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“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension
Egyptian Journal of Neurosurgery ( IF 0.7 ) Pub Date : 2019-11-27 , DOI: 10.1186/s41984-019-0064-5
Ali R. Hamdan , Amr M. Tayel , Eslam El Sayed El Khateeb , Osama Elsoghiar

Assessment of visual field outcomes following the medical or surgical management of increased intracranial pressure in patients with idiopathic intracranial hypertension. Thirty-two patients diagnosed with idiopathic intracranial hypertension who met all the modified Dandy criteria were included in this study. Magnetic resonance brain imaging with contrast and magnetic resonance venography were performed to exclude the presence of secondary causes of intracranial hypertension. Following normal neuroimaging, a lumbar puncture was performed for all patients with papilledema to measure the cerebrospinal fluid opening pressure. The assessment of visual function, including visual acuity, fundus examination (dilated fundus examination to confirm the presence and the grade of papilledema and to exclude the other ocular causes of optic disc swelling), and formal visual field assessment by perimetry when visual acuity was more than 1/60 were performed by the ophthalmologist before and after medical or surgical treatment. Thirty-two patients were included, the majority of whom were females of childbearing age (29/32; 90.6%). All patients complained of headache. Visual assessment revealed the presence of blurry vision in all patients. Papilledema with different grades was observed in 31/32 (96.9%) patients, while the other patient (3.1%) showed optic atrophy; 30/32 (93.8%) patients had visual acuity ˃ 1/60. The average visual field was − 18 dB ± 9.97 SD in the right eye and − 19.47 dB ± 5.43 SD in the left eye. Twenty-nine patients received medical treatment in the form of acetazolamide, which succeeded in controlling idiopathic intracranial hypertension in 24/29 (82.7%) patients, while a theco-peritoneal shunt was inserted in 8/32 (25%) patients. After management, statistically significant improvements in cerebrospinal fluid opening pressure, presenting manifestation, visual acuity, and field were noticed. Permanent visual loss is the most feared complication of idiopathic intracranial hypertension; therefore, early diagnosis and multidisciplinary treatment are necessary to improve visual acuity and visual field.

中文翻译:

“良性颅内高压”是一种更严重疾病的误导性名称:特发性颅内高压病例的视觉结果分析

在特发性颅内高压患者的颅内压增高的医学或外科治疗后,评估视野结局。这项研究包括了32例符合所有修改的Dandy标准的特发性颅内高压患者。进行了带有对比和磁共振静脉造影的磁共振脑成像,以排除颅内高压的继发原因。正常的神经影像检查后,对所有患有乳头水肿的患者进行腰椎穿刺以测量脑脊液的开放压力。视觉功能评估,包括视力,眼底检查(扩大眼底检查以确认乳头水肿的存在和等级,并排除视盘红肿的其他眼部原因),在医学或手术治疗前后,由眼科医生进行视力检查,并通过视野检查进行正式视野评估。包括三十二例患者,其中大多数是育龄女性(29/32; 90.6%)。所有患者均抱怨头痛。视觉评估显示所有患者均存在视力模糊。在31/32(96.9%)的患者中观察到了不同等级的青光眼水肿,而另一名患者(3.1%)出现了视神经萎缩。30/32(93.8%)患者的视力≤1/60。右眼的平均视野为− 18 dB±9.97 SD,左眼的平均视野为− 19.47 dB±5.43 SD。二十九名患者接受了乙酰唑胺治疗,成功地控制了24/29(82.7%)位患者的特发性颅内高压,而在8/32(25%)的患者中插入了腹膜分流术。处理后,注意到脑脊液开放压力,表现形式,视敏度和视野的统计学显着改善。永久性视力丧失是特发性颅内高压最令人担心的并发症。因此,早期诊断和多学科治疗对于提高视力和视野是必要的。
更新日期:2019-11-27
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