Psödotümör Serebri Sendromlu Hastaların Demografik Özellikleri ve Klinik Bulgularının Değerlendirilmesi

Giriş: Bu çalışmanın amacı, psödotümör serebri sendromu (PTSS) hastalarına ait demografik verilerin, klinik bulguların ve tedavi sonuçlarının sunulmasıdır. Yöntemler: PTSS modifiye Dandy tanı kriterlerini karşılayan 69 hastanın klinik verileri geriye yönelik olarak incelendi. Hastaların demografik özellikleri, klinik ve radyolojik bulguları ile tedavi sonuçları kaydedildi. Bulgular: Çalışmaya 69 hasta dahil edildi (62 kadın ve 7 erkek). Hastaların ortalama yaş, kilo ve vücut kitle indeksi (VKİ) sırasıyla 37,97 ± 10,36 yıl, 84,21 ± 16,06 kg, ve 31,89 ± 5,87 idi. Baş ağrısı en sık başvuru yakınması idi ve 68 hastada papil ödemi izlendi. Ek nörolojik bulgu olarak 7 hastada, 6. kraniyal sinir paralizisi mevcuttu. En sık görülen görme alanı defekti konsantrik daralma idi. Hastaların %68,1’inde kraniyal magnetik rezonans görüntüleme sonuçları normal saptandı. Tüm hastalara asetozolamid tedavisi başlandı ve VKİ ≥ 25 olan hastalara kilo vermeleri önerisinde bulunuldu. 9 hastada asetozolamid tedavisine topiramat eklendi. Medikal tedaviye cevap vermeyen 2 hastaya optik sinir kılıf fenestrasyonu ve bir hastaya lumboperitoneal şant cerrahisi uygulandı. Takip süresince 30 hastada medikal tedavi ve kilo kaybı yardımıyla baş ağrısında tam düzelme ve görme alanı defektinde düzelme veya stabilizasyon izlendi. Sonuç: PTSS genellikle genç obez kadınları etkilemektedir. Hastaların semptom, klinik bulgu ve kraniyal görüntüleme sonuçlarının dikkatli değerlendirilmesi tanı için gereklidir. Beyin omurilik sıvısı üretiminin azaltılması ve kilo kaybı ile hastaların çoğunda semptomlar ve klinik bulgular kontrol altına alınabilir. Medikal tedaviye dirençli hastalarda, optik sinir kılıfı fenestrasyonu ve lumboperitoneal şant cerrahisi, alternatif tedavi seçenekleri arasındadır.

Anahtar Kelimeler:

Baş ağrısı, beyin omurilik sıvısı, görme bulanıklığı, psödotümör serebri sendromu

The Evaluation of Demographic Characteristics and Clinical Findings in Patients with Pseudotumor Cerebri Syndrome

Introduction: The study is aimed to present demographic data, clinical findings and treatment outcomes of patients with pseudotumor cerebri syndrome (PTCS). Methods: Clinical data of 69 patients who met PTCS modified Dandy diagnostic criteria were analyzed retrospectively. Patients demographics, clinical and radiological findings and treatment outcomes recorded. Results: Sixty-nine patients were included the study (62 female and 7 male). The mean age, weight and body mass index (BMI) of the patients were 37.97 ± 10.36 years, 84.21 ± 16.06 kg, and 31.89 ± 5.87, respectively. Headache was the most common complaint, and 68 patients had papilledema. Seven patients had sixth cranial nerve paralysis as an additional neurological finding. The most common visual field defect was concentric narrowing. Cranial magnetic resonance imaging results were normal in 68.1% of the patients. Systemic acetazolamide treatment was started in all patients. In addition, weight loss was recommended in patients who have a BMI ≥ 25. Topiramate was added to acetozolamide treatment in 9 patients. Optic nerve sheath fenestration was performed in 2 patients and lumboperitoneal shunt surgery was performed in one patient who did not respond to medical treatment. Complete recovery of headache and either improvement or stabilization of visual field defect were observed in 30 patients with the help of medical treatment and weight loss during the follow-up period. Conclusion: PTCS usually affects young obese women. Careful evaluation of patient’ symptoms, clinical findings, and cranial imaging results are essential for the diagnosis. Symptoms and clinical findings can be controlled in the majority of the patients with the help of reduction of cerebrospinal fluid production and weight loss. Optic nerve sheath fenestration and lumboperitoneal shunt surgery are among the alternative treatment options in patients who are resistant to medical therapy.

Keywords:

Blurred visiocn, cerebrospinal fluid, headache, pseudotumor cerebri syndrome.,

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