Abstract:
Mildly elevated intracranial pressure appears to be a distinct pathology separate from idiopathic increased intracranial pressure and migraine. Many patients present with head fullness-pressure and dizziness, which is often suggestive of a clinical diagnosis of vestibular migraine. These patients may additionally have episodic vertigo as seen in endolymphatic hydrops and positional vertigo in addition to feeling dizzy. In most cases, hearing is normal. A long duration of the condition or a presence of associated ear pathologies, i.e., dehiscence, fistula, hypermobile footplate, or history of chronic ear infections can add hearing loss to clinical presentations. Low-pitch pulsatile tinnitus, when present, is an important symptom. The neuroimaging findings such as partially empty sella, blockage of the dural venous sinus or sigmoid sinus wall defects are frequently observed. The condition is diagnosed by measuring the lumbar puncture opening pressure. Typically, patients have normal cerebrospinal fluid chemistry and microscopy. Lowering the pressure during the lumbar puncture will resolve the patient\'s symptoms temporarily. Medical therapy is typically successful using carbonic anhydrase inhibitors and corrections of medical disorders that may be contributing to the increased pressure. A few require shunting or stenting procedures. In this review article, we define the condition in detail with illustrative cases that we collected from our practices.
摘要:
颅内压轻度升高似乎是与特发性颅内压升高和偏头痛分开的独特病理。许多患者出现头部充盈压力和头晕,这通常提示前庭性偏头痛的临床诊断。这些患者除了感到头晕外,还可能出现发作性眩晕,如在内淋巴积水和位置性眩晕。在大多数情况下,听力正常。长时间的状况或相关的耳部病变的存在,即,开裂,瘘管,超移动踏板,或慢性耳部感染的病史可以增加听力损失的临床表现。低间距脉动性耳鸣,当存在时,是一个重要的症状.神经影像学发现,如部分空蝶鞍,经常观察到硬脑膜静脉窦或乙状窦壁缺损的阻塞。通过测量腰椎穿刺开口压力来诊断该状况。通常,患者脑脊液化学和显微镜检查正常。在腰椎穿刺期间降低压力将暂时解决患者的症状。使用碳酸酐酶抑制剂和可能导致压力增加的医学病症的校正通常是成功的医学治疗。一些需要分流或支架手术。在这篇评论文章中,我们用我们从实践中收集的说明性案例详细定义了条件。