Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Headache Pain. 2024 Sep 4;25(1):144. doi: 10.1186/s10194-024-01852-w.
There have been limited data on idiopathic intracranial hypertension (IIH) in Asians and there remain uncertainties whether a cerebrospinal fluid (CSF) pressure of 250 mm CSF is an optimum diagnostic cutoff. The aims of the present study included (1) characterization of IIH patients in Taiwan, (2) comparisons among different diagnostic criteria for IIH, and (3) comparisons between patients with CSF pressures of > 250 and 200-250 mm CSF.
This retrospective study involved IIH patients based on the modified Dandy criteria from two tertiary medical centers in Taiwan. Clinical manifestations were retrieved from electronic medical records, and findings on ophthalmologic examination and magnetic resonance images (MRIs) were reviewed.
A total of 102 patients (71 F/31 M, mean age 33.4 ± 12.2 years, mean CSF pressure 282.5 ± 74.5 mm CSF) were identified, including 46 (45.1%) with obesity (body-mass index ≥ 27.5), and 57 (62.6%) with papilledema. Overall, 80 (78.4%), 55 (53.9%), 51 (50.0%), and 58 (56.9%) patients met the Second and Third Edition of International Classification of Headache Disorders, Friedman, and Korsbæk criteria, respectively. Patients in the 200-250 mm CSF group (n = 40) were less likely to have papilledema (48.5% vs. 70.7%, p = 0.035), transient visual obscuration (12.5% vs. 33.9%, p = 0.005), and horizontal diplopia (10.0% vs. 30.6%, p = 0.006), and had fewer signs on MRIs (2.2 ± 1.3 vs. 2.8 ± 1.0, p = 0.021) when compared with those with CSF pressures > 250 mm CSF (n = 62). However, the percentages of patients with headache (95.0% vs. 87.1%, p = 0.109) at baseline, chronic migraine at six months (31.6% vs. 25.0%, p = 0.578), and visual field defect (86.7% vs. 90.3%, p = 0.709) were similar.
It was found that obesity and papilledema were less common in Asian IIH patients when compared with Caucasian patients. Although patients with CSF pressures of 200-250 mm CSF had a less severe phenotype, the risks of having headache or visual loss were comparable to those in the > 250 mm CSF group. It is possible that a diagnostic cutoff of > 200 mm CSF could be more suitable for Asians, although further studies are still needed.
亚洲特发性颅内高压（IIH）的数据有限，脑脊液（CSF）压力为 250mm CSF 是否为最佳诊断界值仍存在不确定性。本研究的目的包括：（1）描述台湾的 IIH 患者特征；（2）比较不同 IIH 诊断标准；（3）比较 CSF 压力>250mm CSF 和 200-250mm CSF 的患者。
本回顾性研究纳入了来自台湾两家三级医疗中心的符合改良 Dandy 标准的 IIH 患者。从电子病历中提取临床表现，回顾眼科检查和磁共振成像（MRI）的结果。
共纳入 102 例患者（71 例女性/31 例男性，平均年龄 33.4±12.2 岁，平均 CSF 压力 282.5±74.5mm CSF），其中 46 例（45.1%）肥胖（体质量指数≥27.5），57 例（62.6%）有视乳头水肿。总体而言，80 例（78.4%）、55 例（53.9%）、51 例（50.0%）和 58 例（56.9%）患者分别符合第二和第三版国际头痛疾病分类、Friedman 和 Korsbæk 标准。200-250mm CSF 组（n=40）患者更可能没有视乳头水肿（48.5% vs. 70.7%，p=0.035）、一过性视力模糊（12.5% vs. 33.9%，p=0.005）和水平性复视（10.0% vs. 30.6%，p=0.006），MRI 检查的征象也较少（2.2±1.3 vs. 2.8±1.0，p=0.021），而 CSF 压力>250mm CSF 组（n=62）患者则更多。然而，两组患者基线头痛（95.0% vs. 87.1%，p=0.109）、6 个月时慢性偏头痛（31.6% vs. 25.0%，p=0.578）和视野缺损（86.7% vs. 90.3%，p=0.709）的比例相似。
与高加索患者相比，亚洲 IIH 患者肥胖和视乳头水肿的比例较低。尽管 CSF 压力为 200-250mm CSF 的患者表型较轻，但发生头痛或视力丧失的风险与>250mm CSF 组相当。对于亚洲人来说，诊断界值>200mm CSF 可能更为合适，但仍需要进一步研究。
