Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran.
Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran.
J Clin Neurosci. 2020 Jun;76:171-176. doi: 10.1016/j.jocn.2020.04.066. Epub 2020 Apr 21.
The aim of the current study was to assess the risk factors, clinical symptoms and Cerebrospinal fluid (CSF) pressure of idiopathic intracranial hypertension (IIH) with emphasis on determining the risk factors which involved in poor response to treatment. We retrospectively included 202 patients who were diagnosed with IIH. Disease severity was classified according to prescribed therapeutic option into 4 groups: acetazolamide (group 1), Acetazolamide plus topiramate or Lasix (group 2), repeated LP (group 3) and surgical intervention (group 4). Being in the higher group was considered as a higher severity of disease and poor response to treatment. Among the evaluated features of IIH, the strongest association were observed between opening CSF pressure and disease severity. So that, the highest CSF pressure was observed in patients who underwent surgery, which represent the highest severity of disease (group 4) and poor response to therapy (mean ± SD: 43.9 ± 21.1 cm HO). Headache was the most prevalent symptom of IIH in our series which was significantly higher among acetazolamide group. Blurred vision was the second most common symptoms which, unlike the headache was more reported in surgery group. Our results suggested that higher CSF pressure could be the risk factors of poor response to therapy, which may raise need for more intensive treatment. Furthermore, suffering of headache without blurred vision can consider as a prognostic factor for mild severity and good response to treatment.
本研究旨在评估特发性颅内高压（IIH）的危险因素、临床症状和脑脊液（CSF）压力，重点确定与治疗反应不佳相关的危险因素。我们回顾性纳入了 202 例确诊为 IIH 的患者。根据规定的治疗选择，将疾病严重程度分为 4 组：乙酰唑胺（第 1 组）、乙酰唑胺加托吡酯或速尿（第 2 组）、重复腰椎穿刺（第 3 组）和手术干预（第 4 组）。处于较高组被认为是疾病严重程度较高和治疗反应不佳。在评估的 IIH 特征中，与疾病严重程度相关性最强的是开放 CSF 压力。因此，在接受手术的患者中观察到最高的 CSF 压力，这代表了最高的疾病严重程度（第 4 组）和治疗反应不佳（平均 ± 标准差：43.9 ± 21.1 cm HO）。头痛是我们系列中 IIH 最常见的症状，在乙酰唑胺组中更为明显。视力模糊是第二常见的症状，与头痛不同，它在手术组中更为常见。我们的结果表明，较高的 CSF 压力可能是治疗反应不佳的危险因素，这可能需要更强化的治疗。此外，无视力模糊的头痛可能是轻度严重程度和良好治疗反应的预后因素。
