The expanding spectrum of idiopathic intracranial hypertension

Abstract

Once considered a rare and often difficult diagnosis in the era predating routine MRI, idiopathic intracranial hypertension has become an everyday concern in ophthalmology and neurology clinics where, especially in the latter, essentially every young overweight woman with headaches is initially presumed to have IIH. Has the diagnosis of IIH become too easy, and are we over-diagnosing IIH in this period of an accelerating obesity crisis? Or are we actually missing cases of IIH because they do not fit the classic clinical profile? We think it is both: at the same time IIH is being diagnosed in excess in obese women without papilledema, often resulting in unnecessary procedures, inappropriate treatment and even iatrogenic complications, the spectrum of this disorder is expanding to include a broad array of clinical presentations that involve multiple specialists beyond just the ophthalmologist and neurologist.

摘要

在常规核磁共振成像出现前的时代, 特发性颅内高压 (IIH) 被认为是一种罕见且通常难以诊断的疾病, 如今已经成为眼科和神经科诊所日常的关注点, 特别是在后者, 基本上每个患有头痛的年轻超重女性最初都被推定为IIH。IIH的诊断是否变得过于简单, 在这个肥胖危机加速的时期, 我们是否过度诊断了IIH? 还是我们实际上遗漏了IIH的病例, 因为他们不符合经典的临床特征? 我们认为两者都是: 同时, IIH在无视神经乳头水肿的肥胖女性中被过度诊断, 往往导致不必要的操作、不恰当的治疗甚至是医源性并发症, 这种疾病疾病诊断的范围正在扩大, 包括广泛的临床表现。IIH的诊断除了与眼科医生和神经科医生有关之外, 还涉及到了多个领域的专家。