title: Idiopathic intracranial hypertension eliminated by counterclockwise maxillomandibular advancement: a case report.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) is a secondary cause of intracranial hypertension (IH). Decreased jugular venous drainage has been seen in patients with idiopathic IH.
  
  
  METHODS
  A complex case of a 48-year-old female whose idiopathic IH was put into remission after counterclockwise maxillomandibular advancement (CC-MMA), despite persistence of her OSA.
  
  
  CONCLUSIONS
  This case highlights the relationship between OSA and IH and points to the significant morbidity that can result from mild OSA and from what are considered borderline intracranial pressures. This indicates the need for a high index of suspicion for actual underlying pathology that can be surgically corrected when patients manifest symptoms of a somatic syndrome. This is the first report in the medical literature of clinical elimination of IH by CC-MMA. The authors propose that this positive outcome was effected via mandibular advancement producing a decrease in jugular venous resistance, allowing improved absorption of cerebrospinal fluid.
authors.affiliation: a Independent, Department of Pediatrics , Las Vegas , NV , USA.
authors.forename: Deborah
authors.identifier: http://orcid.org/0000-0002-4275-4447
authors.initials: D
authors.lastname: Wardly
authors.affiliation: b Departments of Oral and Maxillofacial Surgery and Orthodontics , Texas A & M University Health Science Center, Baylor College of Dentistry , Dallas , TX , USA.|c Departments of Oral and Maxillofacial Surgery and Orthodontics , Baylor University Medical Center , Dallas , TX , USA.|d Private Practice , Dallas , TX , USA.
authors.forename: Larry M
authors.identifier: http://orcid.org/0000-0001-5699-4559
authors.initials: LM
authors.lastname: Wolford
authors.affiliation: e Department of Neurology , Southern Hills Hospital , Las Vegas , NV , USA.|f Department of Neurology , Touro University , Las Vegas , NV , USA.
authors.forename: Venkat
authors.initials: V
authors.lastname: Veerappan
mesh_terms: D000328:Adult; D002508:Cephalometry; D005260:Female; D006801:Humans; D019186:Mandibular Advancement / Q000379:methods*; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D011559:Pseudotumor Cerebri / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome
keywords: Environmental intolerance; IIHWOP; Idiopathic intracranial hypertension; Maxillomandibular advancement; Multiple chemical sensitivity; Obstructive sleep apnea; Pseudotumor cerebri; Upper airway resistance syndrome