光学相干断层扫描监测腰椎穿刺后反弹性颅内高压伴乳头水肿增加

IF 1.6 Q3 CLINICAL NEUROLOGY
NeuroSci Pub Date : 2021-10-09 DOI:10.3390/neurosci2040024
Y. Huang-Link, P. Mirabelli, Ge Yang, A. Eleftheriou, H. Link
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引用次数: 0

摘要

目的:我们报道在光学相干断层扫描(OCT)监测下,腰椎穿刺(LP)去除脑脊液(CSF)诱导反弹性颅内高压并增加乳头水肿。背景:严重的乳头水肿如果不治疗会导致视野丧失和中央视力损害。眼底镜检查是诊断乳头状水肿的关键,但对监测治疗效果不够敏感。方法:应用OCT对24岁头痛、视力障碍、双侧严重乳头水肿、脑脊液开口压力升高的女性进行随访。患者首先接受系列LP治疗,导致症状恶化,脑脊液压力升高,视网膜神经纤维层(RNFL)厚度增加。随后,她成功地接受了乙酰唑胺和速尿治疗。结果:脑脊液切除后,OCT显示脑脊液厚度直接减少,脑脊液压力降低。LP后第二天,RNFL厚度增加,头痛加重,视觉功能障碍,脑脊液压力升高。服药后不到24小时,症状逆转,RNFL厚度减少。患者开始用药2周后症状消失。治疗6周后眼底镜检查乳头水肿消失,随访3个月时RNFL厚度恢复正常。结论:本病例证明OCT是一种客观、灵敏的监测乳头状水肿及其对治疗反应的工具,对正确的临床决策具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optical Coherence Tomography to Monitor Rebound Intracranial Hypertension with Increased Papilledema after Lumbar Puncture
Objective: We report that lumbar puncture (LP) with removal of cerebrospinal fluid (CSF) induced rebound intracranial hypertension with increased papilledema as monitored by optical coherence tomography (OCT). Background: Severe papilledema causes visual field loss and central vision damage if untreated. Fundoscopy is a key to diagnose papilledema, but is not sensitive enough to monitor therapeutic effects. Methods: OCT was applied to follow a 24-year-old woman with headache, visual dysfunction, severe bilateral papilledema, and elevated CSF opening pressure. She was first treated with serial LP, which led to symptom deterioration, increased CSF pressure, and increased the retinal nerve fiber layer (RNFL) thickness. She was then successfully treated with acetazolamide and furosemide. Results: OCT showed reduction of RNFL thickness directly after LP with CSF removal, accompanied with reduced CSF pressure. Increased RNFL thickness accompanied with worsened headache, visual dysfunction, and increased CSF pressure was observed on the next day after LP. Less than 24 h after start of medication, the symptoms had reversed and RNFL thickness was reduced. The patient was symptom-free 2 weeks after starting on medical treatment. Papilledema had vanished on fundoscopy 6 weeks after the therapy, and RNFL thickness was normalized at 3 months of follow-up. Conclusion: This case provides evidence that OCT is an objective and sensitive tool to monitor papilledema and its response to therapy, and thereby important to help in correct clinical decision-making.
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