关键词: 特发性颅内压增高症, 误诊, 临床分析

Abstract:

Objective To analyze the clinical characteristics and the causes of misdiagnosis of Idiopathic intracranial hypertension（IIH） to reduce the diagnosis error rate. Design Retrospective case series. Participants 58 patients with IIH misdiagnosed as ophthalmopathy. Methods The clinical data of 58 patients with IIH （according to international of IIH）were analyzed in this retrospective research. These cases were selected from patients hospitalized in Tongren Hospital from January 2014 to December 2017, and were all misdiagnosed as ophthalmopathy before admission. Clinic data were extracted to ascertain the causes of misdiagnosis. Main Outcome Measures Clinical manifestations, misdiagnosis condition, visual function examination, imaging examination, treatment outcome after misdiagnosis and diagnosis after admission. Results 58 cases were under observation, including 22 males (37.9%) and 36 females (62.1%). The duration of disease ranged from 6 days to 8 years, with an average of 7.4 months, including 36 cases (62.1%) within 3 months. The main clinical symptoms were ocular symptoms, while continuous vision loss was the most common (62.0%). The top four misdiagnosis were optic neuritis (ON) in 32 cases (55.2%), anterior ischemic optic neuropathy(AION) in 12 cases (20.7%), papilledema in 6 cases (10.3%) and optic vasculitis in 5 cases(8.6%). 46 patients (79.3%) had received glucocorticosteroid therapy, with poor efficacy. After admission, lumbar puncture was launched and intracranial pressure of all patients was higher than 25 cmH2O. Combined with the medical history, physical signs, and results of brain/orbital imaging examination and laboratory tests, the diagnosis was confirmed as IIH. Medication or surgery may be administered depending on the patient's condition. Conclusions Patients with papilledema who are mainly characterized by decreased vision are easily misdiagnosed as optic neuritis or ischemic optic neuropathy. Timely measurement of intracranial pressure and head magnetic resonance and other auxiliary examinations can effectively improve the accuracy of clinical diagnosis. (Ophthalmol CHN, 2019, 28: 140-144)

Key words: idiopathic intracranial hypertension, misdiagnosis, clinical analysis