Wall M, George D
Department of Neurology, Tulane University School of Medicine, New Orleans, LA 70112.
Brain. 1991 Feb;114 ( Pt 1A):155-80.
Management of patients with idiopathic intracranial hypertension (IIH) should be based on the presence and progression of visual loss. To characterize the clinical course of IIH more completely, we monitored the clinical status, especially visual function, in 50 consecutive newly-diagnosed patients over a period of 2 to 39 months (average follow-up 12.4 months). The mean age at onset of symptoms was 31 (range 11-58) yrs; 46 (92%) were women and 47 (94%) were obese (mean weight 90 kg). Common symptoms were headache (92%), transient visual obscurations (72%) and intracranial noises (60%); 13 of the patients (26%) initially had complaints of sustained visual loss. There was visual loss as determined by Goldmann perimetry in 96% and by automated perimetry in 92%. Contrast sensitivity testing was abnormal in 50% and Snellen acuity in 22%. Two patients (4%) became blind in both eyes. The Goldmann visual field grade improved in 60% of patients but visual function deteriorated in 5 (10%). Deterioration of visual field grade was significantly associated only with weight gain during the year before diagnosis. Visual loss in patients with IIH is common and is often reversible. Patients should be evaluated by perimetry using an appropriate strategy and contrast sensitivity testing, along with careful examination of the optic discs.
特发性颅内高压（IIH）患者的治疗应基于视力丧失的存在及进展情况。为更全面地描述IIH的临床病程，我们对50例连续新诊断的患者进行了2至39个月（平均随访12.4个月）的临床状况监测，尤其关注视觉功能。症状出现时的平均年龄为31岁（范围11 - 58岁）；46例（92%）为女性，47例（94%）肥胖（平均体重90千克）。常见症状包括头痛（92%）、短暂性视力模糊（72%）和颅内杂音（60%）；13例患者（26%）最初有持续性视力丧失的主诉。通过Goldmann视野计检查发现96%的患者存在视力丧失，通过自动视野计检查发现92%的患者存在视力丧失。50%的患者对比敏感度测试异常，22%的患者Snellen视力异常。2例患者（4%）双眼失明。60%的患者Goldmann视野分级改善，但5例患者（10%）视觉功能恶化。视野分级恶化仅与诊断前一年的体重增加显著相关。IIH患者的视力丧失很常见且通常可逆转。应采用适当策略通过视野计检查和对比敏感度测试对患者进行评估，并仔细检查视盘。
