Lancaster Medical School, Bailrigg, Lancaster University, Lancashire.
Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK.
Curr Opin Neurol. 2023 Dec 1;36(6):622-630. doi: 10.1097/WCO.0000000000001209. Epub 2023 Sep 28.
Idiopathic intracranial hypertension (IIH) affects predominantly overweight women of childbearing age, causing chronically-disabling headaches and visual loss. Weight loss remains the most effective management strategy, but innovative treatments and randomized control trials (RCTs) remain few. This paper will review recent IIH research.
Pregnancy-related complications, but not losses, are increased in IIH, while symptom severity is not affected. Weight loss of 24% results in normalization of intracranial pressure (ICP) and improvement in papilledema. Prolonged periods of papilledema result in delayed thinning of the ganglion cell layer. Less-invasive telemetry has improved understanding of the positional effects on ICP with rises seen in the supine and lateral positions. Exenatide, a GLP-1 agonist, may reduce ICP and improve symptoms. Venous sinus stenting is increasingly popular but its benefits over CSF diversion remain unclear.
Early involvement of obstetric care is recommended with pregnancy in IIH. Early intervention is required to avoid chronic papilledema that confers worse visual outcomes. Positional changes may affect ICP readings. The use of novel ICP telemetric devices has significant potential in future disease monitoring. The dual benefits of weight loss and ICP reduction with exenatide have significant potential in IIH management. Surgical RCTs are still required.
特发性颅内高压（IIH）主要影响育龄超重女性，导致慢性致残性头痛和视力丧失。减肥仍然是最有效的治疗策略，但创新的治疗方法和随机对照试验（RCT）仍然很少。本文将综述最近的 IIH 研究进展。
IIH 患者的妊娠相关并发症增加，而不是流产，而症状严重程度不受影响。体重减轻 24%可使颅内压（ICP）正常化，并改善视乳头水肿。视乳头水肿持续时间延长会导致节细胞层变薄。侵入性较小的遥测技术提高了对 ICP 位置影响的理解，仰卧位和侧卧位会导致 ICP 升高。GLP-1 激动剂艾塞那肽可能降低 ICP 并改善症状。静脉窦支架置入术越来越受欢迎，但与 CSF 分流术相比，其益处尚不清楚。
建议 IIH 患者妊娠时尽早接受产科护理。需要早期干预以避免慢性视乳头水肿，因为慢性视乳头水肿会导致更差的视力预后。体位变化可能会影响 ICP 读数。新型 ICP 遥测设备具有在未来疾病监测中具有很大的应用潜力。艾塞那肽在减轻体重和降低 ICP 方面的双重益处在 IIH 治疗中有很大的应用潜力。仍需要进行手术 RCT。
