特发性颅内压增高的临床与影像学特征  

Clinical and imaging features of idiopathic intracranial hypertension

作　　者：王智沁 杨锦霞 廖鑫鑫[1,2] 谢妮娜 罗梦川 田芸[1,2] 姚凌雁 胡雅岑[1,2] 易芳 周亚芳[1,2] 周琳 许宏伟 孙启英[1,2] WANG Zhiqin;YANG Jinxia;LIAO Xinxin;XIE Nina;LUO Mengchuan;TIAN Yun;YAO Lingyan;HU Yacen;YI Fang;ZHOU Yafang;ZHOU Lin;XU Hongwei;SUN Qiying(Department of Geriatric Neurology,Xiangya Hospital,Central South University,Changsha 410008;National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院老年神经内科,长沙410008 [2]国家老年疾病临床医学研究中心(湘雅医院),长沙410008

出　　处：《中南大学学报（医学版）》2021年第11期1241-1250,共10页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2020JJ5927)。

摘　　要：目的:特发性颅内压增高(idiopathic intracranial hypertension,IIH)是排除颅内占位性病变、脑积水、脑血管病、缺血缺氧等继发性病因后的一种颅内压增高综合征。如不能得到及时、有效的诊治,IIH可能导致严重的永久性视力障碍,以及难以治疗的致残性头痛。本研究旨在探讨IIH的临床与影像学特征,以期提高临床医师对该病的认识,减少临床漏诊,改善患者的预后。方法:回顾性分析中南大学湘雅医院于2015年1月至2020年9月收治的15例IIH患者。IIH的诊断依据修订版Dandy标准。整理年龄、性别、身高、体重、病史资料、体格检查、辅助检查、治疗方案、病情转归等临床资料,进行相应的统计分析。结果:共纳入10例女性,5例男性。女性患者22~42(中位年龄39.5)岁,男性患者27~52(中位年龄44.0)岁。患者BMI 24.14~34.17(28.71±2.97)kg/m2。15例患者BMI均超过正常范围(≥24 kg/m2),其中肥胖10例(66.7%),超重5例(33.3%)。11例(73.3%)患者有头痛症状,8例(53.3%)出现不同程度的持续性视力下降或丧失。其他症状包括发作性黑矇(2例)、耳鸣(3例)、水平复视(2例)、单侧周围性面瘫(2例)、单侧眼睑下垂(1例)等。3例患者合并缺铁性贫血,其中1例经纠正贫血后IIH症状消失。其他合并症包括高血压(8例)、多囊卵巢综合征(1例)等。14例患者进行了血脂检测,均有1项或多项血脂异常。神经系统体征包括颈强直(2例)、眼球外展受限(6例)、周围性面瘫(2例)、眼睑下垂(1例)等。所有患者脑脊液常规检查、生化检查、革兰氏染色、抗酸染色、墨汁染色等均正常。部分患者具备提示IIH的典型影像学征象,包括5例(33.3%)空蝶鞍,4例(26.7%)部分空蝶鞍,3例(20.0%)视神经周围蛛网膜下隙增宽,5例(33.3%)眼球后部变平,7例(46.7%)视乳头突出,2例(13.3%)增强扫描后视乳头强化等。眼科检查提示所有患者均有双侧视乳头水肿。所有患者确诊后均�Objective:Idiopathic intracranial hypertension(IIH)is a syndrome that excludes secondary causes such as intracranial space-occupying lesion,hydrocephalus,cerebrovascular disease,and hypoxic ischemic encephalopathy.If not be treated promptly and effectively,IIH can cause severe,permanent vision disability and intractable,disabling headache.This study aims to explore the clinical and image features for IIH,to help clinicians to understand this disease,increase the diagnose rate,and improve the outcomes of patients.Methods:We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital,Central South University,during January 2015 to September 2020.The diagnosis of IIH was based on the updated modified Dandy criteria.We analyzed clinical data of patients and did statistical analysis,including age,gender,height,weight,medical history,physical examination,auxiliary examination,treatment and outcome.Results:There were 10 females and 5 males.Female patients were 22 to 42 years old with median age of 39.5.Male patients were 27 to 52 years old with the median age of 44.0.The BMI was 24.14−34.17(28.71±2.97)kg/m2.All patients had a BMI above the normal range(≥24 kg/m2),among them 10 cases(66.7%)were obese,and 5 cases(33.3%)were overweight.Eleven cases(73.3%)had headache,and 8 cases(53.3%)had persistent visual loss of different severity.Other symptoms included paroxysmal amaurosis(2 cases),tinnitus(3 cases),horizontal diplopia(2 cases),unilateral peripheral facial paralysis(2 cases),and unilateral blepharoptosis(1 case).Iron-deficiency anemia was found in 3 patients.One of them fully recovered from IIH after the correction of anemia.Other comorbidities included hypertension(8 cases)and polycystic ovarian syndrome(1 case).Fourteen patients assessed blood lipid profile,and all of them had abnormity.Nervous system signs included cervical rigidity(2 cases),limited abduction of eyeball(6 cases),peripheral facial paralysis(2 cases),and blepharoptosis(1 case).Cerebral spinal fluids of all patients had normal

关 键 词：特发性颅内压增高 肥胖 缺铁性贫血 神经影像学 眼底检查 

分 类 号：R651.1[医药卫生—外科学]