Bandyopadhyay Sankar, Jacobson Daniel M
Department of Medical Education, Marshfield Clinic, 1000 N. Oak Avenue, Marshfield, WI 54449, USA.
J Neuroophthalmol. 2002 Mar;22(1):9-11. doi: 10.1097/00041327-200203000-00003.
To characterize the clinical features of patients with pseudotumor cerebri (PTC) fulfilling the Modified Dandy Criteria who were diagnosed at or after the age of 44 years.
We reviewed the medical records between 1987 and 1999 of 14 patients at a single institution who were diagnosed as having PTC at 44 years of age or older according to the Modified Dandy Criteria: neurologic manifestations attributable to generalized increased intracranial pressure, elevated cerebrospinal fluid pressure with normal cerebrospinal fluid composition demonstrated by lumbar puncture, and normal or small ventricles demonstrated by neuroimaging. We documented presenting symptoms and signs, significant medical conditions, and visual field follow-up.
There were nine women and five men. Nine patients (64%) were obese. Five patients (36%) were asymptomatic. None presented with headache alone. Four patients (29%) had an identifiable cause of intracranial hypertension, including two with transverse sinus thrombosis, one with severe chronic obstructive pulmonary disease and cor pulmonale, and one with corticosteroid withdrawal after prolonged administration. During a median follow-up of 2 years of 12 patients, visual fields remained stable in 8, improved in 3, and worsened in 1.
In comparison with patients who have idiopathic intracranial hypertension, our small series of 14 patients diagnosed after the age of 44 years were more often men, were less often obese, were less symptomatic, and had identifiable causes of intracranial hypertension in a substantial minority (29%). The visual prognosis in this age group is generally good. Because the nonidiopathic causes of PTC would be overlooked by adhering to the Modified Dandy Criteria, we propose a modification that excludes patients who have dural venous sinus disease demonstrated on magnetic resonance imaging and those who may be exposed to medications or toxins or have systemic disorders that are known to increase intracranial pressure.
描述符合改良丹迪标准且在44岁及以后被诊断为假性脑瘤（PTC）患者的临床特征。
我们回顾了1987年至1999年间在单一机构就诊的14例患者的病历，这些患者根据改良丹迪标准在44岁及以上被诊断为PTC：因颅内压普遍升高导致的神经系统表现、腰椎穿刺显示脑脊液压力升高但脑脊液成分正常、神经影像学显示脑室正常或缩小。我们记录了患者的症状和体征、重大疾病情况以及视野随访结果。
9名女性，5名男性。9例患者（64%）肥胖。5例患者（36%）无症状。无人仅表现为头痛。4例患者（29%）有可识别的颅内高压病因，包括2例横窦血栓形成、1例严重慢性阻塞性肺疾病合并肺心病、1例长期使用皮质类固醇后停药。12例患者中位随访2年，8例视野保持稳定，3例改善，1例恶化。
与特发性颅内高压患者相比，我们这组14例44岁以后诊断的患者男性更多见，肥胖者较少，症状较少，相当一部分少数患者（29%）有可识别的颅内高压病因。该年龄组的视力预后总体良好。由于坚持改良丹迪标准会忽略PTC的非特发性病因，我们建议进行修改，排除磁共振成像显示有硬脑膜静脉窦疾病的患者以及可能接触药物或毒素或患有已知会增加颅内压的全身性疾病的患者。
