Damarsal Olmayan Kafa İçi Hastalıklarla İlişkili Baş Ağrıları
Özet
Uluslararası Baş Ağrısı Derneği (IHS) tarafından yayınlanan ICHD-3 sınıflandırmasına göre damarsal olmayan kafa içi hastalıklarla ilişkili baş ağrıları; artmış veya düşük beyin omurilik sıvısı (BOS) basıncı, enfeksiyöz olmayan inflamatuar hastalıklar, intrakranial neoplaziler, intratekal enjeksiyonlar, epileptik nöbetler ve Chiari tip 1 malformasyonu gibi sekiz ana alt başlık altında incelenmektedir. Artmış BOS basıncına bağlı baş ağrılarında, özellikle obezite ve yüksek vücut kitle endeksi ile ilişkili İdiopatik İntrakranial Hipertansiyon (İİH) öne çıkmakta; tanısında MR görüntüleme, göz dibi muayenesi ve lomber ponksiyon kullanılmaktadır. Tedavide kilo kontrolünün yanı sıra asetazolamid ve topiramat gibi medikal ajanlar veya şant cerrahisi tercih edilmektedir. Metabolik, toksif ve hormonal nedenler arasında karaciğer/böbrek yetmezliği, ilaç kullanımları ve venöz sinüs trombozu yer alırken; düşük BOS basıncına bağlı ağrılar postürle ilişkili olup epidural kan yaması ve kafein ile tedavi edilebilmektedir. Nörosarkoidoz, aseptik menenjit ve HaNDL sendromu gibi inflamatuar durumlar ile üçüncü ventrikül kolloid kisti, karsinomatöz menenjit ve hipofiz adenomları gibi tümörler de kendilerine özgü tanı ve tedavi protokollerine sahiptir. Son olarak, epileptik nöbetlerin iktal veya postiktal evrelerinde ve Chiari malformasyonunda mekanik tetiklenmelerle baş ağrısı kliniği gelişebilmektedir.
According to the ICHD-3 classification published by the International Headache Society (IHS), headaches associated with non-vascular intracranial disorders are evaluated under eight main subcategories, including increased or decreased cerebrospinal fluid (CSF) pressure, non-infectious inflammatory diseases, intracranial neoplasia, intrathecal injections, epileptic seizures, and Chiari type 1 malformation. Among headaches due to increased CSF pressure, Idiopathic Intracranial Hypertension (IIH), which is particularly associated with obesity and a high body mass index, stands out; its diagnosis utilizes MR imaging, fundoscopic examination, and lumbar puncture. In its management, weight control as well as medical agents like acetazolamide and topiramate or shunt surgery are preferred. While metabolic, toxic, and hormonal causes include liver/kidney failure, drug usage, and venous sinus thrombosis, headaches due to low CSF pressure are posture-related and can be treated with epidural blood patches and caffeine. Inflammatory conditions such as neurosarcoidosis, aseptic meningitis, and HaNDL syndrome, alongside tumors like third ventricle colloid cysts, carcinomatous meningitis, and pituitary adenomas, possess their own distinct diagnostic and treatment protocols. Lastly, clinical headache presentations can develop during the ictal or postictal phases of epileptic seizures and through mechanical triggers in Chiari malformation.
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