期刊
CEPHALALGIA
卷 24, 期 6, 页码 495-502出版社
BLACKWELL PUBLISHING LTD
DOI: 10.1111/j.1468-2982.2004.00688.x
关键词
chronic daily headache; idiopathic intracranial hypertension; intracranial pressure monitoring; papilledema; shunt
The aim of the present study was to report on the utility of continuous P-csf monitoring in establishing the diagnosis of idiopathic intracranial hypertension without papilledema (IIHWOP) in chronic daily headache (CDH) patients. We report a series of patients (n = 10) with refractory headaches and suspected IIHWOP referred to us for continuous P-csf monitoring between 1991 and 2000. P-csf was measured via a lumbar catheter and analysed for mean, peak, highest pulse amplitude and abnormal waveforms. A 1-2 day trial of continuous controlled CSF drainage (10 cc/ h) followed P-csf monitoring. Response to CSF drainage was defined as improvement in headache symptoms. Patients with abnormal waveforms underwent a ventriculoperitoneal (VPS) or lumboperitoneal (LPS) shunt insertion. All patients had normal resting P-csf (8 +/- 1 mmHg) defined as ICP < 15 mmHg. During sleep, all patients had B-waves and 90% had plateau waves or near plateau waves. All patients underwent either a VPS or LPS procedure. All reported improvement of their headache after surgery. Demonstration of pathological P-csf patterns by continuous P-csf monitoring was essential in confirming the diagnosis of IIHWOP, and provided objective evidence to support the decision for shunt surgery. Increased P-csf was seen mostly during sleep and was intermittent, suggesting that P-csf elevation may be missed by a single spot-check LP measurement. The similarity between IIHWOP and CDH suggests that continuous P-csf monitoring in CDH patients may have an important diagnostic role that should be further investigated.
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