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神经疾病

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特发性颅内高压导致的视力丧失
原作者: Danya Khoujah,江利冰 翻译 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2014-12-18

Title: Visual Loss in Idiopathic Intracranial Hypertension
题目:特发性颅内高压导致的视力丧失
Author 作者: Danya Khoujah
翻译:江利冰 校对:肖锋

There are a few available options for treatment of visual loss due to idiopathic intracranial hypertension (IIH). The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT), the first randomized, prospective, placebo-controlled trial for the treatment of patients with visual loss from IIH, which results were published earlier this year, provided substantial evidence for the first 2 options.
对于特发性颅内高压引起的视力丧失,有一些可选的治疗方案。特发性颅内高压治疗试验(IIHTT)是第一个关于治疗特发性颅内高压引起的视力丧失的随机分配,安慰剂对照试验,在今年早些时候发表,其结果为以下的前2个治疗选择提供了确实的证据。

1.Weight loss
减轻体重
2.Carbonic anhydrase inhibitors, such as Acetazolamide
碳酸酐酶抑制剂,例如乙酰唑胺
3.Therapeutic lumbar puncture (reserved for pregnant patients or for occasional flare-ups)
治疗性腰椎穿刺(适合于孕妇或者偶然突发的患者)
4.Surgery:
手术:
a.Optic nerve sheath fenestration (ONSF): visual acuity and fields improve in most cases, but symptoms may recur. Benefit? No hardware!
视神经鞘减压术(ONSF):在大多数患者视力和视野都会改善,但是症状可能会再次发生。有用吗?没有确实的证据!
       b.  Shunts: ventriculoperitoneal (VP) and lumboperitoneal (LP) shunts are the most frequently used. No clear benefit for one over the other. VP shunts may be programmable.
分流术:脑室腹腔引流术(VP)和腰池腹腔引流术(LP)是最常使用的。两者没有明确的孰优孰劣。脑室腹腔引流术可能可以程序控制。
       c.   Cerebral venous stenting: endovascular stenting of the transverse sinus may improve the symptoms in some people.
脑静脉支架:横窦血管内支架可能可以改善一些患者的症状。
 
BONUS PEARL: The headache does not correlate with the lumbar opening pressure, degree of papilledema or amount of visual loss. None of the above-mentioned management strategies is meant for the treatment of the headache alone. For that, medical management with standard symptomatic treatments, avoiding opiates and barbiturates, is recommended. Surgery is not recommended for headache alone.
 额外的要点:头痛和脑脊液初始压力、视神经乳头的水肿程度或者视力的丧失程度是没有关系的。以上所提到的治疗策略并不是单单为了治疗头痛。对于头痛,标准的药物对症治疗是推荐的,但是避免使用阿片类药物和巴比妥类药物。单纯的头痛是不推荐外科治疗的。

References 参考文献
Friedman DI. Papilledema and idiopathic intracranial hypertension. Continuum. 2014 Aug;20(4 Neuro-ophthalmology)
 

文章来源:《中华急诊医学杂志》编辑部