The Clinical Features Of 199 Patients With Idiopathic Intracranial Hypertension

Background and ObjectivesIdiopathic intracranial hypertension(IIH)is a syndrome of elevated intracranial pressure of unknown cause,also known as pseudotumor cerebi(PSTC)or benign intracranial hypertension(BIH).Typical IIH presents with symptoms related to headache,transient episodic blurred vision,pulsatile tinnitus,or elevated intracranial pressure.The disease is good in obese women of reproductive age.IIH is a potential headache that seriously threatens vision,with non-specific clinical manifestations,difficult diagnosis,and easy misdiagnosis and overdiagnosis.In order to deepen the understanding of this disease,this study summarized the clinical characteristics of 199 cases of IIH and provided clues for its early diagnosis,so as to prevent the occurrence of serious complications such as irreversible visual impairment.MethodsA total of 199 patients diagnosed with idiopathic intracranial hypertension in the First Affiliated Hospital of Zhengzhou University between January 2013 and July 2021 were collected as the subjects of this study.The clinical data of patients with IIH were retrospectively analyzed,mainly including general data,clinical symptoms,laboratory parameters,imaging characteristics,treatment measures and prognosis.All patients were followed up by telephone in September 2021.Results1.Of the 199 patients diagnosed with idiopathic intracranial hypertension,54(54/199)were male and 145(145/199)were female,with a male to female ratio of 1:2.7 and an age of onset of 36 years.The mean BMI was 26(23.4,29.4)kg/m2,with a mean BMI of 29.3(26.3,29.8)kg/m2 in males and 26(25.7,28.0)kg/m2 in females,with a mean BMI level in males(P=0.016).The mean CSF pressure was 350.0(290.0,400.0)mmH2O,compared with 335.0(277.5,400.0)mmH2O in males and 360.0(300.0,400.0)mmH2O in females,with lower ICP in males(P=0.04).2.In this study,71 patients had acute onset(35.7%),67 had subacute onset(33.7%),and 61 had a chronic course(30.7%),with headache being the most common first symptom,followed by blurred vision.Common symptoms were headache(59.3%),blurred vision(57.8%),nausea and vomiting(28.1%),dizziness(18.1%),tinnitus(13.6%),diplopia(11.6%),and blackouts(8.5%).Female patients were more likely to have blurred vision(P=0.02)and papilledema(P=0.004)in clinical symptoms.3.The common complications of patients in this study were:hyperlipidemia,anemia,hypertension,liver function damage,hyperhomocysteinemia,endocrine disorders,hypoproteinemia,obstructive sleep apnea,and renal failure.59 History of surgery,of which cesarean section is the most common.4.In 199 patients,the most common imaging features were optic nerve sheath dilatation(79.9%),followed by venous sinus stenosis(73.9%),flat posterior margin of the eyeball(64.8%),optic nerve distortion(51.3%),empty sella(43.2%),optic nerve protrusion(26.6%),and cerebellar tonsillar herniation(2.0%).The most common pituitary type was depressed pituitary(72.9%),followed by flat pituitary(19.6%),and convex pituitary was rare(7.5%).Unilateral venous sinus stenosis(43.7%)was more common than venous sinus stenosis(30.2%).Radiologically,female patients were more likely to have empty sella(P<0.001),optic nerve protrusion(P=0.021),and flat posterior margin of the eyeball(P=0.019).5.In this study,117 patients were only given dehydration symptomatic and other drug treatment;43 patients underwent venous sinus stent surgery;16 patients underwent venous sinus balloon dilatation;16 patients underwent venous sinus balloon dilatation and stent implantation;a total of 3 patients underwent lumbar drainage,including 1 patient who underwent venous sinus stent implantation after lumbar drainage,1 patient who underwent endoscopic repair of cerebrospinal fluid rhinorrhea and external lumbar drainage;a total of 4 patients underwent lateral ventriculoperitoneal shunt,including 1 patient who underwent ventriculoperitoneal shunt after venous sinus balloon dilatation.Female patients were more likely to have decreased visual acuity in terms of prognosis(P=0.02).ConclusionThe clinical manifestations of IIH are non-specific,there are significant gender differences,comorbidities are complex,and female are at risk of decreased visual acuity,so more aggressive interventions and closer follow-up of their visual function are needed.