特発性頭蓋内圧亢進症の診断と治療

Diagnosis and Therapy for Idiopathic Intracranial Hypertension

Point

・頭蓋内に腫瘤，血管病変，水頭症などがなくても頭蓋内圧が亢進する病態を特発性頭蓋内圧亢進症と呼ぶ．

・頭痛，嘔気，視神経乳頭浮腫を呈し，妊娠可能な肥満女性に多い．

・病態は未だ不明であり，髄液循環障害，静脈還流障害，代謝障害などが研究されている．

・治療は体重減少のための生活・食事指導，薬物治療，外科治療が報告されているが，エビデンスは低い．

　Idiopathic intracranial hypertension is a pathological state of increased intracranial pressure without intracranial mass lesion, vascular lesion, or hydrocephalus. For the diagnosis of this pathology, various secondary and primary headaches, such as migraine and medication overuse headaches should be excluded. Radiological imaging, including diffusion tensor imaging may show secondary findings of intracranial hypertension. These imaging techniques may be useful to diagnose intracranial hypertension, because at present there is no reliable non-invasive method to measure intracranial pressure. The pathophysiology of idiopathic intracranial hypertension has not been revealed; however there are some theories include, the disorder of cerebrospinal fluid circulation, disturbance of intracranial venous circulation, and metabolic disorders. Headache, nausea, and optic disc edema are frequently observed. The disease is frequently seen in obese females of childbearing age. Several therapies, including weight reduction, medication, and surgery have been studied; however the level of evidence for these therapies remains low.