Not centre of the universe (maybe the earth)

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6.Pseudotumor cerebli と Inflammatory Orbital Pseudotumor(IOP), Idiopathic Orbital Inflammatory Syndrome(IOIS)

眼窩の専門書を見ていない状態


Pseudotumor cerebli =偽脳腫瘍 脳の偽腫瘍
=IIH Idiopathic Intracranial Hypertension
Obesity, female
(sign) B) Optic head edema
(etio) ICP↑
W)274 (treatment) self-limited process
if

1.Severe, intractable headache

2.Evidence of progressive decrease in VA,
or VFL
3.Some ophthalmologists suggest treating all pts w papilledema

 

then

1.Weight loss

2.Acetazolamide 250mg po qid initially

 building up to 500 qid if tolerated

 Use w caution in sulfa-allergic pts
3.Disco any causative meds.

And if above 1-3 is unsuccessful, one of 4-6

4.A short course of stero po in prep for surgery

5.Optic nerve sheath decompression surgery is often effective if vision is threatened and has been reported to improve headache in appr. 50% of pts
6. A neurosurgical shunt(ventriculoperitoneal or lumboperitoneal) should be performed if intractable headache is a prominent (sym).

 


Inflammatory Orbital Pseudotumor(IOP), Idiopathic Orbital Inflammatory Syndrome(IOIS) = 炎症性眼窩偽腫瘍、突発性眼窩炎症症候群(???)

W)158

(treatment) 1.Prednisone 80 to 100 mg po qd as an initial dose in an adult, along with H2bs.
Pediatric dosages typically begin with 1mg/kg/day of prednisone.
All pts are warned about SEs, monitor BS and electrolytes in PCares.
2. Low-dose Rds may be used when the pt

  2-1 does not to steroid po, when

  2-2 disease recurs as steroid are tapered, or when

  2-3 steroids pose risks.
Radiation should only be used once orbital biopsy(!!!) has excluded other (etios).

これらをずっと混同していて理解するのに1hrかかった
一番重要な事はPseudotumor cerebli =Psudotumorでも何でもないという事
ただ(sig)から脳腫瘍でもあるんじゃないかと判断、その時点での暫定名で、そのままIIHの内容が下に継ぎ足されているという点。
(etio)がほぼObesityとmedsと分かった時点で名前を捨てようぜ。
そしてIOISは紛れもなくLow Grade Lymphomaである。(M 16

ただ、Low Grade Lymphomaって何?ちゃんと定義されてるのか?Viral Infectionとの違いは?しかし、それを明確にしなくてもWillsのプロトコル通りに治療すればちゃんと出来てしまう。「もしステロイドが効かなくなったり使えなくなったりしたら、放射線照射という方法もあります」。以降は眼窩のbook/paper。