Clinical analysis of idiopathic intracranial hypertension

doi:10.3969/j.issn.1672-6731.2020.07.013

Abstract

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

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

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.

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.

/ / Recommend / Download Citations

URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2020.07.013

https://journal11.magtechjournal.com/cjcnn/EN/Y2020/V20/I7/632

References

[1] Kilgore KP, Lee MS, Leavitt JA, Mokri B, Hodge DO, Frank RD, Chen JJ. Re-evaluating the incidence of idiopathic intracranial hypertension in an era of increasing obesity[J].Ophthalmology, 2017, 124:697-700.
[2] Ball AK, Clarke CE. Idiopathic intracranial hypertension[J].Lancet Neurol, 2006, 5:433-442.
[3] Binder Dk, Horton JC, Lawton MT, McDermott MW. Idiopathic intracranial hypertension[J]. Neurosurgery, 2004, 54:538-551.
[4] Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri analyses[J]. Neurology, 2013, 81:1159-1165.
[5] Coorperative Meta-analysis Group of China Obesity Task Force. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population[J]. Zhonghua Liu Xing Bing Xue Za Zhi, 2002, 23:5-10.[中国肥胖问题工作组数据汇总分析协作组. 我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究[J]. 中华流行病学杂志, 2002, 23:5-10.]
[6] Foley J. Benign forms of intracranial hypertension:toxic and otitic hydrocephalus[J]. Brain, 1955, 78:1-41.
[7] Biousse V, Bruce BB, Newman NJ. Update on the pathophysiology and management of idiopathic intracranial hypertension[J]. J Neurol Neurosurg Psychiatry, 2012, 83:488-494.
[8] Ko MW, Chang SC, Ridha MA, Ney JJ, Ali TF, Friedman DI, Mejico LJ, Volpe NJ, Galetta SL, Balcer LJ, Liu GT. Weight gain and recurrence in idiopathic intracranial hypertension:a case control study[J]. Neurology, 2011, 76:1564-1567.
[9] Baykan B, Ekizoglu E, Uzun GA. An update on the pathophysiology of idiopathic intracranial hypertension alias pseudomotor cerebri[J]. Agri, 2015, 27:63-72.
[10] Sinclair AJ, Ball AK, Burdon MA, Clarke CE, Stewart PM, Curnow SJ, Rauz S. Exploring the pathogenesis of IIH:an inflflammatory perspective[J]. J Neuroimmunol, 2008, 201/202:212-220.
[11] Edwards LJ, Sharrack B, Ismail A, Tench CR, Gran B, Dhungana S, Brettschneider J, Tumani H, Constantinescu CS.Increased levels of interleukins 2 and 17 in the cerebrospinal fluid of patients with idiopathic intracranial hypertension[J].Am J Clin Exp Immunol, 2013, 2:234-244.
[12] Glueck CJ, Aregawi D, Goldenberg N, Golnik KC, Sieve L, Wang P. Idiopathic intracranial hypertension, polycystic-ovary syndrome, and thrombophilia[J]. J Lab Clin Med, 2005, 145:72-82.
[13] Alvarez-Blasco F, Botella-Carretero JI, Millán JL, Escobar -Morreale HF. Prevalence and characteristics of the polycystic ovary syndrome in overweight and obese women[J]. Arch Intern Med, 2006, 166:2081-2086.
[14] Li W, Yuan F, Zhang JH. Clinical analysis of 26 patients with idiopathic intracranial hypertension[J]. Linyi Yi Xue Zhuan Ke Xue Xiao Xiao Bao, 2003, 25:199-200.[李伟, 袁峰, 张金花. 特发性颅内压增高症26例临床分析[J]. 临沂医学专科学校学报, 2003, 25:199-200.]
[15] Peng B, Li SW. Clinical analysis of 34 patients with idiopathic intracranial hypertension[J]. Zhongguo Shen Jing Jing Shen Ji Bing Za Zhi, 2002, 28:289-290.[彭斌, 李舜伟. 特发性颅内压增高症34例分析[J]. 中国神经精神疾病杂志, 2002, 28:289-290.]
[16] Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension:mechanisms, management, and future directions[J]. Lancet Neurol, 2016, 15:78-91.
[17] Mollan SP, Davies B, Silver NC, Shaw S, Mallucci CL, Wakerley BR, Krishnan A, Chavda SV, Ramalingam S, Edwards J, Hemmings K, Williamson M, Burdon MA, Hassan-Smith G, Digre K, Liu GT, Jensen RH, Sinclair AJ. Idiopathic intracranial hypertension:consensus guidelines on management[J]. J Neurol Neurosurg Psychiatry, 2018, 89:1088-1100.
[18] Brodsky MC, Vaphiades M. Magnetic resonance imaging in pseudotumor cerebri[J]. Ophthalmology, 1998, 105:1686-1693.
[19] Yuh WT, Zhu M, Taoka T, Quets JP, Maley JE, Muhonen MG, Schuster ME, Kardon RH. MR imaging of pituitary morphology in idiopathic intracranial hypertension[J]. J Magn Reson Imaging, 2000, 12:808-813.
[20] Connor SE, Siddiqui MA, Stewart VR, O'Flynn EA. The relationship of transverse sinus stenosis to bony groove dimensions provides an insight into the aetiology of idiopathic intracranial hypertension[J]. Neuroradiology, 2008, 50:999-1004.
[21] Ma ZH, Jiang HQ, Wang JW. Misdiagnosis of 58 cases with idiopathc intracranial hypertension as ophthalmic disease[J].Yan Ke, 2019, 28:140-144.[马中华, 江汉秋, 王佳伟. 58例特发性颅内压增高症早期误诊为眼科疾病之探讨[J]. 眼科, 2019, 28:140-144.]

Please choose a citation manager

Content to export