Department of Ophthalmology, Emory University, Atlanta, GA, USA.
Department of Neurology, Emory University, Atlanta, GA, USA.
Eye (Lond). 2023 Aug;37(12):2361-2364. doi: 10.1038/s41433-022-02361-3. Epub 2022 Dec 12.
Once considered a rare and often difficult diagnosis in the era predating routine MRI, idiopathic intracranial hypertension has become an everyday concern in ophthalmology and neurology clinics where, especially in the latter, essentially every young overweight woman with headaches is initially presumed to have IIH. Has the diagnosis of IIH become too easy, and are we over-diagnosing IIH in this period of an accelerating obesity crisis? Or are we actually missing cases of IIH because they do not fit the classic clinical profile? We think it is both: at the same time IIH is being diagnosed in excess in obese women without papilledema, often resulting in unnecessary procedures, inappropriate treatment and even iatrogenic complications, the spectrum of this disorder is expanding to include a broad array of clinical presentations that involve multiple specialists beyond just the ophthalmologist and neurologist.
曾经在常规 MRI 检查普及之前，特发性颅内高压被认为是一种罕见且难以诊断的疾病，但现在它已成为眼科和神经内科门诊的常见问题。尤其是在神经内科，几乎每个超重且头痛的年轻女性最初都被假定患有 IIH。IIH 的诊断是否变得过于容易，我们是否在肥胖危机加速的这个时期过度诊断了 IIH？还是因为它们不符合经典的临床特征，我们实际上错过了 IIH 的病例？我们认为两者皆有：同时，在没有视乳头水肿的肥胖女性中，IIH 的诊断过于频繁，这常常导致不必要的检查、不恰当的治疗，甚至医源性并发症。这种疾病的范围正在扩大，包括一系列广泛的临床表现，涉及眼科医生和神经科医生以外的多个专科医生。
