Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri.
OBJECTIVE
To determine whether intra-abdominal pressure (as estimated from urinary bladder pressure) is elevated in patients with central obesity (as measured by sagittal abdominal diameter) and pseudotumor cerebri and whether this increased intra-abdominal pressure is associated with increased pleural pressure and cardiac filling pressure, implying a resistance to venous return from the brain.


METHODS
Nonrandomized, prospective.


METHODS
University hospital, operating room.


METHODS
Intracranial pressure, urinary bladder pressure, sagittal abdominal diameter, transesophageal pleural pressure, central venous pressure, pulmonary artery pressure, and pulmonary artery occlusion pressure.


METHODS
Six women with pseudotumor cerebri (one with CSF leak, one with lumboperitoneal shunt).


RESULTS
Urinary bladder pressure (22 +/- 3 cm H2O) and sagittal abdominal diameter (29 +/- 3 cm) were significantly elevated in these patients with elevated intracranial pressure (293 +/- 80 mm H2O) compared with a previously reported group of nonobese control patients. The transesophageal pleural pressure (15 +/- 10 mm Hg), central venous pressure (20 +/- 6 mm Hg), mean pulmonary artery pressure (31 +/- 6 mm Hg), and pulmonary artery occlusion pressure (21 +/- 7 mm Hg) were all markedly elevated compared with published normal values and with previous data from obese patients without pseudotumor cerebri.


CONCLUSIONS
These data support the hypothesis that central obesity raises intra-abdominal pressure, which increases pleural pressure and cardiac filling pressure, which impede venous return from the brain, leading to increased intracranial venous pressure and increased intracranial pressure associated with pseudotumor cerebri.
Sugerman
H J
HJ
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
DeMaria
E J
EJ
Felton
W L
WL
Nakatsuka
M
M
Sismanis
A
A
D000005:Abdomen / Q000503:physiopathology*; D000328:Adult; D003326:Coronary Circulation; D005260:Female; D015390:Gastric Bypass; D006261:Headache / Q000209:etiology; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D009765:Obesity / Q000150:complications* / Q000601:surgery; D011312:Pressure; D011446:Prospective Studies; D011559:Pseudotumor Cerebri / Q000209:etiology* / Q000503:physiopathology*; D014012:Tinnitus / Q000209:etiology