Idiopathic intracranial hypertension in Asians: a retrospective dual-center study.

IF 7.3 1区医学 Q1 CLINICAL NEUROLOGY

Journal of Headache and Pain Pub Date : 2024-09-04 DOI:10.1186/s10194-024-01852-w

Hsiang-Ting Hsu, Hui-Chen Cheng, Tsung-Wei Hou, Yi-Shiang Tzeng, Jong-Ling Fuh, Shih-Pin Chen, Wei-Ta Chen, Wei-Ju Lee, Yen-Wei Pai, Yi-Chung Lee, Jiing-Feng Lirng, Shuu-Jiun Wang, Yen-Feng Wang

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引用次数: 0

Abstract

Background: There have been limited data on idiopathic intracranial hypertension (IIH) in Asians and there remain uncertainties whether a cerebrospinal fluid (CSF) pressure of 250 mm CSF is an optimum diagnostic cutoff. The aims of the present study included (1) characterization of IIH patients in Taiwan, (2) comparisons among different diagnostic criteria for IIH, and (3) comparisons between patients with CSF pressures of > 250 and 200-250 mm CSF.

Methods: This retrospective study involved IIH patients based on the modified Dandy criteria from two tertiary medical centers in Taiwan. Clinical manifestations were retrieved from electronic medical records, and findings on ophthalmologic examination and magnetic resonance images (MRIs) were reviewed.

Results: A total of 102 patients (71 F/31 M, mean age 33.4 ± 12.2 years, mean CSF pressure 282.5 ± 74.5 mm CSF) were identified, including 46 (45.1%) with obesity (body-mass index ≥ 27.5), and 57 (62.6%) with papilledema. Overall, 80 (78.4%), 55 (53.9%), 51 (50.0%), and 58 (56.9%) patients met the Second and Third Edition of International Classification of Headache Disorders, Friedman, and Korsbæk criteria, respectively. Patients in the 200-250 mm CSF group (n = 40) were less likely to have papilledema (48.5% vs. 70.7%, p = 0.035), transient visual obscuration (12.5% vs. 33.9%, p = 0.005), and horizontal diplopia (10.0% vs. 30.6%, p = 0.006), and had fewer signs on MRIs (2.2 ± 1.3 vs. 2.8 ± 1.0, p = 0.021) when compared with those with CSF pressures > 250 mm CSF (n = 62). However, the percentages of patients with headache (95.0% vs. 87.1%, p = 0.109) at baseline, chronic migraine at six months (31.6% vs. 25.0%, p = 0.578), and visual field defect (86.7% vs. 90.3%, p = 0.709) were similar.

Conclusions: It was found that obesity and papilledema were less common in Asian IIH patients when compared with Caucasian patients. Although patients with CSF pressures of 200-250 mm CSF had a less severe phenotype, the risks of having headache or visual loss were comparable to those in the > 250 mm CSF group. It is possible that a diagnostic cutoff of > 200 mm CSF could be more suitable for Asians, although further studies are still needed.

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亚洲人的特发性颅内高压：一项回顾性双中心研究。

背景：有关亚洲人特发性颅内高压（IIH）的数据十分有限，而且脑脊液（CSF）压力为 250 mm CSF 是否是最佳诊断临界值仍存在不确定性。本研究的目的包括：(1) 台湾 IIH 患者的特征；(2) IIH 不同诊断标准之间的比较；(3) CSF 压力大于 250 mm CSF 和 200-250 mm CSF 患者之间的比较：这项回顾性研究涉及台湾两家三级医疗中心根据修改后的 Dandy 标准诊断的 IIH 患者。从电子病历中检索临床表现，并回顾眼科检查和磁共振成像（MRI）结果：共发现 102 名患者（71 名女性/31 名男性，平均年龄（33.4 ± 12.2）岁，平均 CSF 压力（282.5 ± 74.5 mm CSF），其中 46 人（45.1%）患有肥胖症（体重指数≥ 27.5），57 人（62.6%）患有乳头水肿。总体而言，分别有 80 人（78.4%）、55 人（53.9%）、51 人（50.0%）和 58 人（56.9%）符合《国际头痛疾病分类》第二版和第三版、Friedman 和 Korsbæk 标准。200-250 mm CSF 组患者（n = 40）出现乳头水肿（48.5% vs. 70.7%，p = 0.035）、一过性视物模糊（12.5% vs. 33.9%，p = 0.005）和水平复视（10.0% vs. 30.6%，p = 0.006），与 CSF 压力 > 250 mm CSF 的患者（n = 62）相比，MRI 上的体征较少（2.2 ± 1.3 vs. 2.8 ± 1.0，p = 0.021）。然而，基线头痛（95.0% vs. 87.1%，p = 0.109）、6 个月慢性偏头痛（31.6% vs. 25.0%，p = 0.578）和视野缺损（86.7% vs. 90.3%，p = 0.709）患者的比例相似：结论：研究发现，与白种人相比，肥胖和乳头水肿在亚裔 IIH 患者中较少见。虽然 CSF 压力为 200-250 mm CSF 的患者表型较轻，但头痛或视力丧失的风险与 CSF > 250 mm 组的患者相当。尽管仍需进一步研究，但诊断分界值 > 200 mm CSF 可能更适合亚洲人。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Headache and Pain 医学-临床神经学

CiteScore

11.80

自引率

13.50%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The Journal of Headache and Pain, a peer-reviewed open-access journal published under the BMC brand, a part of Springer Nature, is dedicated to researchers engaged in all facets of headache and related pain syndromes. It encompasses epidemiology, public health, basic science, translational medicine, clinical trials, and real-world data. With a multidisciplinary approach, The Journal of Headache and Pain addresses headache medicine and related pain syndromes across all medical disciplines. It particularly encourages submissions in clinical, translational, and basic science fields, focusing on pain management, genetics, neurology, and internal medicine. The journal publishes research articles, reviews, letters to the Editor, as well as consensus articles and guidelines, aimed at promoting best practices in managing patients with headaches and related pain.