Department of Neurology, Soroka Medical Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, Beer Sheva, Israel.
Department of Internal Medicine, Jefferson Einstein Philadelphia Hospital, Philadelphia, PA, USA.
Sci Rep. 2024 Aug 21;14(1):19450. doi: 10.1038/s41598-024-70588-z.
Lumbar puncture opening pressure (LPOP) exceeding 250mmHO is key in diagnosing idiopathic intracranial hypertension (IIH), per revised Friedman's criteria. Some patients do not meet LPOP criteria (with or without papilledema), despite having IIH-related symptoms and neuroimaging findings. This study aimed to investigate the radiological findings and clinical symptoms in patients suspected of having IIH without meeting the LPOP criteria. We retrospectively evaluated cerebral venous sinus stenosis using the conduit Farb score (CFS) and other radiological findings suggestive of IIH by computed tomography venography and magnetic resonance venography in females ≥ 18 years-old with chronic headaches, suspected IIH, and LPOP < 250 mm. Eighty-eight women (56 with LPOP < 200 mm HO and 32 with LPOP ranging between 200 and 250mmHO) were included. Among patients with LPOP 200-250mmHO, 40% (12) exhibited three or more radiological findings supporting IIH, compared to 17% (8) in the LPOP < 200 mmHO group (p = 0.048). Cerebral venous stenosis (CFS ≤ 5) was observed in 80% (24) of those with LPOP 200-250 mmHO, contrasting with 40% (19) of those with LPOP < 200 mmHO (p < 0.001). Cerebral venous stenosis was significantly more common in patients with LPOP 200-250 mmHO than < 200 mmHO, suggesting that they may benefit from IIH treatment.
腰椎穿刺开放压（LPOP）超过 250mmHO 是诊断特发性颅内高压（IIH）的关键，符合修订后的 Friedman 标准。一些患者尽管有 IIH 相关症状和神经影像学发现，但不符合 LPOP 标准（有或无视乳头水肿）。本研究旨在探讨不符合 LPOP 标准但疑似 IIH 的患者的影像学表现和临床症状。我们回顾性评估了 88 名女性（56 名 LPOP<200mmHO，32 名 LPOP 在 200-250mmHO 之间）的大脑静脉窦狭窄情况，这些女性年龄均≥18 岁，有慢性头痛、疑似 IIH 和 LPOP<250mmHO。使用管腔 Farb 评分（CFS）和计算机断层静脉造影及磁共振静脉造影等其他影像学方法评估 IIH 相关的放射学发现。在 LPOP 为 200-250mmHO 的患者中，40%（12 例）有 3 项或更多支持 IIH 的影像学发现，而 LPOP<200mmHO 的患者中仅有 17%（8 例）（p=0.048）。LPOP 为 200-250mmHO 的患者中，80%（24 例）存在大脑静脉狭窄（CFS≤5），而 LPOP<200mmHO 的患者中仅 40%（19 例）（p<0.001）。LPOP 为 200-250mmHO 的患者中大脑静脉狭窄更为常见，提示这些患者可能受益于 IIH 治疗。
