Ogura N, Atsumi T, Sagawa A, Jodo S, Amasaki Y, Nakabayashi T, Watanabe I, Mukai M, Fujisaku A, Nakagawa S
Second Department of Internal Medicine, Hokkaido University, School of Medicine, Sapporo-city.
Ryumachi. 1992 Feb;32(1):66-72.
A case of systemic lupus erythematosus (SLE) with benign intracranial hypertension (BIH) is reported. A 41-year-old male with a history of SLE starting in 1982 was admitted to our hospital in December 1989 because of headache and vertigo. Laboratory examinations on admission showed proteinuria, mild anemia, and positive antinuclear and anti-Sm antibodies. No abnormal findings except high pressure of 350 mmH2O were observed in his cerebrospinal fluid (CSF). Fundoscopic examinations showed marked bilateral papilledema and retinal bleeding. Brain CT, MRI and angiography revealed diffuse brain edema without space occupying lesion and cerebrovascular diseases. Because there were no diseases such as endocrinological disorders, severe anemia, and no history of the administration of drugs which might cause intracranial hypertension, the diagnosis of BIH was made. Subsequently, he was treated with intravenous methylprednisolone therapy and osmotic diuretics and his clinical symptoms and pressure of CSF gradually improved. The decrease of CSF adsorption was observed with RI cisternography in our case. Psychosis, seizures and meningitis are common CNS manifestations in SLE patients. But BIH is very rare and its cause is unclear. Only 17 cases of SLE with BIH have been reported. The pathogenesis and treatment of BIH in SLE patients were discussed in this paper.
报告了一例系统性红斑狼疮（SLE）合并良性颅内高压（BIH）的病例。一名41岁男性，自1982年起有SLE病史，于1989年12月因头痛和眩晕入住我院。入院时实验室检查显示蛋白尿、轻度贫血，抗核抗体和抗Sm抗体阳性。脑脊液（CSF）检查除350 mmH2O的高压外未发现异常。眼底检查显示双侧明显视乳头水肿和视网膜出血。脑部CT、MRI和血管造影显示弥漫性脑水肿，无占位性病变和脑血管疾病。由于没有内分泌紊乱、严重贫血等疾病，也没有使用过可能导致颅内高压的药物史，故诊断为BIH。随后，他接受了静脉注射甲基强的松龙治疗和渗透性利尿剂治疗，其临床症状和脑脊液压力逐渐改善。在我们的病例中，放射性核素脑池造影观察到脑脊液吸收减少。精神病、癫痫发作和脑膜炎是SLE患者常见的中枢神经系统表现。但BIH非常罕见，其病因尚不清楚。仅报告了17例SLE合并BIH的病例。本文讨论了SLE患者BIH的发病机制和治疗方法。
