Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Psödotümör Serebri Sendromlu Hastalarımızda Demografi, Klinik ve Tedavi
Demographic, Clinical and Treatment Findings of Pseudotumor Cerebri Syndrome
Gözde ORMANa, Gülten SUNGURa, Selma UZMANa, Selda KESKİN GÜLERb
aSağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, Ankara, TÜRKİYE
bSağlık Bilimleri Üniversitesi Ankara Eğitim ve Araştırma Hastanesi, Nöroloji Kliniği, Ankara, TÜRKİYE
Turkiye Klinikleri J Ophthalmol. 2020;29(1):25-30
doi: 10.5336/ophthal.2019-66023
Article Language: TR
Full Text
ÖZET
 Amaç: Beyin omurilik sıvısı bileşiminin normal olması ve intrakraniyal yer kaplayıcı lezyon veya hidrosefali gibi yapısal bir lezyonun olmaması ile ortaya çıkan kafa içi basıncının artışı, psödotümör serebri sendromu (PTS) olarak kabul edilmektedir. Bu çalışmada, PTS tanısı ile izlenen hastaların klinik, nörooftalmolojik ve demografik özelliklerinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Ankara Eğitim ve Araştırma Hastanesi Göz Kliniği Nörooftalmoloji Biriminde, Haziran 2016-Haziran 2018 tarihleri arasında başvuran PTS tanılı hastalar retrospektif olarak incelendi. Hastaların tüm nörooftalmolojik muayeneleri, bilgisayarlı görme alanı, optik koherens tomografi ve magnetik rezonans görüntüleme (MRG) bulguları değerlendirildi. Bulgular: PTS tanısı almış 54 hastanın 108 gözü incelendi. Hastaların 48 (%88,9)'si kadın, 6 (%11,1)'sı erkekti. Ortalama yaş 32,5 ± 11,6 yıl idi. Baş ağrısı ile 31 (%57,4), geçici görme kaybı ile 10 (%18,5), rutin göz muayenesi sırasında 9 (%16,7), çift görme ile 3 (%5,6), kulak uğultusu ile 1 (%1,9) hasta başvurmuştu. Yeni tanı almış 24 hastanın 21 (87,5)'inde papil ödem saptandı, 3 (%12,5)'ünde papil ödem yoktu. Hastaların tümüne bakıldığında; 4 (%7,4)'ünde optik disk druseni (ODD) ile birlikte papil ödem, 1'inde iki gözün 6 yıl ara ile etkilendiği tespit edildi. Hastaların tümüne medikal tedavi uygulandı. Olguların 49 (%90,7)'u asetazolamidden yarar gördü. Medikal tedaviye yanıt vermeyen 5 (%9,3) hastaya cerrahi planlandı. Hastaların 4 (%7,4)'üne ventriküloperitoneal şant, 1 (%1,9)'ine optik sinir kılıf fenestrasyonu uygulandı. Sonuç: Çalışmamızda; PTS'li hastaların yarısında oftalmolojik semptomlar ile tanıya gidildiği tespit edilmiştir. Bu nedenle rutin oftalmolojik muayenede fundus değerlendirilmesi önemlidir. Bu çalışmada, hastaların yaklaşık yarısında MRG'nin normal olabileceği, tek taraflı papil ödem, papil ödemsiz ve ODD ile papil ödem hastalarının görülebileceğini vurgulamak istedik. Bu klinik bulgular tespit edilen hastalarda ön tanıda PTS akılda tutulmalıdır. Uygun ve zamanında tanı ve tedavi ile görme kayıplarının önüne geçilebilir.

Anahtar Kelimeler: Psödotümör serebri; demografi; papil ödem
ABSTRACT
 Objective: Pseudotumor cerebri syndrome (PTCS) is increased intracranial pressure with normal cerebrospinal fluid composition and absence of a structural lesion such as intracranial space-occupying lesion or hydrocephalus. This study aimed to investigate the clinical and demographic characteristics of patients with PTCS. Material and Methods: A retrospective analysis of PTCS was performed between June 2016-June 2018 in the Neuro-Ophthalmology Unit of Ankara Training and Research Hospital Eye Clinic. All ophthalmologic examinations, visual field, optical coherence tomography (OCT) and magnetic resonance (MR) findings were evaluated. Results:108 eyes of 54 PTCS patients were assesmented. 48 (88.9%) patients were female and 6 (11.1%) patients were male. The mean age was 32.5 ± 11.6. 31 (57.4%) patients had headache, 10 (18.5%) had transient vision problem, 9 (16.7%) had in routine ophthalmologic examination, 3 (5.6%) had double vision and 1 (1.9%) patient had tinnitus. 24 patients had new diagnosed for PTCS; 21 (87.5%) with papilledema, and 3 (12.5%) without papilledema. In all patients; 4 (7.4%) patients had optic disc drusen (ODD) and papilledema together. All patients were treated. 49 (90.7%) of the cases were in remission with acetazolamide. Five (%9.3) patients who did not respond to medical treatment were undergone surgery. Ventriculoperitoneal shunt was applied to 4 (7.4%) patients, and optic nerve sheath fenestration was applied to 1 (1.9%) patient. Conclusion: The goals of this study; in almost half of the patients with PTCS were diagnosed in routine ophtalmologic examination with ophtalmologic symptoms, and MRI can be normal half of the patients, unilateral papilledema, without papilledema and papilledema with ODD cases can be seen. PTCS should be thought in case of these clinical findings were seen. Loss of vision can be prevented by proper and timely diagnosis and treatment.

Keywords: Pseudotumor cerebri; demography; papilledema
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