Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
RTI Health Advance, RTI International, Research Triangle Park, North Carolina.
Pediatr Neurol. 2024 Apr;153:92-95. doi: 10.1016/j.pediatrneurol.2023.12.016. Epub 2023 Dec 22.
Currently no guidelines for repeating a lumbar puncture to guide management in primary intracranial hypertension (PIH) exist.
An institutional database of patients 18 years and younger followed in the institution's pediatric intracranial hypertension clinic was examined for opening pressure changes in PIH at diagnosis, before medication wean, and following medication wean, as well as to examine whether measurements at the time of diagnosis differed between those with and without disease recurrence.
Forty-two patients were included in this study; 36% were male and the mean age at diagnosis was 11.01 years. Treatment duration averaged 9.68 months in those without recurrence and 8.5 months in those with recurrence. Average body mass index percentile of patients with disease recurrence was 83.7 and 72.1 in those without recurrence (P = 0.16). Average opening pressure values of all patients at diagnosis, prewean, and postwean was 36.53 cm HO, 30.7 cm HO, and 31.1 cm HO, respectively. There was no statistically significant difference in opening pressures across these time points (P = 0.14). The change in opening pressure from diagnosis to postwean was statistically significant with a reduction of 5.18 cm HO (P = 0.04). There was no statistical difference between change in opening pressure at diagnosis versus postwean between those with and without recurrence (P = 0.17).
This clinical observational study suggests that mean opening pressure measurements in patients with PIH remain elevated both before and after medication wean despite papilledema resolution and patient-reported PIH symptoms. Clinically, this suggests that other features such as signs of optic disc edema and symptoms should be used to inform a clinical determination of disease recurrence and treatment course.
目前原发性颅内高压（PIH）尚无重复腰椎穿刺以指导治疗的指南。
对机构内小儿颅内高压门诊中 18 岁及以下患者的机构数据库进行了检查，以了解 PIH 患者在诊断时、药物减药前、药物减药后的颅内压变化情况，并检查诊断时的测量值是否在有无疾病复发之间存在差异。
本研究共纳入 42 例患者；男性占 36%，诊断时的平均年龄为 11.01 岁。无复发患者的治疗持续时间平均为 9.68 个月，复发患者为 8.5 个月。复发患者的平均体重指数百分位数为 83.7，无复发患者为 72.1（P=0.16）。所有患者在诊断、减药前和减药后的平均颅内压值分别为 36.53cmH₂O、30.7cmH₂O 和 31.1cmH₂O，各时间点之间的颅内压值无统计学差异（P=0.14）。从诊断到减药后的颅内压变化具有统计学意义，降低了 5.18cmH₂O（P=0.04）。复发患者与无复发患者之间，从诊断到减药后的颅内压变化无统计学差异（P=0.17）。
这项临床观察性研究表明，尽管视盘水肿消退且患者报告的 PIH 症状缓解，但 PIH 患者的平均颅内压测量值在药物减药前后仍升高。临床上，这表明应使用其他特征，如视盘水肿的迹象和症状，来确定疾病复发和治疗过程。
