特发性颅内压增高的诊疗策略  

Diagnosis and treatment strategy of idiopathic intracranial hypertension

作　　者：陈倩 田国红 CHEN Qian;TIAN Guohong(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,NHC Key laboratory of Myopia and Related Eye Diseases,Shanghai Key Laboratory of Visual Impairment and Restoration,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科、国家卫生健康委员会近视眼及相关眼病重点实验室、上海市视觉损害与重建重点实验室,上海200031

出　　处：《中国眼耳鼻喉科杂志》2024年第5期378-385,共8页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：国家重点研发计划“干细胞及转化研究”重点专项(2020YFA0112700)。

摘　　要：特发性颅内压增高(IIH)指仅有因颅内压增高导致的一系列症状和体征,但颅内并无器质性病变的一组综合征。主要发病人群为育龄期女性伴肥胖者。IIH具体发病机制不明,可能与脑脊液分泌-吸收失衡相关。患者表现为头痛、一过性视物模糊、搏动性耳鸣及复视。双侧视乳头水肿为IIH患者首诊眼科的主要病因,延误诊断及治疗可导致晚期视神经萎缩,甚至失明。治疗手段包括疾病修饰治疗(如减轻体重)、药物治疗(如碳酸酐酶抑制剂)和手术治疗(如视神经鞘开窗术、静脉窦支架植入术及脑脊液分流术等)。本文概述了IIH的流行病学特征、临床表现及诊断要点,并结合国人IIH患者特征总结了治疗流程;希望能引起神经眼科及相关领域医师对IIH的重视,减少该类人群因延误治疗导致晚期严重视功能障碍。Idiopathic intracranial hypertension is defined as signs and symptoms caused only by raised intracranial pressure without established brain pathogenesis.IIH is typically seen in women who are obese and of childbearing age.The pathogenic mechanisms of IIH are still unclear,but the unbalance between production and absorption of cerebral spinal fluid was speculated.The clinical symptoms include headache,transient visual obscuration,pulsation tinnitus,and diplopia.Most patients present to ophthalmologist as bilateral papilledema,whereas underdiagnosed or inappropriate management can lead to severe optic atrophy and permanent visual loss.Management includes disease modification as body weight loss,medication treatment as inhibitor of carbonic anhydrase enzyme,surgical interventions as optic nerve sheath fenestration,venous sinus stenting and CSF diversion.In this review,we focus on the epidemiology feature,clinical manifestations,diagnosed criteria,as well as the characteristic of IIH patients in China.As IIH is not widely understood by ophthalmologist and neurologist in China,we addressed that the prompt diagnosis and treatment can avoid the severe visual loss in patient of late stage IIH.

关 键 词：特发性颅内压增高 大脑假瘤综合征 视乳头水肿 视神经鞘开窗 静脉窦支架 脑脊液分流 

分 类 号：R774[医药卫生—眼科]