benign intracranial hypertension
Introduction
Introduction to benign intracranial hypertension Benignintracranial hypertension (benignintracranialhypertension), also known as primary intracranial pressure hyperplasia (primary intracranial hypertension), pseudo-cerebral tumor (pseudocerebritumor), characterized by increased intracranial pressure, often with headache onset, can be accompanied by nausea Symptoms such as vomiting were first reported by Quincke in 1891, and the cause is still unknown. basic knowledge The proportion of illness: 0.025% Susceptible people: no special people Mode of infection: non-infectious Complications: optic nerve disease
Cause
Causes of benign intracranial hypertension
(1) Causes of the disease
The cause may include endocrine and metabolic disorders, intracranial venous sinus thrombosis, drugs and toxins, as well as primary benign intracranial hypertension, which is unknown.
(two) pathogenesis
The pathogenesis of this disease is still unclear. It is an intracranial hypertension that develops in weeks or months. The direct cause of the increase in intracranial pressure is due to the swelling of the brain parenchyma itself or the change of cerebrospinal fluid. Most people think that it is caused by cerebrospinal fluid absorption, but there is not much evidence.
Karahalios et al (1996) found that all patients with benign intracranial hypertension have increased cerebral venous pressure. In this case, cerebrospinal fluid absorption is blocked, which can cause increased intracranial pressure, but elevated cerebral venous pressure is increased intracranial pressure. The reason or the result is still unclear. In the continuous cerebrospinal fluid monitoring of patients with benign intracranial hypertension, it is found that the pressure of cerebrospinal fluid is uninterrupted, and the fluctuation of irregularity is increased. When the pressure rises, it is plateau for 20-30 minutes. After that, it will suddenly drop to normal level, just like draining the increased CSF (Johnston and Paterson, 1974). A considerable number of patients are reported to have irregular menstruation or amenorrhea, some are pregnant women, some have endocrine system dysfunction, and Some have taken tetracycline, indomethacin, oral contraceptives or other hormones, and have been reported to be associated with vitamin A poisoning. It is inferred that these conditions are related to the increase of benign intracranial pressure, but there is no substantive evidence.
Prevention
Prevention of benign intracranial hypertension
For benign intracranial hypertension and congenital anomalies, mainly timely diagnosis and early treatment.
Complication
Benign intracranial hypertension complications Complications, optic nerve disease
Potential risk of loss of vision.
Symptom
Symptoms of benign intracranial hypertension common symptoms increased intracranial pressure, intracranial hypertension, visual field reduction, localized signs, dull pain, edema, blind spots
The most common clinical symptoms are headache (94%); followed by transient blurred vision (68%); pulsatile intracranial noise (58%); double vision (38%, mostly horizontal) or blindness (30%) .
Headache can be the frontal ridge (more common) or blunt pain or tight-fitting pain; it can be diffuse or unilateral, common signs are different degrees of fundus optic disc edema, but also unilateral or bilateral nerve, peripheral vision, especially nasal or subnasal visual field reduction and blind spot enlargement are also more common, due to the alertness and early diagnosis of this disease in recent years, a considerable number of patients have no or only mild fundus edema.
Other neurological examinations and mental state of mind are normal.
CT or MRI examination of brain parenchyma is normal, the shape and size of the ventricles should be normal or slightly reduced (ventricular stenosis), the sella can be enlarged and filled with cerebrospinal fluid (empty sella), all patients have cerebrospinal fluid during lumbar puncture examination ( CSF) The pressure is increased, and the pressure is increased by 250-450mmH2O.
Examine
Examination of benign intracranial hypertension
1. Cerebrospinal fluid examination pressure is generally higher than 200mmH2O, CSF routine laboratory tests are more normal.
2. Necessary selective examination According to the possible causes, blood routine, blood electrolyte, blood sugar, immune project examination, and differential diagnosis.
3. For chronic intracranial hypertension syndrome, the skull X-ray film can be found in the saddle, especially the saddle back and anterior and posterior sacral bone destruction or absorption; the skull is diffuse and sparse and thin; the cerebral gyrus is increased and deepened. .
4. For patients with positive signs of increased intracranial pressure or positive findings in the neurological examination or clinically highly suspected increase in intracranial pressure, CT or MRI should be performed early.
Diagnosis
Diagnosis and diagnosis of benign intracranial hypertension
Diagnostic criteria
1. There are symptoms and signs of increased intracranial pressure.
2. There is no local localization sign in the nerve examination.
3. Neurological diagnostic examination has no abnormalities other than increased cerebrospinal fluid pressure (no deformation, displacement or obstruction of the ventricular system).
4. The patient is conscious.
5. There is no other cause of increased intracranial pressure.
6. If the cerebrospinal fluid is abnormal, the diagnosis is not established.
Differential diagnosis
Mainly have dural sinus recessive embolism, diffuse disease, cancerous meningitis, granulomatous meningitis and micro-cerebral artery malformation, etc., the main features of the above lesions can cause headache, optic disc edema, severe intracranial pressure, However, there are no space-occupying lesions in the imaging examination. There are no other localization signs in the neurological examination. Cerebral dural venous sinus embolism (including cerebral large vein embolism) and benign intracranial hypertension are sometimes almost indistinguishable in clinical practice, but Cerebral dural venous sinus embolism is acute, headache is mostly at the top, and there may be epilepsy. Note that the shape of the superior sagittal sinus when MRI or contrast CT is helpful for differential diagnosis.
