背景: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。虽然腰椎穿刺(LP)对于诊断IIH是必要的,其治疗效果尚不清楚。我们的目的是评估单一LP在IIH(pwIIH)患者中的治疗效果。
方法:在这项前瞻性观察研究中,我们分析了pwIIH之前的短期神经和眼科结果,LP后1天(D1)和7天(D7)。主要结果是乳头水肿程度从基线的变化。次要结果包括视觉结果,光学相干断层扫描(乳头周围视网膜神经纤维层[pRNFL]厚度和神经节细胞层[GCL]体积)和经球超声检查(蛛网膜视神经鞘直径[AONSD])的形态学变化,和头痛结果(峰值和中位数头痛严重程度以及与头痛相关的负担)。
结果:我们包括30pwIIH(平均年龄32.8岁[SD8.4],93.3%为女性,中位脑脊液[CSF]开放压力33.0cmCSF[IQR26.9-35.3],中位体重指数(BMI)34.8kg/m2[IQR30.9-40.9])。基线时的中位乳头水肿分级为2(FriedmanDI(1999)假性脑瘤。NeurosurgClinNAm10(4):609-621viii);(MollanSP,AguiarM,埃维森F,FrewE,SinclairAJ(2019)特发性颅内高压的日益扩大的负担。EyeLondEngl33(3):478-485);(AbD,GtL,NjV,SlG,MlM,NjN等人。(2007)肥胖概况,体重增加,特发性颅内高压(假性脑瘤)的生活质量。AmJOphalmol[互联网]。4月[引用2024年6月2日];143(4)。https://pubmed.ncbi.nlm.nih.gov/17386271/),并在D7时显著降低(2[1-2],p=0.011)。在D7时,pRNFL厚度中位数显着下降(-9μm[-62.5,-1.3],p=0.035),基线pRNFL厚度与pRNFL变化相关(F(1,11)=18.79,p=0.001)。平均AONSD在两个D1处均显着降低(-0.74mm[0.14],p<0.001)和D7(-0.65mm[0.17],p=0.01),基线AONSD与两个时间点AONSD的变化相关(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时头痛高峰程度略低(-1/10[-3,0],p=0.026),而中位头痛严重程度和头痛负担保持不变。
结论:这项在接受单一LP的pwIIH中进行的短期随访研究表明,对眼科有中等影响,但对头痛结果没有影响。LP作为IIH的治疗措施的有效性仍然存在争议,应该保留给治疗选择有限的患者。例如,怀孕或对药物不耐受。
BACKGROUND: 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).
METHODS: 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).
RESULTS: 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/m2 [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(1,11) = 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.
CONCLUSIONS: 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.