Reader response: Idiopathic intracranial hypertension: The veno glymphatic connections
GoloKronenberg, Psychiatrist, College of Life Sciences - University of Leicester / Leicestershire Partnership NHS Trust (Leicester, England)
HagenKunte, Neurologist and Psychiatrist, MSB-Medical School Berlin (Berlin, Germany)
Published October 07, 2018
The Medical Hypothesis paper by Lenck et al.1 provided an exciting new angle on recent findings concerning CSF circulation in the brain. The authors succinctly summarized clinical and radiologic evidence supporting their hypothesis that dysfunction of veno glymphatic connections lies at the heart of idiopathic intracranial hypertension (IIH). In particular, the authors speculated that chronic overflow of CSF in the sheaths of the olfactory bulbs may result in CSF rhinorrhea by eroding the cribriform plate.1 Olfactory dysfunction, especially a marked impairment in olfactory threshold levels, is an even more common yet under-recognized presentation of IIH.2,3 Indeed, as early as 2008, Dr. Kapoor speculated that dysfunction of the extensive lymphatic network around the olfactory nerves might be causally linked to IIH, making hyposmia a more sensitive predictor of IIH than other clinical features.4
Lenck S, Radovanovic I, Nicholson P, et al. Idiopathic intracranial hypertension: The veno glymphatic connections. Neurology 2018;91:515–522.
Kunte H, Schmidt F, Kronenberg G, et al. Olfactory dysfunction in patients with idiopathic intracranial hypertension. Neurology 2013;81:379–382.
Bershad EM, Urfy MZ, Calvillo E, et al. Marked olfactory impairment in idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry 2014;85:959–964.
Kapoor KG. Do patients with idiopathic intracranial hypertension suffer from hyposmia? Med Hypotheses 2008;71:816–817.
The Medical Hypothesis paper by Lenck et al.1 provided an exciting new angle on recent findings concerning CSF circulation in the brain. The authors succinctly summarized clinical and radiologic evidence supporting their hypothesis that dysfunction of veno glymphatic connections lies at the heart of idiopathic intracranial hypertension (IIH). In particular, the authors speculated that chronic overflow of CSF in the sheaths of the olfactory bulbs may result in CSF rhinorrhea by eroding the cribriform plate.1 Olfactory dysfunction, especially a marked impairment in olfactory threshold levels, is an even more common yet under-recognized presentation of IIH.2,3 Indeed, as early as 2008, Dr. Kapoor speculated that dysfunction of the extensive lymphatic network around the olfactory nerves might be causally linked to IIH, making hyposmia a more sensitive predictor of IIH than other clinical features.4
For disclosures, please contact the editorial office at journal@neurology.org.