继发性颅高压导致视乳头水肿的临床特征及常见病因  

Secondary pseudotumor cerebri syndrome:clinical features and pathogenic analysis

作　　者：陈倩 赵桂宪[3] 陈伟民 冯超逸 孙兴怀 沙炎 李振新 王敏 田国红 CHEN Qian;ZHAO Guixian;CHEN Weimin;FENG Chaoyi;SUN Xinghuai;SHA Yan;LI Zhenxin;WANG Min;TIAN Guohong(Department of Ophthalmology,Eye Ear Nose and Throat Hospital of Fudan University,Shanghai 200031,China;NHC Key Laboratory of Myopia(Fudan University),Key Laboratory of Visual Impairment and Restoration,Shanghai 200031,China;Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200041,China;Department of Neurology,Deji Hospital,Shanghai 200331,China;Department of Radiology,Eye Ear Nose and Throat Hospital of Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031 [2]中国医学科学院近视眼重点实验室(复旦大学),上海200031 [3]复旦大学附属华山医院神经科,上海200041 [4]上海德济医院神经科,上海200331 [5]复旦大学附属眼耳鼻喉科医院放射科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2020年第4期290-294,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的总结首诊眼科的继发性颅高压患者的临床特征及病因。方法回顾分析2015年10月~2017年12月首诊眼科的视乳头水肿患者中颅高压病例,对其人口学特征、眼部表现及病因进行分析。结果54例确诊继发性颅高压患者(108眼),其中女性23例(42.6%),平均年龄(36.43±16.70)岁(5~67岁)。平均病程(8.24±9.76)个月。视力分级呈双峰型:矫正视力0.8以上及低于0.1至数指之间比率分别为26.85%和28.70%。视乳头水肿Frisén分级最常见为4~5级与视神经萎缩,分别占42.59%及52.77%;视野损害最常见类型为生理盲点扩大(28.70%)及弥漫性缩小(60.19%)。病因分析:脑肿瘤22例、脑积水16例、脑静脉窦病变15例及放射性脑病导致颅高压1例。结论以视乳头水肿首诊眼科的颅高压容易误诊及漏诊。首诊时晚期视神经萎缩患者居多。眼部高频B超及光学相干层析成像(OCT)可用以早期预测颅内压及视力预后。Objective To evaluate the clinical characters and pathogenic of patients diagnosed as secondary intracranial hypertension.Methods Cases review study.Secondary intracranial hypertension patients presenting with papilledema diagnosed in neuro-ophthalmology division between October 2015 and December 2017 were collected.The demographic data together with the ophthalmologic examinations were evaluated.Results All together 54 patients with 108 eyes were included with 23 cases of female(42.6%)and mean age of 36.43±16.70 years(5 to 67 years).The mean courses between presenting and final diagnosis were 8.24±9.76 months.Visual acuity(VA)measured at baseline showed bimodal pattern:the percentage of best-corrected VA better than 0.8 and between 0.1 to counting finger were 26.85%and 28.70%respectively.Papilledema degree scale according to Frisén scale,the most common were Grade 4-5 and optic atrophy,the percentage were 42.59%and 52.77%respectively.The common visual field defect type were enlarged blind spot and diffusely constriction,with a percentage of 28.70%and 60.19%respectively.The pathogens of secondary intracranial hypertension included:brain tumer(22 cases);hydrocephalus(16 cases);venous sinus disease(15 cases)and one case of radiation encephalopathy.Conclusions Secondary intracranial hypertension causing papilledema often underdiagnose or misdiagnosed by ophthalmologist and neurologist in clinical practice.Most patients presented with late stage optic atrophy rather than papilledema.The noninvasive high resolution ultrasonography and OCT techniques are very helpful in diagnosing and predicating the prognosis.

关 键 词：大脑假瘤综合征 特发性颅内压增高 视乳头水肿 高频B超 光学相干层析成像 

分 类 号：R774.62[医药卫生—眼科]