特发性颅内压增高临床特点分析

doi:10.3969/j.issn.1672-6731.2020.07.013

中国现代神经疾病杂志 ›› 2020, Vol. 20 ›› Issue (7): 632-637. doi: 10.3969/j.issn.1672-6731.2020.07.013

2 特发性颅内压增高临床特点分析

马中华, 江汉秋, 王佳伟

100730 首都医科大学附属北京同仁医院神经内科

收稿日期:2020-07-13 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 王佳伟,Email:wangjwcq@163.com
基金资助:
2017年首都医科大学附属北京同仁医院重点医学发展计划专项项目（项目编号：trzdyxzy201704）

Clinical analysis of idiopathic intracranial hypertension

MA Zhong-hua, JIANG Han-qiu, WANG Jia-wei

Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

Received:2020-07-13 Online:2020-07-25 Published:2020-07-24
Supported by:
This study was supported by Development Program of Key Medical Discipline (Neuroimmunology), Beijing Tongren Hospital Affiliated to Capital Medical University in 2017 (No. trzdyxzy201704).

摘要/Abstract

摘要：

目的总结特发性颅内压增高临床特点，提高临床确诊率。方法回顾分析2014年1月至2018年5月诊治的153例特发性颅内压增高患者的症状与体征、影像学特点、治疗及预后，比较不同病程（亚急性组或慢性组）患者临床特点。结果特发性颅内压增高患者男女发病比例为1 ∶ 3.14，肥胖或超重者占78.43%（120/153）；临床主要表现为视力下降［77.78%（119/153）］、发作性黑蒙［50.33%（77/153）］、头痛［45.10%（69/153）］；影像学异常者约占64.05%（98/153），表现为空蝶鞍、视神经周围蛛网膜下腔增宽、优势侧或双侧横窦狭窄；颅内压≥ 30 cm H₂O者占73.20%（112/153）。内科治疗138例、外科手术治疗15例，临床好转率约为86.93%（133/153）；其中亚急性组发作性黑蒙发生率低于慢性组［42.55%（40/94）对62.71%（37/59）；χ²=5.892，P=0.015］，临床好转率高于慢性组［91.49%（86/94）对79.66%（47/59）；χ²=4.463，P=0.035］，而视力下降、头痛、搏动性耳鸣和水平复视，以及影像学异常、颅内压组间差异无统计学意义（均P > 0.05）。结论特发性颅内压增高是引起头痛、视觉障碍的重要病因之一，育龄期女性和肥胖人群易感；结合临床表现和影像学特点，早期诊断、及时治疗可以改善患者预后与转归。

关键词: 颅内高压, 视觉障碍, 头痛

Abstract:

Objective To analyze the clinical characteristics of idiopathic intracranial hypertension (IIH) to improve the diagnosis rate. Methods Epidemiological characteristics, clinical manifestations, imaging examination results and treatment outcomes of 153 patients with IIH hospitalized in Beijing Tongren Hospital from January 2014 to May 2018 were analyzed retrospectively. The clinical differences between subacute group (14 d to 3 months) and chronic group (> 3 months) were compared. Results One hundred and fifty-three cases (subacute group 94 cases and chronic group 59 cases) were observed. There were 37 males and 116 females (1:3.14), 53 obses cases (34.64%), 67 overweight case (43.80%). The main clinical symptoms were visiual loss (77.78%, 119/153), transient visual obscuration (50.33%, 77/153), headache (45.10%, 69/153). Abnormal radiologic signs, including empty sella, distension of the perioptic subarachnoid space (DPSS) and transverse venous sinus stenosis (TVSS) were found in 98 cases (64.05%). Intracranial pressures (ICP) of 112 cases (73.20%) were above 30 cm H₂O. After treatments (138 cases underwent routine treatments and 15 cases underwent surgery treatments), 86.93% (133/153) patients achieved clinical improvement. The improvement rate of subacute group was significantly higher than that of chronic group[91.49% (86/94) vs. 79.66% (47/59); χ²=4.463, P=0.035]. The incidence of transient visual obscuration in subactue group was significantly lower than that in chronic group[42.55% (40/94) vs. 62.71% (37/59); χ²=5.892, P=0.015]. No significant differtences of vision loss, headache, tinnitus, diplopia, abnormal image signs or ICP were deteced in patients between subacute group and chronic group. Conclusions IIH is one of the most important causes of vision loss and headache. Women in childbearing period and obese people are susceptible to IIH. Clinicians need to raise the awareness of IIH and give timely treatments.

Key words: Intracranial hypertension, Vision disorders, Headache

马中华, 江汉秋, 王佳伟. 特发性颅内压增高临床特点分析[J]. 中国现代神经疾病杂志, 2020, 20(7): 632-637.

MA Zhong-hua, JIANG Han-qiu, WANG Jia-wei. Clinical analysis of idiopathic intracranial hypertension[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(7): 632-637.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I7/632

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