Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
J Headache Pain. 2024 Sep 5;25(1):145. doi: 10.1186/s10194-024-01851-x.
Idiopathic intracranial hypertension (IIH) is a neurological disorder characterized by increased intracranial pressure. Whilst lumbar puncture (LP) is necessary for the diagnosis of IIH, its therapeutic effect remains unclear. Our aim was to evaluate the therapeutic effect of a single LP in people with IIH (pwIIH).
In this prospective observational study, we analysed short-term neurological and ophthalmological outcomes in pwIIH before, one (D1) and seven days (D7) after the LP. The primary outcome was the change in papilledema degree from baseline. Secondary outcomes included visual outcomes, morphological changes in optical coherence tomography (peripapillary retinal nerve fibre layer [pRNFL] thickness and ganglion cell layer [GCL] volume) and transbulbar sonography (arachnoid optic nerve sheath diameter [AONSD]), and headache outcomes (peak and median headache severity and burden related to headache).
We included 30 pwIIH (mean age 32.8 years [SD 8.4], 93.3% female, median cerebrospinal fluid [CSF] opening pressure 33.0 cmCSF [IQR 26.9-35.3], median body mass index (BMI) 34.8 kg/m [IQR 30.9-40.9]). The median papilledema grading at baseline was 2 (Friedman DI (1999) Pseudotumor cerebri. Neurosurg Clin N Am 10(4):609-621 viii); (Mollan SP, Aguiar M, Evison F, Frew E, Sinclair AJ (2019) The expanding burden of idiopathic intracranial hypertension. Eye Lond Engl 33(3):478-485); (Ab D, Gt L, Nj V, Sl G, Ml M, Nj N et al. (2007) Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol [Internet]. Apr [cited 2024 Jun 2];143(4). https://pubmed.ncbi.nlm.nih.gov/17386271/ ) and was significantly reduced at D7 (2 [1-2], p = 0.011). Median pRNFL thickness had decreased significantly at D7 (-9 μm [-62.5, -1.3], p = 0.035), with pRNFL thickness at baseline being associated with the pRNFL change (F = 18.79, p = 0.001). Mean AONSD had decreased significantly at both D1 (-0.74 mm [0.14], p < 0.001) and D7 (-0.65 mm [0.17], p = 0.01), with AONSD at baseline being associated with the change in AONSD at both time points (D1: β= -0.89, 95% CI -1.37, -0.42, p = 0.002; D7: β= -0.85, 95% CI -1.42, -0.28, p = 0.007). Peak headache severity was slightly lower at D7 (-1/10 [-3, 0], p = 0.026), whereas median headache severity and headache burden remained unchanged.
This short-term follow-up study in pwIIH undergoing a single LP suggests a moderate effect on ophthalmological but not headache outcomes. The usefulness of LP as a therapeutic measure in IIH remains controversial and should likely be reserved for patients with limited treatment options, e.g., in pregnancy or intolerability to medication.
特发性颅内高压（IIH）是一种以颅内压升高为特征的神经系统疾病。腰椎穿刺（LP）虽然是 IIH 诊断所必需的，但其治疗效果尚不清楚。我们的目的是评估 IIH 患者（pwIIH）单次 LP 的治疗效果。
在这项前瞻性观察性研究中，我们分析了 pwIIH 在 LP 前（基线）、LP 后 1 天（D1）和 7 天（D7）的短期神经眼科结局。主要结局是视乳头水肿程度从基线的变化。次要结局包括视觉结局、光学相干断层扫描（pRNFL 厚度和神经节细胞层 [GCL] 容积）和经颅超声（蛛网膜视神经鞘直径 [AONSD]）的形态变化，以及头痛结局（头痛严重程度和与头痛相关的负担的峰值和中位数）。
我们纳入了 30 名 pwIIH（平均年龄 32.8 岁 [8.4 标准差]，93.3%为女性，中位脑脊液 [CSF] 开放压力 33.0 cmCSF [26.9-35.3 四分位间距]，中位体重指数 [BMI] 34.8 kg/m [30.9-40.9 四分位间距]）。基线时视乳头水肿分级中位数为 2 级（Friedman DI（1999）假性脑瘤。神经外科临床北美 10(4):609-621 viii）；（Mollan SP、Aguiar M、Evison F、Frew E、Sinclair AJ（2019）特发性颅内高压的不断扩大的负担。眼伦敦英格兰 33(3):478-485）；（Ab D、Gt L、Nj V、Sl G、Ml M、Nj N 等人。（2007）特发性颅内高压（假性脑瘤）肥胖、体重增加和生活质量的特征。Am J Ophthalmol [互联网]。4 月 [引用 2024 年 6 月 2 日]。https://pubmed.ncbi.nlm.nih.gov/17386271/），在 D7 时显著降低（2 [1-2]，p = 0.011）。中位 pRNFL 厚度在 D7 时显著降低（-9 μm [-62.5，-1.3]，p = 0.035），pRNFL 厚度与 pRNFL 变化相关（F = 18.79，p = 0.001）。平均 AONSD 在 D1 和 D7 时均显著降低（分别为-0.74 毫米 [0.14]，p < 0.001；-0.65 毫米 [0.17]，p = 0.01），AONSD 基线与两个时间点的 AONSD 变化相关（D1：β= -0.89，95% CI -1.37，-0.42，p = 0.002；D7：β= -0.85，95% CI -1.42，-0.28，p = 0.007）。D7 时头痛严重程度略有降低（-1/10 [-3，0]，p = 0.026），而头痛严重程度和头痛负担中位数保持不变。
这项对接受单次 LP 的 pwIIH 的短期随访研究表明，LP 对眼科结局有中度影响，但对头痛结局没有影响。LP 作为 IIH 的治疗措施的有用性仍存在争议，可能应该仅限于治疗选择有限的患者，例如在妊娠期间或对药物不耐受的患者。
