Zhongguo cuzhong zazhi (Aug 2024)
特发性高颅压临床特点和超声表现分析 Analysis of Clinical Features and Ultrasonographic Manifestations of Idiopathic Intracranial Hypertension
Abstract
目的 分析特发性高颅压（idiopathic intracranial hypertension，IIH）的临床特点，以及归纳梳理相关的超声表现。 方法 回顾性连续纳入2021年7月—2023年6月在首都医科大学宣武医院急诊神经内科住院的IIH患者32例。收集患者的基线资料（年龄、性别、身高、BMI、颅内压）、临床表现、MRV或DSA及超声检查的各项参数（颈内静脉的内径及流量、视神经鞘直径、视盘高度等），对数据进行分析和总结。 结果 ①本研究共入组32例患者，年龄（32.0±10.6）岁，男女比例9∶23，身高（162.0±8.3）cm，BMI 27.5（24.0～31.8）kg/m2，颅内压330.0（300.0～396.3）mmHg（1 mmHg=0.133 kPa）。②入组患者的临床表现为头痛16例（50.0%）、视物模糊16例（50.0%）、恶心/呕吐12例（37.5%）、头晕6例（18.8%）、耳鸣/脑鸣6例（18.8%）。③入组的32例患者中，合并糖尿病16例（50.0%）、高脂血症13例（40.6%）、高血压7例（21.9%）、阻塞性睡眠呼吸暂停综合征4例（12.5%）、自发性脑脊液漏2例（6.3%）；入组的23例女性患者中，合并多囊卵巢综合征5例（21.7%）。④超声测量入组患者的视神经鞘直径4.92（4.90～5.09）mm，视盘高度0.83（0～1.28）mm。⑤MRV或DSA结果显示，颅内静脉窦狭窄共7例（21.9%），其中右侧颅内静脉窦狭窄5例（15.6%），左侧颅内静脉窦狭窄2例（6.3%）。⑥颅内静脉窦非狭窄组中，右侧颈内静脉J2、J3段内径大于左侧颈内静脉J2、J3段内径[（6.48±1.69）mm vs.（5.63±1.10）mm，P=0.006；（4.62±1.44）mm vs.（3.42±0.88）mm， P＜0.001]，右侧颈内静脉J2、J3段流量大于左侧颈内静脉J2、J3段流量[（376.8±172.8）mL/min vs.（229.6±93.3）mL/min，（214.4±104.0）mL/min vs.（115.2±62.9）mL/min，均P＜0.001]；颅内静脉窦狭窄组中，狭窄侧颈内静脉J3段内径小于健侧内径[（3.23±1.05）mm vs.（3.99±1.25）mm，P=0.011]，狭窄侧颈内静脉J3段流量小于健侧流量[（91.4±68.7）mL/min vs.（192.9±87.9）mL/min，P=0.004]。 结论 结果显示，IIH与肥胖密切相关，且伴较高的多囊卵巢综合征、自发性脑脊液漏、阻塞性睡眠呼吸暂停综合征、高血压、高脂血症、糖尿病、颅内静脉窦狭窄发病率。同时，颅内静脉窦狭窄侧J3段颈内静脉内径及流量均小于健侧。IIH引起视神经鞘直径的增宽和视盘高度的增高。 Abstract: Objective To analyze the clinical characteristics of idiopathic intracranial hypertension (IIH) and summarize the related ultrasonographic manifestations. Methods A total of 32 patients with IIH hospitalized in the Department of Emergency Neurology, Xuanwu Hospital, Capital Medical University from July 2021 to June 2023 were retrospectively enrolled. Baseline data (age, gender, height, BMI, intracranial pressure), clinical manifestations, MRV or DSA and ultrasound examination parameters (internal diameter and blood flow of internal jugular vein, optic nerve sheath diameter, optic disc height, etc.) of patients were collected, and the data were analyzed and summarized. Results ①A total of 32 patients were enrolled in this study, with age of (32.0±10.6) years, male to female ratio of 9∶23, height of (162.0±8.3) cm, BMI of 27.5 (24.0-31.8) kg/m2, and intracranial pressure of 330.0 (300.0-396.3) mmHg (1 mmHg=0.133 kPa). ②The clinical manifestations of the enrolled patients were headache in 16 cases (50.0%), blurred vision in 16 cases (50.0%), nausea and vomiting in 12 cases (37.5%), dizziness in 6 cases (18.8%), tinnitus and intracranial tinnitus in 6 cases (18.8%). ③Among the 32 enrolled patients, 16 cases (50.0%) had diabetes mellitus, 13 cases (40.6%) had hyperlipidemia, 7 cases (21.9%) had hypertension, 4 cases (12.5%) had obstructive sleep apnea syndrome, and 2 cases (6.3%) had spontaneous cerebrospinal fluid leakage. Among the 23 female patients, 5 cases (21.7%) were complicated with polycystic ovary syndrome. ④The diameter of the optic nerve sheath was 4.92 (4.90-5.09) mm, and the height of the optic disc was 0.83 (0-1.28) mm. ⑤According to MRV or DSA results, there were 7 cases (21.9%) of cerebral venous sinus stenosis, including 5 cases (15.6%) of right cerebral venous sinus stenosis and 2 cases (6.3%) of left cerebral venous sinus stenosis. ⑥In the non-stenosis group, the internal diameters of J2 and J3 segments of the right internal jugular vein were larger than those of J2 and J3 segments of the left internal jugular vein [(6.48±1.69) mm vs. (5.63±1.10) mm, P=0.006; (4.62±1.44) mm vs. (3.42±0.88) mm, P＜0.001]. The blood flow in J2 and J3 segments of the right internal jugular vein was greater than that in J2 and J3 segments of the left internal jugular vein [(376.8±172.8) mL/min vs. (229.6±93.3) mL/min, (214.4±104.0) mL/min vs. (115.2±62.9) mL/min, all P＜0.001]. In the cerebral venous sinus stenosis group, the internal diameter of the J3 segment on the narrow side of the internal jugular vein was smaller than that on the healthy side [(3.23±1.05) mm vs. (3.99±1.25) mm, P=0.011]. The blood flow in the J3 segment on the narrow side of the internal jugular vein was lesser than that on the healthy side [(91.4±68.7) mL/min vs. (192.9±87.9) mL/min, P=0.004]. Conclusions The results showed that IIH was closely related to obesity, and was associated with a higher incidence of polycystic ovary syndrome, spontaneous cerebrospinal fluid leakage, obstructive sleep apnea syndrome, hypertension, hyperlipidemia, diabetes mellitus, and cerebral venous sinus stenosis. Meanwhile, the internal diameter and blood flow in the J3 segment on the narrow side of the internal jugular vein were smaller than those on the healthy side. IIH causes a widening of the optic nerve sheath diameter and an increase in the height of the optic disc.
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