Alix School of Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota.
JAMA Netw Open. 2020 Jun 1;3(6):e206625. doi: 10.1001/jamanetworkopen.2020.6625.
The study of health conditions associated with papilledema will augment the clinical judgment of eye care professionals treating patients with optic disc edema in determining the urgency of additional evaluation and counseling patients accordingly.
To determine the incidence, demographic characteristics, and etiologies of papilledema based on a unique records-linkage research platform; and to describe the demographic and clinical differences between patients with idiopathic intracranial hypertension (IIH) and other causes of papilledema.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective population-based cross-sectional study of patients treated for papilledema at outpatient eye clinics in Olmsted County, Minnesota, using the Rochester Epidemiology Project. Data were collected from January 1990 to December 2014 and analyzed from September 2018 to April 2019.
Etiologies of papilledema, body mass index, incidence of headache, or localizing neurologic signs.
Eighty-six patients were diagnosed with papilledema during the 24-year period, providing an age- and sex-adjusted incidence of 2.5 individuals per 100 000 per year; 68 patients (79%) were women, 73 (85%) were white patients, and the median (range) age was 27.7 (6.2-64.2) years. Nineteen patients (22%) presented with a previously diagnosed attributable cause (eg, trauma or intracranial tumor). Among patients presenting with papilledema without a previously diagnosed attributable cause, 58 patients (87%) had IIH, and 9 patients (13%) were found to have a secondary cause of raised intracranial pressure, such as intracranial tumor, cerebral venous sinus thrombosis, or granulomatous meningitis. Patients with IIH had a higher median (range) body mass index (37.5 [20.4-55.7] vs 27.4 [16.6-40.1]; P = .003) and headache prevalence (54 of 58 patients [93%] vs 6 of 9 patients [67%]; P = .004) than patients with other causes of papilledema. Of 9 patients with papilledema but no IIH, 2 (22%) had localizing neurologic signs, such as gait abnormalities, hearing loss, focal weakness or numbness, visual field defects, or aphasia. Among 42 patients with demographic characteristics typically associated with IIH (female sex, with obesity, aged 15 to 45 years, and absent localizing neurologic signs or symptoms), 40 (95%) had papilledema that was associated with IIH. Conversely, among the 19 patients without these demographic characteristics, 7 (37%) had an alternative cause.
In this study, most patients who presented to the eye clinic with papilledema without a previously known cause were found to have IIH. These patients were more likely to present with headaches and had statistically higher body mass index. Clinicians should take these findings into account when determining the pretest probability of a patient having IIH or an alternative cause of papilledema.
研究与视盘水肿相关的健康状况将增强眼科保健专业人员的临床判断，有助于确定额外评估的紧迫性，并相应地为患者提供咨询。
基于独特的记录链接研究平台，确定基于人群的特发性颅内高压（IIH）和其他视盘水肿病因的发病率、人口统计学特征和病因；并描述 IIH 和其他视盘水肿病因患者的人口统计学和临床差异。
设计、设置和参与者：明尼苏达州奥姆斯特德县门诊眼科诊所治疗视盘水肿的患者进行的回顾性基于人群的横断面研究。数据收集自 1990 年 1 月至 2014 年 12 月，分析时间为 2018 年 9 月至 2019 年 4 月。
视盘水肿的病因、体重指数、头痛发生率或局部神经体征。
在 24 年期间，86 例患者被诊断为视盘水肿，每年每 10 万人中有 2.5 例发病；68 例（79%）为女性，73 例（85%）为白人，中位（范围）年龄为 27.7（6.2-64.2）岁。19 例（22%）患者有明确的既往可归因病因（例如，外伤或颅内肿瘤）。在没有既往可归因病因的视盘水肿患者中，58 例（87%）为 IIH，9 例（13%）为颅内压升高的继发性病因，如颅内肿瘤、脑静脉窦血栓形成或肉芽肿性脑膜炎。IIH 患者的中位（范围）体重指数更高（37.5 [20.4-55.7] 比 27.4 [16.6-40.1]；P=0.003），头痛患病率更高（58 例中有 54 例[93%]比 9 例中有 6 例[67%]；P=0.004）。9 例视盘水肿但无 IIH 的患者中，有 2 例（22%）有局灶性神经体征，如步态异常、听力损失、局灶性无力或麻木、视野缺损或失语。在 42 例具有通常与 IIH 相关的人口统计学特征（女性、肥胖、年龄 15 至 45 岁、无局灶性神经体征或症状）的患者中，有 40 例（95%）的视盘水肿与 IIH 相关。相反，在 19 例无这些人口统计学特征的患者中，有 7 例（37%）有其他病因。
在这项研究中，大多数因先前未知病因就诊于眼科诊所的视盘水肿患者被发现患有 IIH。这些患者更有可能出现头痛，且体重指数统计学上更高。临床医生在确定患者患有 IIH 或其他视盘水肿病因的可能性时，应考虑到这些发现。
