Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector48910.17816/ACEN.2017.3.8Clinical analysisКлинический разборUnknownBenign intracranial hypertension: clinical observationsДоброкачественная внутричерепная гипертензия: клинические наблюденияMagzhanovRim V.МагжановРим В.
Russian Federation
angelika7d@mail.ruDavletovaAnzhelika I.ДавлетоваАнжелика И.
Russian Federation
angelika7d@mail.ruBakhtiyarovaKlara Z.БахтияроваКлара З.
Russian Federation
angelika7d@mail.ruPervushinaEkaterina V.ПервушинаЕкатерина В.
Russian Federation
angelika7d@mail.ruTunikValeriy F.ТуникВалерий Ф.
Russian Federation
angelika7d@mail.ruBashkir State Medical UniversityФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава РФKuvatov Republican Clinical HospitalГБУЗ «Республиканская клиническая больница им. Г.Г. Куватова»28092017113535928092017Copyright ©; 2017, Magzhanov R.V., Davletova A.I., Bakhtiyarova K.Z., Pervushina E.V., Tunik V.F.Copyright ©; 2017, Magzhanov R.V., Davletova A.I., Bakhtiyarova K.Z., Pervushina E.V., Tunik V.F.2017Magzhanov R.V., Davletova A.I., Bakhtiyarova K.Z., Pervushina E.V., Tunik V.F.Magzhanov R.V., Davletova A.I., Bakhtiyarova K.Z., Pervushina E.V., Tunik V.F.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/489

The complexity of diagnosing benign intracranial hypertension is associated with the low specificity of symptoms. For a timely diagnosis and exclusion of the secondary nature of the disease, it is sometimes necessary to conduct a broad range of additional examinations. The article describes 2 cases of benign intracranial hypertension, representing a diagnostic challenge. In the first case the disease developed in a patient with iron deficiency, hyperprolactinemia and obesity. The patient was treated with diuretics and corticosteroids, therapeutic lumbar punctures were performed. In the second case the disease developed in a patient with recent childbearing, obesity and mastitis. Due to the ineffectiveness of drug therapy surgery was carried out – ventriculoperitoneal shunting was performed with a temporary positive effect. Later breast cancer was diagnosed. The etiology, epidemiology, pathogenesis and symptoms of the disease are discussed. Particular attention is focused on the treatment of benign intracranial hypertension.

Сложность диагностики доброкачественной внутричерепной гипертензии обусловлена низкой специфичностью симптоматики. Для своевременной постановки диагноза и исключения вторичной природы заболевания порой необходимо провести целый комплекс дополнительных обследований. В статье описаны 2 клинических случая доброкачественной внутричерепной гипертензии, представлявших определенные диагностические трудности. У первой пациентки заболевание развилось на фоне железодефицитной анемии, гиперпролактинемии и ожирения, проводилась консервативная терапия диуретиками, кортикостероидами, также были выполнены лечебные люмбальные пункции. У второй – на фоне недавних родов в анамнезе, избыточной массы тела, нелактационного мастита; вследствие неэффективности медикаментозного лечения проведено оперативное вмешательство – вентрикулоперитонеальное шунтирование с временным положительным эффектом, позже диагностирован рак молочной железы. Также рассмотрены вопросы этиологии, эпидемиологии, патогенеза и клинической картины заболевания. Уделено внимание тактике лечения таких пациентов.

benign intracranial hypertension, iron deficiency, hyperprolactinemia, breast cancerдоброкачественная внутричерепная гипертензия, железодефицитная анемия, гиперпролактинемия, рак молочной железыBandyopadhyay S. Pseudotumor cerebri. Arch. Neurol. 2001; 58(10): 1699-1701. PMID: 11594936, doi: 10.1001/archneur.58.10.1699.Wall M. Idiopathic intracranial hypertension. Neurol. Clin. 2010; 28: 593–617. PMID: 20637991, doi: 10.1016/j.ncl.2010.03.003.Kaul B., Ramanarayanan S., Mahapatra H. et al. Iron deficiency masquerading as idiopathic intracranial hypertension. BMJ Case Rep. 2009. PMID: 21686848, doi: 10.1136/bcr.06.2008.0346.Huna-Baron R., Kupersmith M.J. Idiopathic intracranial hypertension in pregnancy. J. Neurol. 2002; 249(8): 1078-1081. PMID: 12195458, doi: 10.1007/s00415-002-0791-4Durcan F.J., Corbett J.J., Wall M. The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana. Arch. Neurol. 1988; 45(8): 875-877. PMID: 3395261, doi: 10.1001/archneur.1988.00520320065016.Raoof N., Sharrack B., Pepper I.M., Hickman S.J. The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK. Eur J Neurol. 2011; 18(10): 1266-1268. PMID: 21426442, doi: 10.1111/j.1468-1331.2011.03372.x.Sergeev A. V. [Idiopathic intracranial hypertension]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2016; 116(5): 93-97. (in Russ.). doi: 10.17116/jnevro20161165193-97.Boulton M., Armstrong D., Flessner M. et al. Raised intracranial pressure increases CSF drainage through arachnoid villi and extracranial lymphatics. Am J Physiol. 1998; 275(3 Pt 2): 889–896. PMID: 9728088.Johnson L.N., Krohel G.B., Madsen R.W., March G.A. Jr. The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri). Ophthalmology. 1998; 105(12): 2313-2317. PMID: 9855165, doi: 10.1016/S0161-6420(98)91234-9.Higgins J.N., Gillard J.H., Owler B.K. et al. MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry. 2004; 75(4): 621-625. PMID: 15026510, DOI: http://dx.doi.org/10.1136/jnnp.2003.021006.Farb R.I., Vanek I., Scott J.N. et al. Idiopathic intracranial hypertension:the prevalence and morphology of sinovenous stenosis. Neurology. 2003; 60(9): 1418-24. PMID: 12743224, DOI: http://dx.doi.org/10.1212/01.WNL.0000066683.34093.E2.Gasparyan S.S., Eliseeva N.M., Tanyashin S.V. Klinicheskie rekomendatsii. Diagnostika i lechenie dobrokachestvennoy vnutricherepnoy gipertenzii. [Clinical recommendations. Diagnosis and treatment of benign intracranial hypertension]. Moscow. 2015. 17 p. (in Russ.).Sugerman H.J., DeMaria E.J., Felton W.L. 3rd et al. Increased intra-abdominal pressure and cardiac filling pressures in obesity associated pseudotumor cerebri. Neurology. 1997; 49(2): 507-511. PMID: 9270586, doi: http://dx.doi.org/10.1212/WNL.49.2.507.Ooi L.Y., Walker B.R., Bodkin P.A., Whittle I.R. Idiopathic intracranial hypertension: can studies of obesity provide the key to understanding pathogenesis? Br J Neurosurg. 2008; 22(2): 187-194. PMID: 18348012, doi: 10.1080/02688690701827340.Sinclair A.J.,Walker E.A., Burdon M.A. et al. Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: a link between 11 beta HSD1 and intracranial pressure regulation? J Clin Endocrinol Metab. 2010; 95(12): 5348-5356. PMID: 20826586, doi: 10.1210/jc.2010-0729.Giuseffi V., Wall M., Siegel P.Z. et al. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology. 1991; 41: 239–244. PMID: 1992368.Friedman D.I., Jacobson D.M. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002; 59: 1492–1495. PMID: 12455560, DOI: http://dx.doi.org/10.1212/01.WNL.0000029570.69134.1B.Mollan S.P., Ali F., Hassan-Smith G. et al. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry. 2016; 87(9): 982-992. PMID: 26888960, doi: 10.1136/jnnp-2015-311302.Brodsky M.C., Vaphiades M. Magnetic resonance imaging in pseudotumor cerebri. Ophthalmology. 1998; 105: 1686–1693. PMID: 9754178, doi: 10.1016/S0161-6420(98)99039-X.Agid R., Farb R.I., Willinsky R.A. et al. Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology. 2006; 48(8): 521-527. PMID: 16703359, doi: 10.1007/s00234-006-0095-y.McGirt M.J., Woodworth G., Thomas G. et al. Cerebrospinal fluid shunt placement for pseudotumor cerebri - associated intractable headache: predictors of treatment response and an analysis of long-term outcomes. J Neurosurg. 2004; 101(4): 627-632. PMID: 15481717, doi: 10.3171/jns.2004.101.4.0627.Acheson J.F., Green W.T., Sanders M.D. Optic nerve sheath decompression for the treatment of visual failure in chronic raised intracranial pressure. J Neurol Neurosurg Psychiatry. 1994; 57(11): 1426-1429. PMID: 7964827, DOI:http://dx.doi.org/10.1136/jnnp.57.11.1426. 23. Goh K.Y., Schatz N.J., Glaser J.S. Optic nerve sheath fenestration for pseudotumor cerebri. J Neuroophthalmol. 1997; 17(2): 86-91. PMID: 9176777, DOI:http://dx.doi.org/10.1097/00041327-199706000-00003.Chandrasekaran S., McCluskey P., Minassian D., Assaad N. Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions. Clin Exp Ophthalmol. 2006; 34(7): 661-665. PMID: 16970759, doi: 10.1111/j.1442-9071.2006.01301.x.Corbett J.J. The 1982 Silversides lecture. Problems in the diagnosis and treatment of pseudotumor cerebri. Can J Neurol Sci. 1983; 10(4): 221-229. PMID: 6652584.Keren T., Lahat E. Pseudotumor cerebri as a presenting symptom of acute sinusitis in a child. Pediatr Neurol. 1998; 19(2): 153-154. PMID: 9744640, DOI: http://dx.doi.org/10.1016/S0887-8994(98)00035-6.Onwuchekwa A.C., Nwankwo C.N., Chapp-Jumbo E.N. A 14-year-old Nigerian female with idiopathic intracranial hypertension (Pseudotumor cerebri or benign intracranial hypertension). Afr Health Sci. 2002; 2(3): 124–126. PMID: 12789098.Johnston M., Zakharov A., Papaiconomou C. et al. Evidence of connections between cerebrospinal fluid and nasal lymphatic vessels in humans, non-human primates and other mammalian species. Cerebrospinal Fluid Res. 2004; 1(1): 2. PMID: 15679948, doi: 10.1186/1743-8454-1-2.Kupersmith M.J., Gamell L., Turbin R. et al. Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology. 1998; 50(4): 1094-1098. PMID: 9566400, DOI: http://dx.doi.org/10.1212/WNL.50.4.1094.Shishkova V.N. [Obesity and hyperprolactinemia]. Consilium Medicum. 2010; 12: 83-86. (in Russ.).Egorova E.S. [Risk factors for the optic nerve secondary atrophy development in patients with idiopathic intracranial hypertension]. Vestnik VGMU. 2016; 15(3): 78-83. (in Russ.).