良性颅内压增高病因分析(附25例报告)

Etiology of benign intracranial hypertension:25 cases analysis

目的 对良性颅内压增高的病因进行分析 ,以提高对该病的认识。方法 回顾性总结 2 5例临床诊断为良性颅内压增高患者的临床资料 ,结合文献对其可能的病因、临床症状、体征、实验室及影像学检查以及治疗转归情况进行分析。结果 病因 :静脉窦血栓形成 15例 ,原因不明 6例 ,单纯肥胖、撤激素反应、鼻窦炎、垂体饱满各 1例。临床症状、体征以头痛、恶心、呕吐、视乳头水肿、视物模糊为主。头颅MRI发现空泡蝶鞍 16例。CSF检查 4例蛋白轻度增高 ,2例寡克隆抗体区带 (+)。所有病例均行降颅压治疗 ,抗凝治疗 7例 ,加用激素治疗 3例 ,加用开颅减压治疗 1例 ,均有不同程度好转。结论 良性颅内压增高并非完全良性 ,有时可导致严重的视力损害。多数均有病因可寻 ,其中由静脉窦血栓形成引起者比例较高 ,部分实验室及影像学检查可有异常发现。因此 ,对良性颅内压增高病人提倡行头颅DSA或MRV以及血凝机制的检查 ,对寻找病因有帮助。早期治疗临床效果佳。

Objective To analyze the etiology and improve the acknowledgement of the benign intracranial hypertension.Methods 25 cases who were diagnosed as benign intracranial hypertension were reviewed during 1990 2001 in PUMC hospital,the etiology,clinical manifestation,laboratory test,imaging, treatment, prognosis were analyzed.Results 15 cases were thrombosis of venous sinus,6 cases with unknown reason,1 case was simple obesity,1 case was hormone withdrawal reaction,1 case was nasal sinusitis,1 case was full of pituitary.The main clinical manifestations were headache,nausea,vomiting,optical papillary edema and visual blurring.Head MRI revealed 16 cases of empty sella turcica.CSF revealed 4 cases with protein elevation,2 cases with positive oligoclonal band.All cases were treated with lowering the intracranial hypertension,7 cases were treated with anticoagulation,3 cases were treated with hormone,and 1 case was treated with craniotomy decompression.Conclusions Benign intracranial hypertension may result in severe visual damage,most of them have definite reasons.The venous sinus thrombosis are mostly common some lab and imaging tests can reveal the abnormalities,therefore,if possible,head DSA,MRV and the test of coagulation system are recommended,they are helpful in finding the reasons.Early treatment can get the best effect.