Idiopathic intracranial hypertension (IIH) is characterised by elevated intracranial pressure (ICP), which leads to optic nerve head swelling and a risk of visual loss. The impact of straining and exercise on ICP regulation is poorly understood yet clinically relevant to IIH patient care. Valsalva manoeuvres (VMs) are a function of multiple activities of daily living but, importantly, are also a key aspect to the second stage of labour. The authors of this paper aimed to investigate the impact of VMs and exercise on ICP and cerebrovascular haemodynamics in IIH. People with IIH were prospectively enrolled and had an intraparenchymal telemetric ICP sensor inserted. Three participants (age [mean ± standard deviation]: 40.3 ±13.9 years) underwent continuous real-time ICP monitoring coupled with cerebrovascular haemodynamic assessments during VMs and moderate exercise. Participants had IIH with supine ICP measuring 15.3 ±8.7mmHg (20.8 ±11.8cm cerebrospinal fluid (CSF)) and sitting ICP measuring −4.2 ±7.9mmHg (−5.7 ±10.7cmCSF). The pattern of ICP changes during the VM phases was associated to that of changes in blood pressure, the middle cerebral artery blood velocity and prefrontal cortex haemodynamics. Exercise led to minimal effects on ICP. The authors concluded from their small sample size that VM-induced changes in ICP were coupled to cerebrovascular haemodynamics and showed no sustained impact on ICP. Exercise did not lead to prolonged elevation of ICP. Those with IIH experiencing VMs (for example, during exercise and labour) may be reassured at the brief nature of the changes. Future research is required in a larger IIH cohort if these findings are to have any statistical and clinical significance.
Is intracranial pressure affected by the valsalva manoeuvres and exercise?
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