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Clinical and demographic data of patients followed up with the diagnosis of pseudotumor cerebri in Erzurum and environmental provinces

Year 2019, Volume: 16 Issue: 2, 331 - 335, 29.08.2019
https://doi.org/10.35440/hutfd.531383

Abstract

Background: Pseudotumor cerebri is a common disease in
reproductive-age women characterized by increased intracranial pressure. The
aim of our study was to investigate the clinical and demographic
characteristics of pseudotumor cerebri patients from Erzurum and nearby
provinces living in eastern Turkey.

Methods: In our study, the records of 27 patients from
Erzurum and nearby provinces, followed-up with the diagnosis of pseudotumor
cerebri at the Ataturk University, Neurology Outpatient Clinic between January
2015 and December 2018, were retrospectively reviewed. The diagnosis of the
patients was made with modified Dandy criteria.

Results: Of the patients, 23 (85.18%) were female and
4 (14.81%) were male. The mean age was 38.75 in females and 48.25 in males. Of
the patients, 17 (62.96%) had headache, 14 (51.85%) had blurred vision, 4
(14.81%) had double vision, 5 (18.51%) had nausea and vomiting, 3 (11.11%) had
tinnitus. Fundus examination revealed unilateral papilledema in 3 (11.11%)
patients and bilateral papilledema in 24 (88.88%) patients. The mean CSF
pressure measurement was 348.33 mmH2O. Magnetic resonance venography showed
unilateral hypoplasia of the transverse sinus in 5 (18.51%) patients.
Distention of the perioptic subarachnoid space was the most common finding on
Magnetic resonance Imaging examinations with 62.96% (n=17). Obesity and history
of drug use were found to be the etiological causes in 8 and 3 patients,
respectively, while the etiology could not be determined in 16 patients.







Conclusion: The most common symptom is headache and
findings is papillary edema in patients. Neuroimaging does not show parenchymal
or meningeal pathology, but findings that support the diagnosis are observed.
Since the most important complication of the disease is loss of vision, early
diagnosis is important to maintain visual functions.

References

  • 1. Quincke H. Uber meningitis serosa: Sammlung Klinische Vortrage 67. Inn Med 23. 1893:655–694.
  • 2. Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management and future directions. The Lancet Neurol 2016; 15(1):78–91.
  • 3. Mollan SP, Ali F, Hassan-Smith G, Botfield, H, Friedman DI, Sinclair AJ. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry 2016; 87(9):982–992.
  • 4. Orefice G, Celentano L, Scaglione M, Davoli M, Striano S. Radioisotopic cisternography in benign intracranial hypertension of young obese women. A seven-case study and pathogenetic suggestions. Acta Neurol (Napoli) 1992; 14(1):39–50.
  • 5. Smith SV, Friedman DI. The idiopathic intracranial hypertension treatment trial: a review of the outcomes. Headache 2017; 57(8):1303–1310.
  • 6. Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, et all. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 2014; 71(6): 693–701.
  • 7. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, (beta version). Cephalalgia 2013;33(9):629-808.
  • 8. Giuseffi V, Wall M, Siegel PZ, Rojas PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology 1991;41(2 part 1):239-244.
  • 9. Keltner JL, Johnson CA, Cello KE, Wall M. Baseline visual field findings in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Invest Ophthalmol Vis Sci 2014; 55(5):3200–3207.
  • 10. Friedman DI, Liu G, Digre KB. Diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81(13):1159–1165.
  • 11. Friedman DI. The pseudotumor cerebri syndrome. Neurologic Clinics 2014; 32(2): 363-396.
  • 12. Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, et all. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol. 1982;39(8):461-474.
  • 13. Aylward SC, Aronowitz C, Roach ES. Intracranial hypertension without papilledema in children. J Child Neurol 2016;31(2):177-183.
  • 14. Wall M. The headache profile of idiopathic intracranial hypertension. Cephalalgia 1990;10(6):331-335.
  • 15. Kupersmith MJ, Gamell L, Turbin R, Peck V, Spiegel P, Wall M. Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology 1998;50(4):1094–1098.
  • 16. Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain 1991; 114(1):155–180.
  • 17. Almarzouqi SJ, Morgan ML, Lee AG. Idiopathic intracranial hypertension in the Middle East: A growing concern. Saudi J Ophthalmol 2015;29(1):26-31.
  • 18. Cleves-Bayon C. Idiopathic intracranial hypertension in children and adolescents: an update. Headache J Head Face Pain. 2017;58(3): 485–93.
  • 19. Portelli M, Papageorgiou P. An update on idiopathic intracranial hypertension. Acta Neurochir. 2016;159(3):491–9.
  • 20. Thambisetty M, Lavin P, Newman N, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology. 2007;68(3):229–32.
  • 21. Huna-Baron R, Kupersmith M. Idiopathic intracranial hypertension in pregnancy. J Neurol. 2002;249(8):1078–81.

Erzurum ve çevre illerde psödotümör serebri tanısı ile takip edilen hastaların klinik ve demografik verileri

Year 2019, Volume: 16 Issue: 2, 331 - 335, 29.08.2019
https://doi.org/10.35440/hutfd.531383

Abstract

Amaç: Psödotümör serebri kafa içi basınç
artışı ile karakterize olan ve doğurganlık çağındaki kadınlarda sık görülen bir
hastalıktır. Çalışmamızda Türkiye’nin doğusunda yaşayan Erzurum ve çevre
illerden gelen psödotümör serebri hastalarının klinik ve demografik
özelliklerinin araştırılması amaçlanmıştır.

Materyal
ve Metot:

Çalışmamızda Ocak 2015-Aralık 2018 tarihleri arasında Atatürk Üniversitesi
Nöroloji kliniğinde psödotümör serebri tanısı ile takip edilen Erzurum ve çevre
illerden gelen 27 hastanın kayıtları retrospektif olarak tarandı. Hastaların
tanısı modifiye Dandy kriteleri ile konuldu.

Bulgular: Hastaların 23’ ü (%85,18) kadın, 4’ü
(%14,81) erkekti. Yaş ortalaması kadınlarda 38,75, erkeklerde 48,25 idi. 17
(%62,96) hastada baş ağrısı, 14 (%51,85) hastada bulanık görme, 4 (%14,81)
hastada çift görme, 5 (%18,51) hastada bulantı-kusma, 3 (%11,11) hastada kulak
çınlaması vardı. Göz dibi muayenesinde 3 (%11,11) hastada tek taraflı, 24
(%88,88) hastada bilateral papil ödem izlenmişti. BOS basınç ölçümü ortalaması
348,33 mmH2O idi. Manyetik rezonans venografide 5 (%18,51) hastada
transvers sinüste tek taraflı hipoplazi izlenmişti. Manyetik rezonans
görüntüleme incelemelerinde %62,96 (n=17) ile perioptik subaraknoid boşluğun
genişlemesi en sık görülen bulguydu. Etiyolojik neden olarak 8 hastada obesite,
3 hastada ilaç kullanım öyküsü tesbit edilirken 16 hastada etiyoloji
saptanamadı.







Sonuç: Hastalarda en sık görülen semptom baş
ağrısı ve en sık muayene bulgusu papil ödemdir. Nörogörüntülemede parankimal
veya meningeal patoloji olmayıp tanıyı destekleyici bulgular izlenir.
Hastalığın en önemli komplikasyonu görme kaybı olduğundan erken tanı vizüel
fonksiyonları korumak için önemlidir.

References

  • 1. Quincke H. Uber meningitis serosa: Sammlung Klinische Vortrage 67. Inn Med 23. 1893:655–694.
  • 2. Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management and future directions. The Lancet Neurol 2016; 15(1):78–91.
  • 3. Mollan SP, Ali F, Hassan-Smith G, Botfield, H, Friedman DI, Sinclair AJ. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry 2016; 87(9):982–992.
  • 4. Orefice G, Celentano L, Scaglione M, Davoli M, Striano S. Radioisotopic cisternography in benign intracranial hypertension of young obese women. A seven-case study and pathogenetic suggestions. Acta Neurol (Napoli) 1992; 14(1):39–50.
  • 5. Smith SV, Friedman DI. The idiopathic intracranial hypertension treatment trial: a review of the outcomes. Headache 2017; 57(8):1303–1310.
  • 6. Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, et all. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 2014; 71(6): 693–701.
  • 7. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, (beta version). Cephalalgia 2013;33(9):629-808.
  • 8. Giuseffi V, Wall M, Siegel PZ, Rojas PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology 1991;41(2 part 1):239-244.
  • 9. Keltner JL, Johnson CA, Cello KE, Wall M. Baseline visual field findings in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Invest Ophthalmol Vis Sci 2014; 55(5):3200–3207.
  • 10. Friedman DI, Liu G, Digre KB. Diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81(13):1159–1165.
  • 11. Friedman DI. The pseudotumor cerebri syndrome. Neurologic Clinics 2014; 32(2): 363-396.
  • 12. Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, et all. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol. 1982;39(8):461-474.
  • 13. Aylward SC, Aronowitz C, Roach ES. Intracranial hypertension without papilledema in children. J Child Neurol 2016;31(2):177-183.
  • 14. Wall M. The headache profile of idiopathic intracranial hypertension. Cephalalgia 1990;10(6):331-335.
  • 15. Kupersmith MJ, Gamell L, Turbin R, Peck V, Spiegel P, Wall M. Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology 1998;50(4):1094–1098.
  • 16. Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain 1991; 114(1):155–180.
  • 17. Almarzouqi SJ, Morgan ML, Lee AG. Idiopathic intracranial hypertension in the Middle East: A growing concern. Saudi J Ophthalmol 2015;29(1):26-31.
  • 18. Cleves-Bayon C. Idiopathic intracranial hypertension in children and adolescents: an update. Headache J Head Face Pain. 2017;58(3): 485–93.
  • 19. Portelli M, Papageorgiou P. An update on idiopathic intracranial hypertension. Acta Neurochir. 2016;159(3):491–9.
  • 20. Thambisetty M, Lavin P, Newman N, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology. 2007;68(3):229–32.
  • 21. Huna-Baron R, Kupersmith M. Idiopathic intracranial hypertension in pregnancy. J Neurol. 2002;249(8):1078–81.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Fatma Şimşek 0000-0003-1662-5534

Nuray Bilge 0000-0002-9328-1678

Mustafa Ceylan 0000-0002-9916-0156

Publication Date August 29, 2019
Submission Date February 23, 2019
Acceptance Date May 15, 2019
Published in Issue Year 2019 Volume: 16 Issue: 2

Cite

Vancouver Şimşek F, Bilge N, Ceylan M. Erzurum ve çevre illerde psödotümör serebri tanısı ile takip edilen hastaların klinik ve demografik verileri. Harran Üniversitesi Tıp Fakültesi Dergisi. 2019;16(2):331-5.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty