Psödotümör Serebri Sendromlu Hastaların Demografik Özellikleri ve Klinik Bulgularının Değerlendirilmesi

Year 2021, Volume: 2 Issue: 3, 185 - 189, 17.11.2021

Dilek Top Karti , Neslihan Eşkut , Özge Yılmaz Küsbeci

Abstract

Giriş: Bu çalışmanın amacı, psödotümör serebri sendromu (PTSS) hastalarına ait demografik verilerin, klinik bulguların ve tedavi sonuçlarının sunulmasıdır. Yöntemler: PTSS modifiye Dandy tanı kriterlerini karşılayan 69 hastanın klinik verileri geriye yönelik olarak incelendi. Hastaların demografik özellikleri, klinik ve radyolojik bulguları ile tedavi sonuçları kaydedildi. Bulgular: Çalışmaya 69 hasta dahil edildi (62 kadın ve 7 erkek). Hastaların ortalama yaş, kilo ve vücut kitle indeksi (VKİ) sırasıyla 37,97 ± 10,36 yıl, 84,21 ± 16,06 kg, ve 31,89 ± 5,87 idi. Baş ağrısı en sık başvuru yakınması idi ve 68 hastada papil ödemi izlendi. Ek nörolojik bulgu olarak 7 hastada, 6. kraniyal sinir paralizisi mevcuttu. En sık görülen görme alanı defekti konsantrik daralma idi. Hastaların %68,1’inde kraniyal magnetik rezonans görüntüleme sonuçları normal saptandı. Tüm hastalara asetozolamid tedavisi başlandı ve VKİ ≥ 25 olan hastalara kilo vermeleri önerisinde bulunuldu. 9 hastada asetozolamid tedavisine topiramat eklendi. Medikal tedaviye cevap vermeyen 2 hastaya optik sinir kılıf fenestrasyonu ve bir hastaya lumboperitoneal şant cerrahisi uygulandı. Takip süresince 30 hastada medikal tedavi ve kilo kaybı yardımıyla baş ağrısında tam düzelme ve görme alanı defektinde düzelme veya stabilizasyon izlendi. Sonuç: PTSS genellikle genç obez kadınları etkilemektedir. Hastaların semptom, klinik bulgu ve kraniyal görüntüleme sonuçlarının dikkatli değerlendirilmesi tanı için gereklidir. Beyin omurilik sıvısı üretiminin azaltılması ve kilo kaybı ile hastaların çoğunda semptomlar ve klinik bulgular kontrol altına alınabilir. Medikal tedaviye dirençli hastalarda, optik sinir kılıfı fenestrasyonu ve lumboperitoneal şant cerrahisi, alternatif tedavi seçenekleri arasındadır.

Keywords

Baş ağrısı, beyin omurilik sıvısı, görme bulanıklığı, psödotümör serebri sendromu

Supporting Institution

YOK

Project Number

YOK

Thanks

YOK

The Evaluation of Demographic Characteristics and Clinical Findings in Patients with Pseudotumor Cerebri Syndrome

Abstract

Introduction: The study is aimed to present demographic data, clinical findings and treatment outcomes of patients with pseudotumor cerebri syndrome (PTCS). Methods: Clinical data of 69 patients who met PTCS modified Dandy diagnostic criteria were analyzed retrospectively. Patients demographics, clinical and radiological findings and treatment outcomes recorded. Results: Sixty-nine patients were included the study (62 female and 7 male). The mean age, weight and body mass index (BMI) of the patients were 37.97 ± 10.36 years, 84.21 ± 16.06 kg, and 31.89 ± 5.87, respectively. Headache was the most common complaint, and 68 patients had papilledema. Seven patients had sixth cranial nerve paralysis as an additional neurological finding. The most common visual field defect was concentric narrowing. Cranial magnetic resonance imaging results were normal in 68.1% of the patients. Systemic acetazolamide treatment was started in all patients. In addition, weight loss was recommended in patients who have a BMI ≥ 25. Topiramate was added to acetozolamide treatment in 9 patients. Optic nerve sheath fenestration was performed in 2 patients and lumboperitoneal shunt surgery was performed in one patient who did not respond to medical treatment. Complete recovery of headache and either improvement or stabilization of visual field defect were observed in 30 patients with the help of medical treatment and weight loss during the follow-up period. Conclusion: PTCS usually affects young obese women. Careful evaluation of patient’ symptoms, clinical findings, and cranial imaging results are essential for the diagnosis. Symptoms and clinical findings can be controlled in the majority of the patients with the help of reduction of cerebrospinal fluid production and weight loss. Optic nerve sheath fenestration and lumboperitoneal shunt surgery are among the alternative treatment options in patients who are resistant to medical therapy.

Keywords

Blurred visiocn, cerebrospinal fluid, headache, pseudotumor cerebri syndrome.

Project Number

YOK

References

• 1. Friedman DI. The pseudotumor cerebri syndrome. NeurolClin. 2014;32:363-96.
• 2. Mc Geeney BE, Friedman DI. Pseudotumor cerebri pathophysiology. Headache. 2014;54:445-58.
• 3. Portelli M, Papageorgiou PN. An update on idiopathic intracranial hypertension. Acta Neurochir (Wien). 2017;159:491-99.
• 4. Madriz Peralta G, Cestari DM. An update of idiopathic intracranial hypertension. Curr Opin Ophthalmol. 2018;29:495-502.
• 5. Phillips PH, Sheldon CA. Pediatric Pseudotumor Cerebri Syndrome. J Neuroophthalmol. 2017;37 :33-40.
• 6. Wall M, Corbett JJ. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2014;83:198-9.
• 7. Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002;59:1492–5.
• 8. Smith JL. Whence pseudotumor cerebri? J Clin Neuroophthalmol.1985;5:55–6.
• 9. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159–65.
• 10. Hove MW, Friedman DI, Patel AD, Irrcher I, Wall M, McDermott MP; NORDIC Idiopathic Intracranial Hypertension Study Group. Safety and Tolerability of Acetazolamide in the Idiopathic Intracranial Hypertension Treatment Trial. J Neuroophthalmol. 2016;36:13-9.
• 11. Mukherjeem N, Bhatti MT. Update on the surgical management of idiopathic intracranial hypertension. Curr Neurol Neurosci Rep. 2014;14:438.
• 12. Arslan D, Arıkanoğlu A, Akıl E. Clinical and Demographic Features of Pseudotumor Cerebri Syndrome Diagnosed in a University Hospital. Turk J Neurol. 2017;23:60-3.
• 13. Radojicic A, Vukovic-Cvetkovic V, Pekmezovic T, Trajkovic G, Zidverc-Trajkovic J, Jensen RH. Predictive role of presenting symptoms and clinical findings in idiopathic intracranial hypertension. J Neurol Sci. 2019:399:89-93.
• 14. Kosmorsky GS. Idiopathic intracranial hypertension: pseudotumor cerebri. Headache. 2014;54:389-393.
• 15. Mondragon J, Klovenski V. Pseudotumor Cerebri. [Updated 2019 Jan 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Availablefrom: https://www.ncbi.nlm.nih.gov/books/NBK536924.
• 16. Almarzouqi SJ, Morgan ML, Lee AG. Idiopathic intracranial hypertension in the Middle East: A growing concern. Saudi J Ophthalmol 2015;29:26-31.
• 17. Mills RP, HeijlAWall M. Themorphology of visual field damage in idiopathic intracranial hypertension: an anatomic region analysis. In: Mills RP, Heijl A eds. Perimetry Update 1990/1991. Amsterdam, the Netherlands: Kugler Publishers; 1991:20–7.
• 18. Griebel SR, Kosmorsky GS. Choroidal fold sassociated with increased intracranial pressure. Am J Ophthalmol 2000;129:513–6
• 19. Barkatullah AF, Leishangthem L, Moss HE. MRI findings as markers of idiopathic intracranial hypertension. Curr Opin Neurol 2021;34:75-83.
• 20. Celebisoy N, Gokcay F, Sirin H, Akyurekli O. Treatment of idiopathic intracranial hypertension: topiramate sacetazolamide, an open-label study. Acta Neurol Scand 2007;116:322-7.
• 21. Gafoor VA, Smita B, Jose J. Long-termResponse of Cerebrospinal Fluid Pressure in Patients with Idiopathic Intracranial Hypertension - A Prospective Observational Study. Ann Indian Acad Neurol. 2017;20:220–4.
• 22. Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ, Biousse V. Brain Imaging in Idiopathic Intracranial Hypertension. J Neuroophthalmol 2015;35:400-11.
• 23. Lin A, Foroozan R, Danesh-Meyer HV, De Salvo G, Savino PJ, Sergott RC. Occurrence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension. Ophthalmology 2006;113:2281–4.
• 24. Daniels AB, Liu GT, Volpe NJ, et al. Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol 2007;143:635–41.
• 25. Sugerman HJ, DeMaria EJ, Felton WL, et al. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 1997;49:507–11
• 26. Brazis PW. Pseudotumor cerebri. Curr Neurol Neurosci Rep 2004;4:111–6.
• 27. Matthews MK, Sergott RC, Savino PJ. Pseudotumor cerebri. Curr Opin Ophthalmol 2003;14:364–70.
• 28. Lueck CJ, McIlwaine GG. Idiopathic intracranial hypertension. Pract Neurol 2002:262–71.
• 29. Johnston I, Paterson A. Benign intracranial hypertension. II. CSF pressure and circulation. Brain 1974;97:301–12.
• 30. Yazici Z, Yazici B, Tuncel E. Findings of magnetic resonance imaging after optic nerve sheath decompression in patients with idiopathic intracranial hypertension. Am J Ophthalmol 2007;144:429–35
• 31. Banta JT, Farris BK. Pseudotumor cerebri and optic nerve sheath decompression. Ophthalmology 2000;107:1907–12.