Department of Paediatrics, Strabismus and Neuro-ophthalmology, Moorfields Eye Hospital, London, UK.
Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Cephalalgia. 2021 Apr;41(4):472-478. doi: 10.1177/0333102421997093. Epub 2021 Feb 25.
To review and discuss the clinical presentation and treatment of idiopathic intracranial hypertension.
Visual alterations and headache are the two main symptoms of idiopathic intracranial hypertension, although additional features including cranial nerve palsies, cognitive deficits, olfactory deficits and tinnitus are not uncommon. The headache associated with idiopathic intracranial hypertension frequently has a migrainous phenotype. The underlying cause of the disorder has not yet been elucidated. Several hypotheses have been postulated but none of them can explain the full clinical picture. Therapeutic options remain limited, focusing mainly on reduction in body weight and the reduction of CSF production with carbonic anhydrase inhibitors.
The accurate diagnosis of idiopathic intracranial hypertension is essential as visual deterioration due to papilledema may be irreversible. Given its phenotypic similarity and frequent overlap with chronic migraine it is essential to consider idiopathic intracranial hypertension in the diagnostic workup of chronic headache; in particular, when considering its increasing prevalence. Understanding in detail the pathophysiological mechanisms behind the associated headache would also allow study of current and future therapeutic options in a structured way.
回顾和讨论特发性颅内高压的临床表现和治疗。
视觉改变和头痛是特发性颅内高压的两个主要症状，但也不罕见其他特征，包括颅神经麻痹、认知缺陷、嗅觉缺陷和耳鸣。特发性颅内高压相关的头痛常具有偏头痛样的表型。该疾病的根本原因尚未阐明。已经提出了几种假说，但没有一种能够解释完整的临床表现。治疗选择仍然有限，主要集中在减轻体重和使用碳酸酐酶抑制剂减少 CSF 产生。
特发性颅内高压的准确诊断至关重要，因为视乳头水肿引起的视力恶化可能是不可逆的。鉴于其表型相似性和与慢性偏头痛的频繁重叠，在慢性头痛的诊断评估中必须考虑特发性颅内高压；特别是在考虑其发病率不断增加的情况下。详细了解相关头痛背后的病理生理机制也将允许以结构化的方式研究当前和未来的治疗选择。
