A carregar...
Publicação
Aspetos imagiológicos da hipertensão intracraniana idiopática
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 567.31 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
Introdução: A hipertensão intracraniana idiopática, (HII), previamente designada pseudotumor cerebri, é caracterizada por um aumento da pressão intracraniana, sem causa conhecida, após a exclusão de outras possíveis causas secundárias. Os exames de neuroimagem permitem excluir causas secundárias, que requeiram intervenção emergente. Todavia, a neuroimagem tem também um pertinente contributo na deteção de sinais indiretos de HII, sobretudo em casos cujo diagnóstico clínico não é claro. Esta revisão retrospetiva de casos tem como intuito identificar a frequência dos achados imagiológicos em tomografia computorizada (TC) e ressonância magnética (RM), descritos na literatura associados a hipertensão intracraniana idiopática, num hospital universitário terciário, o Centro Hospitalar Universitário Lisboa Norte (CHULN).
Métodos: Realizou-se uma revisão retrospetiva de todos os doentes que cumpriam os seguintes critérios: 1) serem admitidos no CHULN, entre 2000-2023, 2) diagnóstico de HII confirmado, 3) pressão intracraniana superior a 250 mmH20, 4) terem realizado TC e/ou RM crânio-encefálica no CHULN e 5) idade superior a 18 anos.
A metodologia utilizada consistiu na pesquisa através de palavras-chave, nomeadamente: «hipertensão intracraniana idiopática», «pseudotumor cerebri», «papiledema» e «HII» no Sistema de Informação de Radiologia -Byme, de forma a obter os diferentes relatórios imagiológicos dos doentes com hipertensão intracraniana idiopática. O EPR-Multiplataforma foi utilizado para confirmar que foi assumido o diagnóstico de HII dos doentes selecionados, bem como para colher dados sociodemográficos e clínicos, tais como: sexo, idade, índice de massa corporal (IMC), valores da pressão de abertura intracraniana. Posteriormente, através do Sistema de Arquivo de Imagens Local e Comunicação-SECTRA, analisaram-se as imagens dos respetivos doentes com apoio da equipa de Imagiologia Neurológica do CHULN.
Resultados: 17 doentes foram selecionados com o diagnóstico de HII confirmada. Relativamente aos dados sociodemográficos, a idade dos doentes variou de 20 a 69 anos, sendo 16 do sexo feminino. O IMC foi superior a 25 kg/m2 em 76.4% dos doentes, na altura do diagnóstico. A pressão de abertura intracraniana, avaliada através de punção lombar, com o doente em decúbito, variou entre 250mmH2O e 500mmH20. Clinicamente, os sinais e sintomas mais frequentes foram cefaleias (88%) e papiledema(76%) e, menos frequentemente, diminuição da acuidade visual(45%), diplopia (23%) , náuseas e vómitos (17%), acufenos (11%) e dor ocular(5%).
Relativamente aos exames de imagem, 76% dos doentes efetuaram RM, e 100% dos doentes realizaram TC. Na TC, o padrão de sela turca parcialmente vazio, tortuosidade do nervo óptico e distensão da bainha do nervo óptico foram os achados imagiológicos mais observados (17%). Seguindo-se aplanamento do globo posterior e padrão de sela turca vazia (5%). Os achados imagiológicos encontrados na RM foram os seguintes, por ordem decrescente aplanamento do contorno posterior do globo ocular (69%), distensão da bainha do nervo óptico(69%), padrão de sela turca parcialmente vazia (46%), tortuosidade do nervo óptico (38%), estenose do seio transverso (30%), padrão de sela turca vazia(23%), protusão intraocular da cabeça do nervo óptico(7%), alargamento do cavum de Meckel (7%).
Conclusão: O diagnóstico de HII pode ser desafiante. Assim, a integração dos achados imagiológicos com dados clínicos, incluindo a punção lombar é essencial para a marcha diagnóstica.
Introduction: Idiopathic intracranial hypertension (IIH), previously referred to as pseudotumor cerebri, is characterized by an increase in intracranial pressure without a known cause, after excluding other possible secondary causes. Neuroimaging exams allow for the exclusion of secondary causes that require urgent intervention. However, neuroimaging also plays a significant role in detecting indirect signs of IIH, especially in cases where the clinical diagnosis is unclear. This retrospective review of cases aims to identify the frequency of imaging findings on computed tomography (CT) and magnetic resonance imaging (MRI) described in the literature associated with idiopathic intracranial hypertension at a tertiary university hospital, Centro Hospitalar Universitário Lisboa Norte (CHULN). Methods: A retrospective review was conducted on all patients who met the following criteria: 1) admission to CHULN between 2000-2023, 2) confirmed diagnosis of IIH, 3) intracranial pressure exceeding 250 mmH20, 4) undergoing cranial computed tomography (CT) and/or magnetic resonance imaging (MRI) at CHULN, and 5) age over 18 years. The methodology involved keyword searches, specifically for "idiopathic intracranial hypertension," "pseudotumor cerebri," "papilledema," and "IIH" in the Radiology Information System - Byme, to obtain different imaging reports of patients with idiopathic intracranial hypertension. The EPR-Multiplatform was used to confirm the diagnosis of IIH in the selected patients and to gather sociodemographic and clinical data such as gender, age, body mass index (BMI), and intracranial opening pressure values. Subsequently, using the Local Image and Communication Archive System - SECTRA, the images of the respective patients were analyzed with the support of the Neurological Imaging team at CHULN. Results: Seventeen patients were selected with confirmed IIH diagnosis. Regarding sociodemographic data, the patients' ages ranged from 20 to 69 years, with 16 being female. The BMI was above 25 kg/m2 in 76.4% of the patients at the time of diagnosis.The intracranial opening pressure, assessed through lumbar puncture with the patient in a reclined position, ranged between 250 mmH2O and 500 mmH20. Clinically, the most frequent signs and symptoms were headaches (88%) and papilledema (76%), and less frequently, decreased visual acuity (45%), diplopia (23%), nausea and vomiting (17%), tinnitus (11%), and ocular pain (5%). Regarding imaging exams, 76% of the patients underwent MRI, and 100% of the patients had a CT scan. In CT scans, the most observed imaging findings were a partially empty sella turcica, tortuosity of the optic nerve, and distension of the optic nerve sheath (17%). This was followed by flattening of the posterior globe and an empty sella turcica pattern (5%). The imaging findings in MRI were as follows, in descending order: flattening of the posterior contour of the eyeball (69%), distension of the optic nerve sheath (69%), partially empty sella turcica pattern (46%), tortuosity of the optic nerve (38%), transverse sinus stenosis (30%), empty sella turcica pattern (23%), intraocular protrusion of the optic nerve head (7%), and Meckel's cave enlargement (7%). Conclusion: The diagnosis of IIH can be challenging. Therefore, the integration of imaging findings with clinical data, including lumbar puncture, is essential for the diagnostic process.
Introduction: Idiopathic intracranial hypertension (IIH), previously referred to as pseudotumor cerebri, is characterized by an increase in intracranial pressure without a known cause, after excluding other possible secondary causes. Neuroimaging exams allow for the exclusion of secondary causes that require urgent intervention. However, neuroimaging also plays a significant role in detecting indirect signs of IIH, especially in cases where the clinical diagnosis is unclear. This retrospective review of cases aims to identify the frequency of imaging findings on computed tomography (CT) and magnetic resonance imaging (MRI) described in the literature associated with idiopathic intracranial hypertension at a tertiary university hospital, Centro Hospitalar Universitário Lisboa Norte (CHULN). Methods: A retrospective review was conducted on all patients who met the following criteria: 1) admission to CHULN between 2000-2023, 2) confirmed diagnosis of IIH, 3) intracranial pressure exceeding 250 mmH20, 4) undergoing cranial computed tomography (CT) and/or magnetic resonance imaging (MRI) at CHULN, and 5) age over 18 years. The methodology involved keyword searches, specifically for "idiopathic intracranial hypertension," "pseudotumor cerebri," "papilledema," and "IIH" in the Radiology Information System - Byme, to obtain different imaging reports of patients with idiopathic intracranial hypertension. The EPR-Multiplatform was used to confirm the diagnosis of IIH in the selected patients and to gather sociodemographic and clinical data such as gender, age, body mass index (BMI), and intracranial opening pressure values. Subsequently, using the Local Image and Communication Archive System - SECTRA, the images of the respective patients were analyzed with the support of the Neurological Imaging team at CHULN. Results: Seventeen patients were selected with confirmed IIH diagnosis. Regarding sociodemographic data, the patients' ages ranged from 20 to 69 years, with 16 being female. The BMI was above 25 kg/m2 in 76.4% of the patients at the time of diagnosis.The intracranial opening pressure, assessed through lumbar puncture with the patient in a reclined position, ranged between 250 mmH2O and 500 mmH20. Clinically, the most frequent signs and symptoms were headaches (88%) and papilledema (76%), and less frequently, decreased visual acuity (45%), diplopia (23%), nausea and vomiting (17%), tinnitus (11%), and ocular pain (5%). Regarding imaging exams, 76% of the patients underwent MRI, and 100% of the patients had a CT scan. In CT scans, the most observed imaging findings were a partially empty sella turcica, tortuosity of the optic nerve, and distension of the optic nerve sheath (17%). This was followed by flattening of the posterior globe and an empty sella turcica pattern (5%). The imaging findings in MRI were as follows, in descending order: flattening of the posterior contour of the eyeball (69%), distension of the optic nerve sheath (69%), partially empty sella turcica pattern (46%), tortuosity of the optic nerve (38%), transverse sinus stenosis (30%), empty sella turcica pattern (23%), intraocular protrusion of the optic nerve head (7%), and Meckel's cave enlargement (7%). Conclusion: The diagnosis of IIH can be challenging. Therefore, the integration of imaging findings with clinical data, including lumbar puncture, is essential for the diagnostic process.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Hipertensão intracraniana idiopática Pseudotumor cerebri Neuroimagem Papiledema Aumento da pressão intracraniana Imagiologia