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Nervenheilkunde 2018; 37(01/02): 21-28
DOI: 10.1055/s-0038-1642073
Kopfschmerz
Schattauer GmbH

Kopfschmerz bei Liquorüberdruck

Headache in increased intracranial pressure
J. Hoffmann
1   Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Hamburg
,
S. Förderreuther
2   Klinik für Neurologie, Ludwig-Maximilians-Universität München – Innenstadtklinikum, München
› Author Affiliations
Further Information

Publication History

eingegangen am: 01 November 2017

angenommen am: 13 November 2017

Publication Date:
30 March 2018 (online)

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Zusammenfassung

Die idiopathische intrakranielle Hypertension beruht auf einer intrakraniellen Drucksteigerung unklarer Ätiologie. Das daraus resultierende klinische Bild ist in erster Linie durch einen weitgehend unspezifischen Kopfschmerz und progrediente, potenziell irreversible Sehstörungen charakterisiert wobei nicht selten auch Hirnnervenlähmungen, Riechstörungen und kognitive Defizite beobachtet werden. Die Ursache der intrakraniellen Drucksteigerung ist nicht eindeutig geklärt. Das Vorliegen einer venösen Abflussstörung, die aufgrund des häufig bestehenden Übergewichts oder auch aufgrund eines vaskulären Hindernisses in Form einer bilateralen Stenose des Sinus transversus auftreten kann, erscheint am nahe liegendsten. Auch hormonelle Faktoren könnten von wesentlicher Bedeutung sein und erklären warum überwiegend Frauen von der Erkrankung betroffen sind. Die Behandlung besteht in erster Linie aus einer Gewichtsreduktion und der oralen Gabe von Carboanhydrasehemmern, wobei lediglich für Acetazolamid Daten aus einer placebo-kontrollierten Studie vorliegen. Invasive Behandlungsverfahren sollten nur in therapierefraktären oder besonders fulminanten Fällen mit drohendem Verlust des Sehvermögens erwogen werden.

Summary

Idiopathic intracranial hypertension is caused by an increase of intracranial pressure of unknown etiology. The clinical picture is characterized by a rather unspecific headache and progressive and potentially irreversible visual disturbances but cranial nerve palsies, olfactory disturbances and cognitive deficits may also occur. The underlying cause remains largely unknown. The presence of a disturbance in venous outflow either caused by the commonly observed obesity or bilateral stenoses of the sinus transversus are thought to represent a crucial element in the pathobiology of the disorder. The role of hormonal factors is increasingly discussed as these may explain female preponderance. Treatment is mainly based on weight reduction and the use of carboanhydrase inhibitors although data from randomized-controlled trials exist only for acetazolamide. Invasive treatments should only be considered in therapy-resistant cases as well as in those with a fulminant course of the disorder with an acute risk of an irreversible loss of visual function.

Schlüsselwörter

Idiopathische intrakranielle Hypertension - Pseudotumor cerebri - Kopfschmerz - Acetazolamid

Keywords

Idiopathic intracranial hypertension - pseudotumor cerebri - headache - acetazolamide
 

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