Several diseases were considered and carefully eliminated to correctly diagnose the patient in question. Initially, the possibility of migraine-type headache (migraine) secondary to the recurrence of the IIH, was considered.
The non-invasive method of ICP assessment and compliance analysis, using the brain4care (B4C) device, was used for patient follow-up. To understand the results, it is necessary to know that the monitoring of ICP happens through the evaluation of the waves originated in each cardiac cycle, in which the blood flow is directed to the brain. Therefore, 3 waves are formed: P1 (percussion wave, which reflects the arterial pressure transmitted from the choroid plexus to the cerebral ventricle), P2 (tidal wave, related to intracranial compliance), P3 (dichroitic wave, related to the aortic valve closure during diastole), and for validation of a good result, the waves should remain P1>P2>P3.
Non-invasive monitoring of ICC in the office was performed and made it possible to exclude the hypothesis of intracranial hypertension (ICH) due to an IIH, since a mean P2/P1 ratio of 1.21 was verified, that is, the P2 component was higher than P1, suggesting reduced ICC, however, without alteration in the opening pressure of the cerebrospinal fluid (CSF). In the posterior consultation, without overweight, the patient referred a new episode of migraine, reporting being in her menstrual period accompanied by menstrual pain, and the non-invasive monitoring indicated a P2/P1 ratio of 1.36. The clinical view of the patient, her history of obesity and use of oral contraceptives (1) associated with the identification of decreased brain compliance without pressure change, by means of non-invasive monitoring, were determinant in the diagnosis of migraine, a multifactorial disease that has a strong hormonal influence (2, 4, 5, 9, 11). Especially this case, the non-invasive monitoring was fundamental because, she had hydrodynamic disease, and the decision-making is really tough, when headache really appear after months of the treatment. In this case was possible to know exactly what was happen, and compare the treatments.
This study aims to show that diagnosis and treatment, as well as the evaluation of the ICP and ICC, can be made easier with the use of non-invasive monitoring in the doctor's office, avoiding hospital admissions and invasive procedures.