Malky Islam El, Aita Wael Elshazly, Abdelkhalek Hazem, Tayel Amr M, Abdelhafiz Mahmoud
Associate Prof. of Neurology, Department of Neurology, Director of Interventional Neurovascular Unit, South Valley University, Qena, Egypt.
MD Ophthalmology, Department of Ophthalmology, South Valley University, Qena, Egypt.
Sci Rep. 2025 Aug 22;15(1):30925. doi: 10.1038/s41598-025-14758-7.
The application of Friedman's criteria to diagnose suggested IIH WOP will prevent many chronic patients with migraine (CM) from proper diagnosis and treatment. Our prospective study aimed to compare the prevalence of suggested IIH WOP in case of following Friedman's criteria and in case of novel proposed criteria (OP > 200 mmH2O and radiological finding ≥ two), also reporting the predictive radiological signs for IIH WOP. Refractory chronic patients with migraine underwent ophthalmologic, neurological evaluation, MRI, and a lumbar puncture (LP) with opening pressure (OP) measurement. CSF withdrawal was performed in patients with CSF OP > 200 mmH20. Suggested IIHWOP was defined according to Friedman's criteria and our novel criteria. Regression analysis was performed to detect the strongest predictor of suggested IIHWOP. The effect of CSF withdrawal was evaluated clinically after two months. One hundred and two consecutive CM were enrolled (95 F, age 32.34 ± 9.45, and BMI 29.04 ± 5.89) without papilledema. Eighteen patients (17.65%) had OP greater than 250 mmH2O, and 20 patients (19.61%) with OP ≥ 200 mmH2O and ≤ 250 mH2O. Prevalence of suggested IIH WOP, according to Friedman's diagnostic criteria, was three patients (2.9%) only. In case of our novel diagnostic criteria (Absent 6th nerve palsy, ICP > 200 mmH2O, and ≥ two radiological signs), eight patients (7.8%) were discovered. After CSF withdrawal, 85% of patients with migraine with OP > 200 mm H2O improved, specially CM with bilateral Transverse sinus stenosis (TSS). The prevalence of suggested IIH WOP in CM was 7.8%. Bilateral TSS was the only predictor of IIHWOP.
应用弗里德曼标准诊断疑似IIH WOP会使许多慢性偏头痛（CM）患者无法得到正确的诊断和治疗。我们的前瞻性研究旨在比较遵循弗里德曼标准和新提出的标准（眼压>200 mmHg2O且影像学发现≥两项）时疑似IIH WOP的患病率，同时报告IIH WOP的预测性影像学征象。难治性慢性偏头痛患者接受了眼科、神经学评估、MRI检查以及测量初压（OP）的腰椎穿刺（LP）。对脑脊液眼压>200 mmHg2O的患者进行了脑脊液引流。根据弗里德曼标准和我们的新标准定义疑似IIH WOP。进行回归分析以检测疑似IIH WOP的最强预测因素。两个月后对脑脊液引流的效果进行了临床评估。连续纳入102例无视乳头水肿的CM患者（95例女性，年龄32.34±9.45，体重指数29.04±5.89）。18例患者（17.65%）眼压大于250 mmHg2O，20例患者（19.61%）眼压≥200 mmHg2O且≤250 mH2O。根据弗里德曼诊断标准，疑似IIH WOP的患病率仅为3例（2.9%）。按照我们的新诊断标准（无第六神经麻痹、颅内压>200 mmHg2O且≥两项影像学征象），发现8例患者（7.8%）。脑脊液引流后，85%眼压>200 mmHg2O的偏头痛患者病情改善，特别是伴有双侧横窦狭窄（TSS）的CM患者。CM中疑似IIH WOP的患病率为7.8%。双侧TSS是IIH WOP的唯一预测因素。
