Gliomatosis cerebri or benign intracranial hypertension?

Benign intracranial hypertension is a condition of obscure aetiology which presents with episodic headaches and nausea. It is a diagnosis based on the exclusion of other intracranial pathology and computed tomography is usually normal. We present a case of gliomatosis cerebri which was initially diagnosed and treated as benign intracranial hypertension.     

良性颅内压增高病因分析(附25例报告)

目的对良性颅内压增高的病因进行分析,以提高对该病的认识.方法回顾性总结25例临床诊断为良性颅内压增高患者的临床资料,结合文献对其可能的病因、临床症状、体征、实验室及影像学检查以及治疗转归情况进行分析.结果病因:静脉窦血栓形成15例,原因不明6例,单纯肥胖、撤激素反应、鼻窦炎、垂体饱满各1例.临床症状、体征以头痛、恶心、呕吐、视乳头水肿、视物模糊为主.头颅MRI发现空泡蝶鞍16例.CSF检查4例蛋白轻度增高,2例寡克隆抗体区带(+).所有病例均行降颅压治疗,抗凝治疗7例,加用激素治疗3例,加用开颅减压治疗1例,均有不同程度好转.结论良性颅内压增高并非完全良性,有时可导致严重的视力损害.多数均有病因可寻,其中由静脉窦血栓形成引起者比例较高,部分实验室及影像学检查可有异常发现.因此,对良性颅内压增高病人提倡行头颅DSA或MRV以及血凝机制的检查,对寻找病因有帮助.早期治疗临床效果佳.     

Tetracycline and benign intracranial hypertension: report of five cases

Benign intracranial hypertension occurred in four young women taking tetracycline for acne; two were also taking vitamin A. In a fifth case a 14-year-old boy developed papilloedema after taking a short course of tetracycline for bronchitis. All symptoms disappeared soon after stopping the drugs, though in two cases the papilloedema persisted for many months. Benign intracranial hypertension should be sought in any young woman complaining of headache during treatment with tetracycline. Moreover, young women given vitamin A and tetracycline in combination for acne may be at special risk and should be kept under surveillance.     

Beh?et's disease presenting as benign intracranial hypertension.

Two siblings with Behçet''s disease presenting as benign intracranial hypertension are reported and the literature is reviewed. We suggest that raised intracranial pressure should be added to the clinical criteria considered for the diagnosis of Behçet''s disease.     

脊膜膨出术后并发良性颅内压增高23例临床分析

目的 探讨脊膜膨出术后并发良性颅内压增高的原因,总结诊治经验.方法 回顾性分析23例脊膜膨出术后片发良性颅内压增高患者的临床资料.结果 1例因延误诊疗双目几近失明,5例因诊疗不及时双眼视力明显下降,17例经过规范治疗疗效满意.结论 脊膜膨出术后可并发良性颅内压增高,早期诊断、规范治疗可取得满意疗效,延误治疗可导致视力...     

终池引流治疗良性颅内高压所致顽固性头痛

目的探讨连续终池引流治疗良性颅内高压所致顽固性头痛的临床效果。方法将60例良性颅内高压所致的头痛病例,随机分为两组,A组(研究组)常规内科治疗3日后应用连续终池引流治疗。模拟硬脊膜外麻醉L3-4或L4-5正人法穿刺进针,先确认硬膜外间隙后,继续进针到蛛网膜下腔,再置管于蛛网膜下腔终池内,低位引流200-400ml/24h,并记录治疗后(视觉模拟评分法)VAS值。结果研究组、对照组,在治疗前颅内压等差异无显著性;终池引流治疗后,研究组与对照组比较,颅内压由治疗前的(2.28±0.22)mmHg下降到(1.8±0.20)mmHg.而对照组几无变化,头痛症状减半时间、头痛治愈时间均优于对照组(P<0.01)。结论对良性颅内高压所致的顽固性头痛应用连续终池引流方法治疗效果良好。     

婴幼儿良性颅内压增高症78例诊治分析

目的 :探讨婴幼儿良性颅内压增高症的促发因素及治疗。方法 :对 78例婴幼儿良性颅内压增高症患儿的临床资料进行分析。结果 :在促发因素中 ,发热性疾病或呼吸道感染占 41 .0 % ,药物因素占 34.6% ,中耳炎占 5 .1 %。反映感染性疾病和药物是诱发婴幼儿良性颅内压增高的重要因素 ,中耳炎所占比例下降 ;全部病例经积极治疗基础疾病 ,用甘露醇及地塞米松降颅压均全部痊愈。结论 :婴幼儿良性颅内压增高症呈良性预后 ,临床医生在小儿用药上要重视药物的剂量及不良反应。     

Steroid-induced arachnoiditis

Eighteen cases are reported in which the myelographic appearances of adhesive arachnoiditis were found. These patients have had intrathecal steroid injections as either the only procedure or the most likely procedure that could have induced such changes. Adhesive arachnoiditis has not been found at this hospital in the absence of some type of intervention. Other possible iatrogenic causes of arachnoiditis have been excluded in this group. The literature on the aetiology and symptomatology of steroid-induced arachnoiditis is reviewed.     

特发性颅内压增高综合征的临床研究

特发性颅内压增高综合征(IIH)是一种相对少见、病因不明的慢性颅内压增高,易发生在育龄肥胖女性。临床以头痛、视盘水肿为主要表现,无脑结构和脑脊液成分的异常,视觉丧失是最重要的致残原因。病程早期的治疗强调减肥和服用碳酸酐酶抑制剂,若颅内高压导致进行性视力减退应提前施行视神经鞘开窗术。作者回顾了近年对该病发病机制、诊断和鉴别诊断以及治疗方面的研究进展。     

Rapid weight gain and benign intracranial hypertension in an AIDS patient on treatment with highly active anti-retroviral therapy (HAART)

We present the case of a 30-year-old woman with HIV/AIDS who experienced a 47% weight gain over a period of a year after commencing treatment with highly active anti-retroviral therapy (HAART) and went on to develop benign intracranial hypertension (BIH). She was not on any other medication associated with BIH. Although weight gain has been reported in patients on treatment with protease inhibitors, such gains have been minimal to moderate. We are unaware of any previous report of this degree of weight gain or BIH in a patient on protease inhibitors.     

Analysis of 164 patients with non-space-occupying intracranial hypertension

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高血压无症状性颅内动脉狭窄的分布特征及危险因素

目的:探讨高血压患者无症状性颅内动脉狭窄的特点及影响因素。方法:收集358例住院高血压病患者,排除合并中风或中风史、糖尿病、其他颅内疾病。用经颅多普勒超声诊断颅内动脉狭窄。结果:高血压患者颅内动脉狭窄患病率为21.79%(78/358)。共检查动脉2644条,动脉总狭窄率为6.58%(174/2644)。大脑中动脉狭窄频数最高,次为颈内动脉虹吸段。颈内动脉系统动脉狭窄明显高于椎基底动脉系统。老年高血压患者总动脉狭窄率高于非老年患者,高血压病程和动脉狭窄率之间关系明显。狭窄组LDL水平明显高于非狭窄组,HDL水平降低。结论:高血压患者最常见的无症状性颅内动脉狭窄发生在大脑中动脉和颈内动脉虹吸段,年龄、高血压病程、血LDL升高是颅内动脉狭窄的危险因素,HDL是脑血管的保护因子。     

高血压脑出血外科手术治疗

目的探讨外科手术在高血压脑出血临床治疗中的作用。方法回顾分析笔者所在医院2006～2008年中47例外科手术治疗的高血压脑出血患者。其中壳核出血21例,脑叶皮质下出血11例,小脑出血8例,单纯脑室内出血4例,丘脑出血2例,桥脑出血1例。根据患者的病情采用了小骨窗开颅血肿清除术25例,微创定向血肿抽吸术7例,骨瓣开颅血肿清除术8例,双侧脑室外引流术7例。结果血肿平均清除率在85%。术后5例患者死亡,植物状态有11例,其余患者意识状态均较手术前改善。随访中28例患者完全或部分恢复功能。结论把握手术的时机和指征,采用合理的手术方法,是治疗高血压脑出血的关键。     

原发性颅内压增高的影像学及临床研究

目的 研究原发性颅内压增高（ＩＩＨ）患者的影像学变化。方法 定量分析３２例ＩＩＨ患者垂体、蝶鞍形态的变化及其与视力变化的相关性。结果 ＩＩＨ患者可出现垂体变薄（９０．６０％）、蝶鞍扩大（５６．２２％）。垂体形态的变化与相应的视力之间具有相关性,相关系数为０．４１６（Ｐ〈０．０５）。经治疗后,２例可见垂体形态增厚。结论 垂体形态的变化可作为诊断ＩＩＨ的一个新的影像学参考指标。     

良性前列腺增生与原发性高血压的关系

目的:探讨良性前列腺增生(BPH)与原发性高血压之间的关系。方法:将100例BPH患者分为2组,其中BPH合并原发性高血压组(A组)45例,单纯 BPH组(B组)55例。A组内再根据收缩压、舒张压、高血压病程的长短分小组。对A、B组患者的发病年龄、国际前列腺症状评分(IPSS)、残余尿量、前列腺体积(PV)、血清前列腺特异性抗原、尿潴留次数等指标进行统计学分析。结果:A组患者年龄、IPSS评分、PV和尿潴留次数均大于B组(P<0.05~P<0.01)。A组中收缩压>160 mmHg组的年龄与B组差异有统计学意义(P<0.01);舒张压90~110 mmHg及舒张压>110 mmHg组的PV和尿潴留次数均大于B组(P<0.05~P<0.01);高血压病程>20年组的发病年龄、IPSS评分和尿潴留次数均大于高血压病程<10年组与病程10~20年组(P<0.05~P<0.01)。结论:高血压可能会对BPH的发生及临床进展产生影响,及早地控制和改善高血压,有利于减轻BPH相关症状。