Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Eye (Lond). 2023 Oct;37(15):3243-3248. doi: 10.1038/s41433-023-02499-8. Epub 2023 Mar 16.
We reviewed the medical case report literature to determine the proportion of cases of idiopathic intracranial hypertension (IIH) that were either inappropriately labelled as IIH or prematurely given this diagnosis.
We searched OVID MEDLINE from 2012 to 2022 to identify case reports that diagnosed patients with IIH. Case reports were assessed for diagnostic accuracy using Friedman et al.'s revised diagnostic criteria for primary pseudotumor cerebri syndrome. Our primary outcome was the crude prevalence of inappropriate or premature IIH diagnoses. Our secondary outcome was determining if inaccurate IIH diagnoses were associated with variables such as journal subscription model and impact factor, author affiliation, country of origin, and year of publication.
A total of 33/185 case reports (17.8%) either incorrectly labelled a patient as having IIH or did not perform all of the investigations necessary to make a diagnosis of IIH. Some of these studies (4.8%) were believed to still represent 'probable' IIH given the clinical presentation, whereas 13.0% of studies were determined to have mislabelled their patients as having IIH. The most common reason that case reports did not meet diagnostic criteria included: a lack of MRV in atypical patient cases (42.4%, n = 14), no papilledema in addition to a lack of characteristic neuroimaging features (33.3%, n = 11), intracranial hypertension being secondary to another documented cause (12.1%, n = 4), normal LP opening pressure in addition to other factors (12.1%,n = 4), no description of neuroimaging (6.1%, n = 2), and abnormal CSF composition (6.1%, n = 2). Case reports that used the term 'IIH' incorrectly had a significantly lower journal impact factor (2.0 vs. 2.6, p = 0.01).
There is a high prevalence of premature or inappropriate diagnoses of IIH in the peer-reviewed case report literature. Adherence to published diagnostic criteria is needed when publishing IIH case reports, and authors are expected to report all relevant data in their report to ensure that an accurate diagnosis is made.
我们回顾了医学病例报告文献，以确定特发性颅内高压 (IIH) 病例中被不恰当地标记为 IIH 或过早做出此诊断的比例。
我们在 OVID MEDLINE 上搜索了 2012 年至 2022 年的病例报告，以确定诊断为 IIH 的患者病例报告。使用 Friedman 等人修订的原发性假性脑瘤综合征的诊断标准评估病例报告的诊断准确性。我们的主要结果是不适当或过早的 IIH 诊断的粗患病率。我们的次要结果是确定不准确的 IIH 诊断是否与期刊订阅模式和影响因素、作者归属、原籍国和出版年份等变量相关。
共有 33/185 份病例报告（17.8%）要么错误地将患者标记为患有 IIH，要么没有进行所有必要的检查以做出 IIH 诊断。其中一些研究（4.8%）仍被认为是基于临床表现的“可能”IIH，而 13.0%的研究被确定为错误地将患者标记为患有 IIH。病例报告不符合诊断标准的最常见原因包括：在非典型患者病例中缺乏 MRV（42.4%，n=14），除了缺乏特征性神经影像学特征外没有视乳头水肿（33.3%，n=11），颅内压升高继发于另一个已记录的原因（12.1%，n=4），除其他因素外，腰穿开放压正常（12.1%，n=4），没有描述神经影像学（6.1%，n=2），和异常 CSF 成分（6.1%，n=2）。使用“IIH”不正确术语的病例报告的期刊影响因子显著较低（2.0 与 2.6，p=0.01）。
在同行评审的病例报告文献中，IIH 的过早或不适当诊断比例很高。在发表 IIH 病例报告时需要遵循已发表的诊断标准，并且作者应在报告中报告所有相关数据，以确保做出准确的诊断。
