Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada.
Faculty of Medicine, University of Toronto, Canada.
J Neurol Sci. 2022 Jun 15;437:120271. doi: 10.1016/j.jns.2022.120271. Epub 2022 Apr 29.
Idiopathic intracranial hypertension (IIH) is a condition that most often occurs in women of reproductive age with elevated body mass index (BMI) (typical patients). Individuals outside of this demographic group (atypical patients) may have a different pathophysiology underlying raised intracranial pressure (ICP) leading to unique clinical presentations and prognosis.
Retrospective chart review of patients with IIH in typical and atypical demographic groups: men, those diagnosed at age 40 or older and those with BMI <26.0 kg/m.
193 typical and 50 atypical patients with IIH were included. Age at diagnosis was higher in men and patients with normal BMI (37.2 ± 11.8 and 32.3 ± 9.8 years versus 27.3 ± 5.6 years). Older patients presented with headache less often than typical patients (42.9% versus 77.2%). Opening pressure on lumbar puncture (LP) and degree of optic disc edema were not significantly different between groups, though men had worse mean deviation (MD) on visual fields (VFs) (10.16 ± 10.40 dB versus 4.52 ± 5.53 dB in typical group). There was no significant difference between the typical and atypical groups in visual outcomes including number of patients requiring surgical treatment, development of optic atrophy and presence of persistent papilledema, though a trend toward worse VF MD was seen in men. In a pooled analysis of all patients, MD on VF at presentation was the only significant predictor of final visual outcome.
Men and patients with normal BMI are diagnosed with IIH later in life. Clinical presentations of typical and atypical groups are similar, although older patients report headaches less frequently. Final visual outcomes were not significantly different between typical and atypical patients and VF loss at presentation is the most consistent predictor of final visual outcome in all patients.
特发性颅内高压（IIH）是一种常见于育龄期肥胖（典型患者）女性的疾病。在这个年龄组之外的人群（非典型患者），颅内压升高（ICP）可能存在不同的病理生理学基础，导致独特的临床表现和预后。
对典型和非典型人口统计学组（男性、40 岁及以上诊断的患者和 BMI<26.0kg/m²的患者）的 IIH 患者进行回顾性图表审查。
纳入 193 例典型和 50 例非典型 IIH 患者。男性和 BMI 正常患者的诊断年龄较高（37.2±11.8 岁和 32.3±9.8 岁 vs. 27.3±5.6 岁）。老年患者头痛的发生率低于典型患者（42.9% vs. 77.2%）。腰椎穿刺（LP）的开放压和视盘水肿程度在两组之间无显著差异，但男性视野（VF）的平均偏差（MD）更差（10.16±10.40dB vs. 4.52±5.53dB 典型组）。虽然男性 VF MD 较差，但在视力结果方面，包括需要手术治疗的患者数量、视神经萎缩的发展和持续性乳头水肿的存在，典型和非典型组之间无显著差异。在所有患者的汇总分析中，VF 初始 MD 是最终视力结果的唯一显著预测因素。
男性和 BMI 正常的患者在生命后期被诊断为 IIH。典型和非典型组的临床表现相似，尽管老年患者头痛的发生率较低。典型和非典型患者的最终视力结果无显著差异，VF 初始损失是所有患者最终视力结果的最一致预测因素。
