İdiyopatik Intrakraniyal Hipertansiyonda Klinik Özellikler, Baş Ağrısı Fenotipleri ve Nörogörüntüleme Bulguları: Tek Merkezli Çalışma

Öz

İdiyopatik intrakraniyal hipertansiyon (İİH), ikincil bir neden olmaksızın artmış intrakraniyal basınç ile karakterize olup en sık baş ağrısı ve görsel semptomlarla ilişkilidir. Bu çalışmanın amacı, İİH’li hastalarda demografik ve klinik özelliklerin yanı sıra başağrısı fenotipleri, eşlik eden semptomlar ve nörogörüntüleme bulgularını değerlendirmektir. Bu retrospektif gözlemsel çalışma, 2020–2025 yılları arasında İİH tanısı alan 80 hastayı içermektedir. Baş ağrısı özellikleri, eşlik eden semptomlar, beyin omurilik sıvısı açılış basıncı ve manyetik rezonans görüntüleme (MRG) bulguları tıbbi kayıtlardan elde edilmiştir. Migren-benzeri baş ağrısı, Uluslararası Baş Ağrısı Sınıflandırması’na göre (ICHD-3) tanımlanmıştır. Hastaların çoğu kadındı (%78,8) ve medyan tanı yaşı 38 idi. Baş ağrısı en sık başvuru semptomu olup hastaların %87,5’inde bildirilmiştir; bunu geçici görsel bulanıklık (%70,0) ve pulsatil tinnitus (%46,3) izlemiştir. Baş ağrısı olan hastaların %37,1’inde migren-benzeri baş ağrısı saptanmıştır. İİH ile ilişkili tipik MRG bulguları — empty sella veya parsiyel empty sella, perioptik subaraknoid mesafede genişleme, optik sinir tortiyozitesi ve transvers sinus stenozu— değişen oranlarda gözlenmiştir. Tüm hastalara asetazolamid başlanmış olup topiramat yaklaşık üçte birinde kullanılmış, cerrahi girişim yalnızca az sayıda hastada gerekmiştir. Bu çalışma, İİH’nin heterojen klinik bir tablo sergilediğini ve İİH’ye bağlı baş ağrısı ile migren-benzeri baş ağrısı fenotiplerinin sıklıkla örtüştüğünü göstermektedir. Bu klinik özelliklerin destekleyici görüntüleme bulgularıyla birlikte tanınması, erken tanıya katkı sağlayabilir ve primer baş ağrısı bozukluklarıyla yanlış sınıflandırmayı azaltabilir.

Anahtar Kelimeler

• idiopatik intrakraniyal hipertansiyon
• başağrısı
• migren-benzeri başağrısı
• nörogörüntüleme

Clinical Characteristics, Headache Phenotypes, and Neuroimaging Findings in Idiopathic Intracranial Hypertension: A Single-Center Study

Öz

Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure in the absence of secondary causes and is most commonly associated with headache and visual disturbances. The aim of this study was to investigate the demographic and clinical characteristics, headache phenotypes, associated symptoms, and neuroimaging findings of patients with IIH. This retrospective observational study included 80 patients diagnosed with IIH between 2020 and 2025. Clinical information including headache characteristics, associated symptoms, cerebrospinal fluid opening pressure, and magnetic resonance imaging (MRI) findings was obtained from medical records. Migraine-like headache was defined by using the International Classification of Headache Disorders, 3rd edition (ICHD-3). The majority of patients were women (78.8%), and the median age at diagnosis was 38 years. Headache was the most frequent presenting symptom (87.5%), followed by transient visual obscurations (70.0%) and pulsatile tinnitus (46.3%). Migraine-like headache was identified in 37.1% of patients with headache. Typical MRI findings of IIH—including empty or partially empty sella, perioptic subarachnoid space distension, optic nerve tortuosity, and transverse sinus stenosis—were observed at varying frequencies. Acetazolamide was prescribed to all patients, while topiramate was used in approximately one-third; surgical interventions were required in a minority of cases. The findings of this study underscore the heterogeneous clinical presentation of IIH, with substantial overlap between IIH-related and migraine-like headache phenotypes. Recognition of these clinical features, together with supportive neuroimaging findings, may facilitate earlier diagnosis and reduce misclassification with primary headache disorders.

Anahtar Kelimeler

• idiopathic intracranial hypertension
• headache
• migraine-like headache
• neuroimaging

Kaynakça

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