Guy J, Johnston P K, Corbett J J, Day A L, Glaser J S
Department of Ophthalmology, University of Florida, Gainesville 32610.
Neurology. 1990 Jan;40(1):28-32. doi: 10.1212/wnl.40.1.28.
Ten patients with pseudotumor cerebri associated with renal insufficiency had papilledema and elevated intracranial pressure, but neurologic examinations and CT were normal. The 40% frequency of severe visual loss, 20/100 or worse, was higher than expected for pseudotumor cerebri. While furosemide was effective in 3 patients with renal transplants, administration of corticosteroids to 2 other patients did not halt progressive loss of vision. The visual function of 2 patients deteriorated even after lumboperitoneal shunting. Five patients underwent fenestration of the optic nerve sheath. This procedure improved the visual acuity of 3 patients and stabilized vision in the others. While the pathogenesis of pseudotumor cerebri in renal insufficiency is unknown, optic nerve sheath fenestration is the surgical treatment of choice for visual loss unresponsive to medical therapy.
十例伴有肾功能不全的假性脑瘤患者出现视乳头水肿和颅内压升高，但神经系统检查和CT结果正常。严重视力丧失（20/100或更差）的发生率为40%，高于假性脑瘤的预期发生率。虽然速尿对3例肾移植患者有效，但另外2例患者使用皮质类固醇并未能阻止视力的进行性丧失。2例患者即使在进行腰大池腹腔分流术后视力仍恶化。5例患者接受了视神经鞘开窗术。该手术使3例患者的视力得到改善，其他患者的视力得以稳定。虽然肾功能不全患者假性脑瘤的发病机制尚不清楚，但视神经鞘开窗术是对药物治疗无反应的视力丧失的首选手术治疗方法。
