PSEUDOTUMOR CEREBRI - CT FINDINGS AND CORRELATION WITH VISION LOSS
PSEUDOTUMOR CEREBRI - CT FINDINGS AND CORRELATION WITH VISION LOSS
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DOI：
10.2214/ajr.160.1.8416612
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发表时间：
1993-01-01
影响因子：
5
通讯作者：
SERGOTT, RC
中科院分区：
文献类型：
--
作者：
GIBBY, WA;COHEN, MS;SERGOTT, RC
OBJECTIVE.本研究的目的是确定眼眶和脑部CT是否可以用于区分正常患者与假性脑瘤患者，并将CT表现与视力损害的严重程度相关联。将17例临床诊断为假性脑瘤的患者与20例年龄和性别匹配的对照组进行比较。所有受试者均可获得眼眶的薄层冠状面和轴向CT扫描以及全脑轴向CT扫描。在不了解受试者是否患有假性脑瘤的情况下，评价了视神经鞘的直径、视神经乳头的翻转程度、空鞍的存在和程度以及脑室和脑沟的大小。同样的参数比较了两个亚组的假性脑瘤患者：轻度视力丧失和重度视力丧失。假性脑瘤患者的视神经鞘明显大于对照组（6.5 +/- 0.83 mm vs 5.4 +/- 0.69 mm）。17例患者中有12例有视乳头水肿伴视乳头翻转的放射学证据，而20例对照组中有1例。空蝶鞍在假性脑瘤患者中比对照组更常见且程度更高（16 vs 7）。9例重度视力丧失患者中有8例和8例轻度至中度视力丧失患者中有4例出现视神经乳头逆转;重度视力丧失组的程度更大。两组间心室大小或脑沟扩大无差异。两组视力丧失患者的开放CSF压力无显著差异（348 +/- 80 mm H2O vs 391 +/- 98 mm H2O）。除了CT在排除颅内疾病作为假性脑瘤临床综合征的基础方面的作用外，眼眶的薄层CT还显示了一系列的发现，包括假性脑瘤患者的视神经鞘增大、视神经乳头翻转和空蝶鞍。此外，这些患者的严重视力丧失与更频繁和更严重的视神经乳头逆转相关。
OBJECTIVE. The purpose of this study was to determine if orbital and cerebral CT can be used to distinguish normal patients from those with pseudotumor cerebri, and to correlate CT findings with the severity of visual impairment.SUBJECTS AND METHODS. Seventeen patients with a clinical diagnosis of pseudotumor cerebri were compared with 20 age- and sex-matched control subjects. Thin-section coronal and axial CT scans of the orbit and whole-brain axial CT scans were available for all subjects. The diameter of the optic nerve sheath, the degree of reversal of the optic nerve head, the presence and degree of empty sellae, and ventricular and sulcal sizes were evaluated without knowledge of whether or not the subject had pseudotumor cerebri. The same parameters were compared for two subgroups of patients with pseudotumor cerebri: those with mild vision loss and those with severe vision loss.RESULTS. Patients with pseudotumor cerebri had significantly larger optic nerve sheaths than did control subjects (6.5 +/- 0.83 mm vs 5.4 +/- 0.69 mm). Radiologic evidence of papilledema with reversal of the optic nerve head was found in 12 of 17 patients compared with one of 20 control subjects. An empty sella was seen more frequently and to a greater degree in patients with pseudotumor cerebri than in control subjects (16 vs seven). Eight of nine patients with severe vision loss and four of eight patients with mild to moderate vision loss had reversal of the optic nerve head; the degree was greater in the group with severe vision loss. No difference in ventricular size or sulcal enlargement was seen between any of the groups. The opening CSF pressures of the two groups with vision loss were not significantly different (348 +/- 80 mm H2O vs 391 +/- 98 mm H2O).CONCLUSION. In addition to the role of CT in excluding intracranial disease as a basis for the clinical syndrome of pseudotumor cerebri, thin-section CT of the orbits reveals a constellation of findings, including enlarged optic nerve sheaths, reversal of the optic nerve head, and empty sellae in patients with pseudotumor cerebri. Furthermore, severe vision loss in these patients correlates with more frequent and more severe reversal of the optic nerve head.