首诊于眼科的特发性颅内压增高

Idiopathic intracranial hypertension patients firstly visit the ophthalmologic clinical practice

目的:分析首诊于眼科的特发性颅内压增高的临床特点。方法:回顾性分析首诊于眼科的特发性颅内压增高患者6例12眼的发病诱因、自觉症状、视力、眼底、视野、同视机、头部磁共振平扫(MRI)、头部磁共振血管成像(MRV)、腰椎穿刺脑脊液(CSF)压力和常规生物化学等检查。结果:患者6例12眼的发病诱因分别是感冒、紧张焦虑和口服多西环素,症状是阵发性眼前发黑、双眼复视、头痛眼痛,视力正常或轻度下降,眼底双侧视乳头水肿,同视机结果提示双侧或单侧外直肌麻痹,视野无缺损或生理盲点扩大,MRI和MRV未见明显异常,CSF压力升高在250～300mmH2O之间,常规生物化学检查未见明显异常。结论:对于以眼部视乳头水肿和外直肌麻痹症状首诊于眼科的患者,应进行详细的神经系统检查,以确诊或除外特发性颅内压增高的可能。

AIM： To investigate the features of idiopathic intracranial hypertension （IIH） in the patients firstly visit the ophthalmologic clinical practice. METHODS： Six patients with 12 eyes were enrolled in this study. The predisposition, symptom, visual acuity, ocularfundus, visual field, ocular aligment, cerebral magnetic resonance imaging （MRI） and magnetic resonance venography （ MRV）, cerebro- spinal fluid （ CSF ） suppressor and biochemical analysis were recorded and analyzed. RESULTS： The predispositions included catching a cold, anxiety reaction and taking doxycycline orally. The symptom included paroxysmal darkness, blurred vision, diplopia, and headache. The visual acuity remained normal or decreased mildly. The papilledema could be found in the ocular fundus examination. Normal visual field or enlargement of physiology scotoma, paralysis of lateral rectus in ocular aligment, normal cerebral MRI and MRV, and normal CSF biochemical results were thefeature of these patients except the increased CSF suppressor between 250 and 300mmH20. CONCLUSION. The detailed examination of central nerve system is essential for patients firstly visit the ophthalmologic clinical practice withpapilledema and lateral rectus paralysis to diagnose or exclude the possibility of IIH.