重视特发性颅内压增高导致的视神经损害  

Optic nerve damage caused by increased idiopathic intracranial hypertension: clinical significance

作　　者：李仰龙 刘浩成[1] 邱鄂[1] 张家亮[1] 李永[1] 赵尚峰[1] 徐勇[1] 张天明[1] 傅继弟[1] 

机构地区：[1]首都医科大学附属北京同仁医院神经外科,100730

出　　处：《中华眼科医学杂志（电子版）》2015年第4期1-6,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：特发性颅内压增高(IIH)是指以头痛、视乳头水肿等颅内压增高(ICH)的相关症状和体征为主要临床表现,但影像学检查并未发现颅内占位性病变,且脑脊液(CSF)成分检测结果正常的一组临床综合征。IIH好发于育龄期的肥胖女性。临床检查可见视乳头水肿、视野缺损及视力下降等表现,视力损害多数较稳定,但亦可渐进性的加重甚至突然加重,严重者可致失明。由于缺乏临床治疗试验,该疾病暂无特定的推荐治疗方法。治疗的主要方法包括减轻体重、药物治疗以及手术治疗。手术治疗方式包括脑室腹腔分流术(LPS)、腰大池腹腔分流术(VPS)、视神经鞘开窗减压术(ONSF)及颅内静脉窦支架置入术(IVSS)等。本文中笔者对IIH的历史演变、流行病学、发病机制、临床表现以及规范的诊断与治疗方法进行述评,旨在帮助眼科医师从颅脑疾病的角度重新认识相关的眼科疾病。Idiopathic intracranial hypertension（ IIH）,also known as pseudotumor cerebri（ PTC） or benign intracranial hypertension（ BIH）,is a clinical syndrome characterized by raised intracranial pressure,headache and optic disc swelling（ papilloedema） but normal neuroimaging and cerebrospinal fluid（ CSF）examination findings. IIH Often occurs in obese women of childbearing age. Visual impairment is stable in most cases but may be worsened gradually or even abruptly in case of fulminant disease. Currently,the main treatment targets for IIH are prevention of visual loss and symptom relief through advice on weight loss,medical therapy and or surgical intervention and there are no other specific therapeutic recommendations.Among the major surgical procedures are lumboperitoneal shunting（ LPS）,ventriculoperitoneal shunting（ VPS）,optic nerve sheath fenestration（ ONSF）,and intracranial venous sinus stenting. In this article,we will review the historical perspective,epidemiology,pathogenesis and clinical features of IIH,in a hope to alert ophthalmologists to the importance of viewing and treating IIH as a cranial disease.

关 键 词：特发性颅内压增高 视乳头水肿 视力损害 外科治疗 

分 类 号：R741[医药卫生—神经病学与精神病学] R774.6[医药卫生—临床医学]