한국인 환자 대상 특발두개내압상승의 임상적 특징 및 시력 예후: 단일 의료기관 분석
Clinical Characteristics and Visual Prognosis of Idiopathic Intracranial Hypertension in Korea: A Single-center Experience
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 한국인을 대상으로 특발두개내압상승의 임상적 양상, 인구 통계학적 특성 및 시력 예후에 대해 분석하고자 하였다. 대상과 방법: 2011년 9월부터 2023년 1월까지 삼성서울병원 신경안과 클리닉을 방문한 특발두개내압상승 환자들의 의무기록을 후향적으로 분석하였다. 발병 당시의 인구 통계학적 특성, 임상 양상, 마지막 진료 당시의 시력 예후를 종합적으로 평가하였다. 결과: 총 34명 중 20명은 변형 Dandy criteria를 충족하였고 나머지 14명은 특발두개내압상승 의증이었다. 여성은 29명(85.3%)이었다. 평균 비만도는 29.15 ± 6.43으로, 16명(47.0%)이 비만 범주에 속하였다. 가장 흔한 증상은 두통(29명, 85.3%), 박동성 이명(22명, 64.7%), 일시적 시야흐림(11명, 32.4%) 순이었다. 6개월 이상 추적 관찰한 23명의 환자 중 20명(87.0%)에서 좋은 예후를 보였으며, 2명(8.7%)은 보통, 1명(4.3%)은 나쁜 예후를 보였다. 시신경위축은 9안(19.6%)에서 관찰되었다. 초기와 마지막 검진에서의 시신경 주위 망막신경섬유층의 평균 두께는 각각 우안 143.56 ± 62.41 μm, 좌안 139.3 ± 76.38 μm에서 97.39 ± 25.72 μm, 94.91 ± 19.32 μm로 감소하였다. 결론: 한국인의 경우 서구권에 비해 비만 환자의 비율이 여전히 낮았으나, 이전 보고된 것에 비해 그 비율과 평균 비만도 수치가 비교적 증가한 양상이었다. 또한 대부분의 환자들에서 양호한 시력 경과를 보였다.
Abstract
Purpose: To examine the clinical characteristics, demographic features, and visual prognosis of idiopathic intracranial hypertension (IIH) in Korean patients. Methods: We conducted a retrospective chart review of patients diagnosed with IIH who visited the Neuro-ophthalmology Clinic at Samsung Medical Center from September 2011 to January 2023. This analysis focused on demographic characteristics at onset, clinical manifestations, and visual outcomes at the last follow-up. Results: Out of 34 patients, 20 met the modified Dandy criteria and 14 were presumed to have IIH. The mean age at onset was 32.97 ± 9.6 years with females comprising 85.3% (n = 29) of the sample. The average body mass index (BMI) was 29.15 ± 6.43, with 47.0% of patients (n = 16) classified as obese. The most frequent symptom was headache, reported by 85.3% (n = 29) of patients, followed by pulsatile tinnitus (64.7%, n = 22) and transient visual obscuration (TVO; 32.4%, n = 11). Treatment included observation for 3 patients (8.8%), acetazolamide therapy for 26 patients (76.5%), and ventriculo-peritoneal shunt (V-P shunt) for 2 patients (5.9%). Out of 23 patients with follow-up > 6 months, 87.0%, 8.7%, and 4.3% showed good, fair, and poor visual outcomes, respectively; optic nerve atrophy was observed in 19.6% (9 eyes). The initial peripapillary retinal nerve fiber layer (pRNFL) thickness measured by OCT was 143.56 ± 62.41 μm in the right eye and 139.3 ± 76.38 μm in the left which decreased to 97.39 ± 25.72 and 94.91 ± 19.32 μm, respectively by the last examination. Conclusions: While the proportion of obese patients in this Korean cohort and the average BMI were lower than in western countries, both have increased relative to previous reports from Korea. Most patients experienced a benign course.
참고문헌 (38)
- Wakerley BR, "Idiopathic intracranial hypertension", Cephalalgia, 35, pp.248~261 (2015)
- Wall M, "Update on idiopathic intracranial hypertension", Neurol Clin, 35, pp.45~57 (2017)
- Raoof N, "Diagnosis and treatment of idiopathic intracranial hypertension", Cephalalgia, 41, pp.472~478 (2021)
- Markey KA, "Understanding idiopathic intracranial hypertension : mechanisms, management, and future directions", Lancet Neurol, 15, pp.78~91 (2016)
- Wang MTM, "Idiopathic intracranial hypertension : pathophysiology, diagnosis and management", J Clin Neurosci, 95, pp.172~179 (2022)
- Baheti NN, "Long-term visual outcome in idiopathic intracranial hypertension", Ann Indian Acad Neurol, 14, pp.19~22 (2011)
- Mollan SP, "Idiopathic intracranial hypertension : consensus guidelines on management", J Neurol Neurosurg Psychiatry, 89, pp.1088~1100 (2018)
- Per H, "Clinical spectrum of the pseudotumor cerebri in children : etiological, clinical features, treatment and prognosis", Brain Dev, 35, pp.561~568 (2013)
- Radhakrishnan K, "Idiopathic intracranial hypertension(pseudotumor cerebri). Descriptive epidemiology in Rochester, Minn, 1976 to 1990", Arch Neurol, 50, pp.78~80 (1993)
- Yiangou A, "Idiopathic intracranial hypertension : a step change in understanding the disease mechanisms", Nat Rev Neurol, 19, pp.769~785 (2023)
- Liu IH, "Idiopathic intracranial hypertension : clinical features in Chinese patients", Jpn J Ophthalmol, 55, pp.138~142 (2011)
- Pal A, "Pattern of idiopathic intracranial hypertension in indian population", Ann Indian Acad Neurol, 22, pp.350~351 (2019)
- Kim TW, "Obesity may not be a risk factor for idiopathic intracranial hypertension in Asians", Eur J Neurol, 15, pp.876~879 (2008)
- Sharma B, "Clinical and radiological profile of 122 cases of idiopathic intracranial hypertension in a tertiary care centre of india : an observational study", Neurol India, 70, pp.704~709 (2022)
- Rao HL, "Relationship between severity of visual field loss at presentation and rate of visual field progression in glaucoma", Ophthalmology, 118, pp.249~253 (2011)
- Park KA, "Characteristics of optic neuritis in South Korean children and adolescents : a retrospective multicenter study", J Ophthalmol, 2022, pp.4281772~ (2022)
- Alberti KG, "The metabolic syndrome--a new worldwide definition", Lancet, 366, pp.1059~1062 (2005)
- Frisén L, "Swelling of the optic nerve head : a staging scheme", J Neurol Neurosurg Psychiatry, 45, pp.13~18 (1982)
- Corbett JJ, "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, 39, pp.461~474 (1982)
- Wall M, "Idiopathic intracranial hypertension. A prospective study of 50 patients", Brain, 114, pp.155~180 (1991)
- Chen JJ, "Causes and prognosis of visual acuity loss at the time of initial presentation in idiopathic intracranial hypertension", Invest Ophthalmol Vis Sci, 56, pp.3850~3859 (2015)
- Yabe I, "Incidence of idiopathic intracranial hypertension in Hokkaido, the northernmost island of Japan", J Neurol, 247, pp.474~475 (2000)
- Miah L, "Incidence, prevalence and health care outcomes in idiopathic intracranial hypertension : a population study", Neurology, 96, pp.e1251~e1261 (2021)
- Mollan SP, "The expanding burden of idiopathic intracranial hypertension", Eye(Lond), 33, pp.478~485 (2019)
- Bruce BB, "Idiopathic intracranial hypertension in men", Neurology, 72, pp.304~309 (2009)
- Durcan FJ, "The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana", Arch Neurol, 45, pp.875~877 (1988)
- Galvin JA, "Clinical characterization of idiopathic intracranial hypertension at the Detroit Medical Center", J Neurol Sci, 223, pp.157~160 (2004)
- Radhakrishnan K, "Epidemiology of idiopathic intracranial hypertension : a prospective and case-control study", J Neurol Sci, 116, pp.18~28 (1993)
- Wall M, "Idiopathic intracranial hypertension", Neurol Clin, 28, pp.593~617 (2010)
- Wall M, "The idiopathic intracranial hypertension treatment trial : clinical profile at baseline", JAMA Neurol, 71, pp.693~701 (2014)
- Yang YS, "Obesity fact sheet in Korea, 2021 : trends in obesity prevalence and obesity-related comorbidity incidence stratified by age from 2009 to 2019", J Obes Metab Syndr, 31, pp.169~177 (2022)
- Haam JH, "Diagnosis of obesity : 2022 update of clinical practice guidelines for obesity by the Korean society for the study of obesity", J Obes Metab Syndr, 32, pp.121~129 (2023)
- Razak F, "Defining obesity cut points in a multiethnic population", Circulation, 115, pp.2111~2118 (2007)
- Al-Hashel JY, "Demographics, clinical characteristics, and management of idiopathic intracranial hypertension in Kuwait : a single-center experience", Front Neurol, 11, pp.672~ (2020)
- Thambisetty M, "Fulminant idiopathic intracranial hypertension", Neurology, 68, pp.229~232 (2007)
- Celebisoy N, "Pseudotumor cerebri : etiological factors, presenting features and prognosis in the western part of Turkey", Acta Neurol Scand, 106, pp.367~370 (2002)
- Kesler A, "Idiopathic intracranial hypertension : risk of recurrences", Neurology, 63, pp.1737~1739 (2004)
- Satti SR, "Meta-analysis of CSF Diversion procedures and dural venous sinus stenting in the setting of medically refractory idiopathic intracranial hypertension", Am J Neuroradiol, 36, pp.1899~1904 (2015)