Department of Diagnostic Radiology, McGill University, Montreal, Canada.
Neurol Sci. 2023 Mar;44(3):845-858. doi: 10.1007/s10072-022-06478-x. Epub 2022 Nov 5.
To review the clinical features, proposed pathophysiology, and the role of medical imaging in the diagnosis and treatment of idiopathic intracranial hypertension and spontaneous intracranial hypotension.
The authors conducted a narrative review of the current literature on intracranial hypertension and hypotension syndromes, with a focus on imaging findings and role of neurointerventional radiology as a therapeutic option for these pathologies.
Idiopathic intracranial hypertension commonly presents in obese women of childbearing age, being headache and papilledema the main clinical manifestations. Characteristic radiological findings consist of increased cerebrospinal fluid around the optic nerve, partially empty sella turcica and stenosis of the transverse sinuses. Transverse sinus stenting is a treatment alternative that has proven valuable utility in the recent years. Spontaneous intracranial hypotension in most of cases presents with orthostatic headache and has predilection for female population. The typical radiological features in the brain consist of subdural fluid collections, enhancement of the dura, engorgement of the venous structures, pituitary enlargement, and sagging of the brain. In this pathology, a cerebrospinal fluid leak in the spine associated with a defect in the dura, meningeal diverticulum, or a cerebrospinal fluid-venous leak must be actively ruled out.
Neurologic complaints secondary to changes in intracranial pressure exhibit certain clinical features that in combination with fairly specific radiological patterns allow a highly accurate diagnosis. The diverse specialists in neurosciences should be aware of the multiple image modalities in the study of these syndromes as well as the treatment alternatives by neurointerventional radiology.
回顾特发性颅内高压和自发性颅内低血压的临床特征、提出的病理生理学以及医学影像学在诊断和治疗中的作用。
作者对颅内高压和低血压综合征的当前文献进行了叙述性综述，重点介绍了影像学发现以及神经介入放射学作为这些病变治疗选择的作用。
特发性颅内高压常见于肥胖的育龄妇女，主要临床表现为头痛和视乳头水肿。特征性影像学表现包括视神经周围脑脊液增多、部分空蝶鞍和横窦狭窄。横窦支架置入术是近年来证明有价值的治疗选择。自发性颅内低血压在大多数情况下表现为直立性头痛，且多见于女性人群。大脑的典型影像学特征包括硬脑膜下积液、硬脑膜强化、静脉结构充血、垂体增大和脑下垂。在这种病理情况下，必须积极排除脊柱脑脊液漏与硬脑膜缺陷、脑膜憩室或脑脊液静脉漏相关。
继发于颅内压变化的神经症状表现出某些临床特征，结合相当特异性的影像学模式，可实现高度准确的诊断。神经科学领域的各种专家应了解这些综合征研究中的多种影像学方式以及神经介入放射学的治疗选择。
