以视乳头水肿为主征的颅内高压患者病因及临床特征分析

Etiology and Clinical Features of Intracranial Hypertension Mainly Presented as Papilledema

目的观察以视乳头水肿为主征的颅内高压患者病因分布。方法收集2002年12月至2011年7月间北京同仁医院神经内科以视乳头水肿为主要体征的颅内高压住院患者的临床和颅脑影像资料,回顾性分析并确定病因学诊断,观察这一类患者的病因构成及各组疾病的临床特点。结果符合入组条件的颅内高压患者174例,男56例,女118例,平均发病年龄(38.6±11.2)岁。符合特发性颅内高压(idiopathic intracr&nial hypertension,ⅡH)127例(73.0%),静脉窦血栓形成(cerebralvenous sinus thrombosis,CVST)20例(11.5%),其他病因27例(15.5%),该27例包括良性颅内占位性病变7例,硬脑膜动静脉瘘6例,手术相关因素6例(包括慢性中耳炎和胆脂瘤术后、硬脑膜动静脉瘘、动静脉畸形及神经鞘瘤术后),Castleman病、淋巴瘤、脑囊虫、Arnold-Chiari畸形、脑膜癌病、变应性肉茅肿性血管炎(churg-strauss syndrome)各1例,可疑颅内感染2例。ⅡH组体重超重者占73.4%(47/64),视力低于0.1的眼球占11.4%(29/254),本组平均年龄(38.3±11.1)岁,女性占75.6%(96/127);CVST组平均年龄(38.3±11.7)岁,影像学提示侧窦受累者占85%(17/20),其中孤立性侧窦血栓形成占65%(13/20),本组中男性13例(65%)。结论ⅡH为本组以视乳头水肿为特征的颅内高压患者最为常见的病因。该组惠者多为育龄期超重女性,临床主要表现为不同程度视功能损害。CVST是第二常见病因,其中以孤立性侧窦血栓形成较为多见。应注意鉴别包括某些恶性病变在内的其他少见病因。

Objective To investigate the causes and clinical features of intracranial hypertension mainly presented as papilledema. Methods The medical records of patients with diagnosis of intracranial hypertension mainly presented as papilledema were reviewed. Clinical features and imaging data were retrospectively analyzed and etiological diagnosis were defined according to the relevant diagnosis criteria. Results In totally 174 cases included, 127（73.0%） met the diagnostic criteria of idiopathic intracranial hypertension（IIH）. Twenty cases（l1.5%） were diagnosed as cerebral venous sinus thrombosis（CVST）. Other causes included benign intracranial mass for 7 cases, dural arterio- veous fistula（DAVF） for 6 cases, surgery related complication for 6 cases and other causes of single case including Castleman disease, lymphoma, meningeal carcinomatosis, churg-strauss syndrome, cysticercosis, Arnold-Chiari malformation. Two cases were classified as uncertain intracranial infection. Female cases（96/127, 75.6%） and overweight（73.4%） were common In IIH group while male predominance（13/20, 65%） was seen in CVST group. Isolated Lateral sinus thrombolysis was found in 13 of 20（65%） in CVST patients. Conclusion lIH is the most common cause in this group of intracranial hypertension patients mainly presented as papilledma. Female overweight patients are common in IIH group; some patients may have severe visual loss. CVST was the second commonest cause, of which isolated lateral sinus thrombosis is common. Even rarely, some malignant entity can be the cause of intracranial hypertension mainly presented as papilledema.