Marcelis J, Silberstein S D
Department of Internal Medicine, Temple University Hospital, Philadelphia, PA.
Arch Neurol. 1991 Apr;48(4):392-9. doi: 10.1001/archneur.1991.00530160060014.
We describe 10 patients with idiopathic intracranial hypertension who did not have papilledema. Idiopathic intracranial hypertension without papilledema, although rarely reported, may well be a clinically important headache syndrome. Historical and demographic features of patients with idiopathic intracranial hypertension without papilledema are similar to those of patients with papilledema. Obese women with chronic daily headache and symptoms of increased intracranial pressure, pulsatile tinnitus, history of head trauma or meningitis, an empty sella on imaging studies, or a headache that is unrelieved by standard therapy should have a diagnostic lumbar puncture. Findings from laboratory and neurologic investigations are normal in most patients with idiopathic intracranial hypertension without papilledema. Initial management should include removal of possible inciting agents, weight loss if applicable, and standard headache therapy. Lumbar puncture and diuretic therapy should precede a trial of corticosteroids. Surgery (lumboperitoneal or ventriculoperitoneal shunt or perhaps optic nerve sheath fenestration) may be indicated for prolonged incapacitating headache that is not responsive to medical management or lumbar puncture.
我们描述了10例无视乳头水肿的特发性颅内高压患者。无视乳头水肿的特发性颅内高压虽鲜有报道，但很可能是一种具有临床重要性的头痛综合征。无视乳头水肿的特发性颅内高压患者的病史和人口统计学特征与有视乳头水肿的患者相似。患有慢性每日头痛且有颅内压升高症状、搏动性耳鸣、头部外伤或脑膜炎病史、影像学检查显示空蝶鞍或标准治疗无法缓解头痛的肥胖女性，应进行诊断性腰椎穿刺。大多数无视乳头水肿的特发性颅内高压患者的实验室和神经系统检查结果正常。初始治疗应包括去除可能的诱发因素，如有必要进行减重，以及采用标准的头痛治疗方法。在试用皮质类固醇之前应先进行腰椎穿刺和利尿治疗。对于药物治疗或腰椎穿刺无效的长期失能性头痛，可能需要进行手术（腰大池-腹腔分流术或脑室-腹腔分流术，或许还有视神经鞘开窗术）。
