabilities such as third-window disorders, chronic ear disease, or abnormal venous sinus anatomy. The article highlights characteristic clinical patterns, imaging findings (including empty sella and transverse sinus abnormalities), lumbar puncture pressure measurements, and response to pressure-lowering therapy such as acetazolamide.
Perspectives
Our goal was to encourage clinicians evaluating dizziness, pulsatile tinnitus, vestibular migraine-like symptoms, or unexplained head pressure to consider intracranial pressure physiology as part of the differential diagnosis — even in the absence of papilledema.
Bulent Mamikoglu
New York Medical School
Read the Original
This page is a summary of: The clinical findings to notice mild elevation of intracranial pressure in an otology clinic, American Journal of Otolaryngology, November 2023, Elsevier,
DOI: 10.1016/j.amjoto.2023.104004.
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