Mafrici Marco, Tona Francesca, Fragiotta Serena, Lorenzi Umberto, Gitto Lorenzo, Toscani Laura
Department of Ophthalmology, Ales-Cevennes Hospital, Ales, France.
Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK.
Case Rep Ophthalmol Med. 2023 Jul 11;2023:6688445. doi: 10.1155/2023/6688445. eCollection 2023.
The underlying mechanisms of papilledema associated with intracranial hypertension remain unclear. A case of bilateral papillary edema in a patient with chronic idiopathic intracranial hypertension who was asymptomatic during her two pregnancies is reported. . A 19-year-old Caucasian female, in her third month of pregnancy, complained of difficulties with close reading. The patient's visual acuity was 20/20 on the Snellen chart and improved with a 0.50 D correction in both eyes. Near vision and slit lamp examinations revealed normal findings bilaterally. However, a fundus examination showed bilateral papillary edema without evidence of hemorrhages or neovascularization. Blood tests were unremarkable, except for a slight increase in C-reactive protein levels. The patient had a prepregnancy weight of 63 kilograms, with a BMI of 24.91 kg/m. Magnetic resonance imaging of the brain revealed features consistent with chronic idiopathic intracranial hypertension, which resolved after delivery. Two and a half years later, during a subsequent pregnancy, the patient experienced a recurrence of bilateral papillary edema due to the IIH. It was managed similarly as the first occurrence, resulting in bilateral anatomical and functional recovery. Recent research revealed that, during pregnancy, hormones interact with the central nervous system, leading to an increase in the size of neurons which could potentially result in intracranial hypertension.
The influence of hormonal fluctuations during pregnancy on the development of transient central nervous system abnormalities in individuals with chronic intracranial hypertension, leading to papillary edema, remains a matter of debate.
颅内高压相关视乳头水肿的潜在机制仍不清楚。本文报告了一例慢性特发性颅内高压患者在两次妊娠期间均无症状的双侧视乳头水肿病例。一名19岁的白人女性，妊娠第三个月时，主诉近距离阅读困难。患者的斯内伦视力表视力为20/20，双眼矫正0.50 D后视力改善。近视力和裂隙灯检查双侧结果均正常。然而，眼底检查显示双侧视乳头水肿，无出血或新生血管形成迹象。血液检查无明显异常，仅C反应蛋白水平略有升高。患者孕前体重63千克，体重指数为24.91 kg/m²。脑部磁共振成像显示符合慢性特发性颅内高压的特征，产后症状缓解。两年半后，在随后的一次妊娠期间，该患者因IIH再次出现双侧视乳头水肿。治疗方式与首次发作时相同，最终双侧在解剖结构和功能上均恢复正常。最近的研究表明，在妊娠期间，激素与中枢神经系统相互作用，导致神经元体积增大，这可能会引发颅内高压。
妊娠期间激素波动对慢性颅内高压患者短暂性中枢神经系统异常发展导致视乳头水肿的影响，仍是一个有争议的问题。
