颅内压增高视神经乳头改变的临床观察

Clinical study of optic papilla change caused by increased intracranial pressure

目的探讨颅内疾病导致颅内高压后视神经乳头改变的临床特点及意义。方法对颅内肿瘤934例(包括胶质瘤、脑膜瘤、垂体瘤、神经纤维瘤、颅咽管瘤等),颅脑外伤360例(均为重型以上颅脑损伤),脑血管病58例(动脉瘤及AVM破裂出血),直接采用眼底镜进行动态观察。结果颅内肿瘤视乳头改变发生率达64%,多为视乳头水肿;颅脑损伤视乳头改变发生率为28%,其中多发生于外伤后1周以后;脑血管病视乳头改变发生率为55%,多发生于出血后10～30 d内。结论急性颅内压增高短期内很少发生视乳头水肿,亚急性颅内压增高视乳头水肿发生率高,慢性颅内压增高视乳头水肿发生率较低,而且视神经萎缩的发生率高于视乳头水肿。

Objective To observe the changes of optic papilla due to increased intracranial pressure in 1352 case to find the feature and clinical significance.Methods Our series included 934 cases of encephalic tumours（including glioma,meningnoma,pituitary tumours,nerve-fiber tumours,craniopharyngioma,et al.）,360 cases of severe brain injury,58 cases of cerebral vascular disease（aneurism and venous-arterial malformation）.Results The incidence of optic papilla alteration in brain tumours was 64%,most of which was edema.The incidence in brain injury was 28%,which occurred at 1 week after injury.The incidence in cerebral vascular disease was 55%,most of which occurred at 10-30 days after hemorrhage.Conclusion Aute intracranial hypertension patients complicate dropsy of optic papilla was seldom happened.There was a high incidence of dropsy of optic papilla in subacute intracranial hypertension and in chronic intracranial hypertension was lower.Moreover,the incidence of atrophy of optic nerve was higher than dropsy of optic papilla