特发性颅内高压的非典型表现:病例系列与文献综述

Asian journal of neurosurgery Pub Date : 2024-05-27 eCollection Date: 2024-06-01 DOI:10.1055/s-0044-1779447
Fawaz S Almotairi, Aued I Alanazi, Sherin Hamad Alokayli, Sarah Maghrabi, Sherif M Elwatidy
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引用次数: 0

摘要

特发性颅内高压(IIH)是一种颅内压(ICP)无明显原因升高的疾病。患者通常表现为头痛、头晕、搏动性耳鸣、视觉障碍、视力模糊、复视、畏光、视野缺损以及眼底镜检查时出现乳头水肿。文献中曾讨论过 IIH、自发性脑脊液(CSF)鼻出血和蛛网膜囊肿之间的关联,但对这种关联尚无明确的解释。我们的目的是对四例确诊为 IIH 但表现不典型的患者进行系列研究,讨论每个病例的处理方法,并对这种关联做出解释,以提醒临床医生注意 IIH 的不典型表现,并促进早期诊断和通过 CSF 转移对该病症进行正确治疗。这是一项回顾性病例系列研究,研究对象是 2001 年至 2022 年期间所有被确诊为 IIH 的患者,这些患者在至少一次手术干预失败后,经脑室腹腔分流术插入后病情有所改善,其主要原因是放射学和临床发现。我们记录了有关人口统计学、临床表现、放射学检查结果、手术治疗和 IIH 诊断标准的数据。我们确定了四名确诊为 IIH 的患者,他们的非典型表现如下:颅内蛛网膜囊肿、颈椎蛛网膜囊肿、巨大 Virchow 血管周围间隙和自发性鼻出血(CSF)。所有患者在针对原发病变的手术治疗失败后,都对 CSF 转流术做出了反应。在自发性脑脊液鼻出血、脊髓和头颅蛛网膜囊肿以及无症状脑室腹腔分流术等原发性手术治疗失败后,应怀疑存在 IIH。这种情况下的治疗应针对 IIH,同时进行 CSF 分流。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Atypical Presentation of Idiopathic Intracranial Hypertension: A Case Series and Literature Review.

Idiopathic intracranial hypertension (IIH) is a condition in which intracranial pressure (ICP) increases without an apparent cause. Typically, patients present with headaches, dizziness, pulsatile tinnitus, visual disturbances, blurred vision, diplopia, photophobia, visual field defects, and papilledema on fundoscopy. The association between IIH, spontaneous cerebrospinal fluid (CSF) rhinorrhea, and arachnoid cysts has been discussed in the literature; however, there is no clear explanation for this association. We aimed to present a series of four patients with a confirmed diagnosis of IIH with atypical presentations, discuss the management of each case, and provide an explanation for this association to alert clinicians to the atypical presentation of IIH and facilitate early diagnosis and proper treatment of this condition by CSF diversion. This was a retrospective case series of all patients who were diagnosed with IIH and showed improvement after ventriculoperitoneal shunt insertion after failure of at least one operative intervention resulting from primary radiological and clinical findings in 2001 to 2022. Data on demographics, clinical presentation, radiological findings, surgical management, and diagnostic criteria for IIH were recorded. We identified four patients with a confirmed diagnosis of IIH who presented with atypical presentations as follows: intracranial arachnoid cyst, cervical spine arachnoid cyst, giant Virchow perivascular space, and spontaneous CSF (CSF) rhinorrhea. All patients responded to CSF diversion after failure of surgical treatment targeting the primary pathology. IIH should be suspected after the failure of primary surgical treatment in cases of spontaneous CSF rhinorrhea, spinal and cranial arachnoid cysts, and symptomatic ventriculoperitoneal shunt. Treatment in such situations should be directed toward IIH with CSF diversion.

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