自发性低颅压综合征31例临床特征和影像学分析  

The clinical characters and CT and MRI findings of spontaneous intracranial hypotension

作　　者：钱进[1] 张炳蔚[1] 

机构地区：[1]大连医科大学附属一院神经内科,116011

出　　处：《卒中与神经疾病》2007年第2期102-104,共3页Stroke and Nervous Diseases

摘　　要：目的探讨自发性低颅压综合征(SIH)的临床特点和影像学改变。方法回顾性分析31例SIH患者的临床及影像资料。结果所有患者均有体位性头痛,可伴有恶心、呕吐、头晕、耳鸣、听力丧失、行走不稳、一过性视物模糊、复视、颈肩部疼痛、颈强直;CSF压力均<70mmH2O,蛋白升高12例,WBC增多11例,RBC增多7例;全部患者行头颅CT检查,8例见脑肿胀,脑沟变浅,脑室变窄,临床症状消失后复查均恢复正常;15例行头颅MRI检查,8例行增强检查示硬脑膜弥漫性强化,头颅CT及MRI检查见4例硬膜下积液、2例硬膜下血肿;全部患者采用内科综合疗法,1例行硬膜下血肿清除术,均痊愈。结论SIH的临床表现多样,体位性头痛是特征性症状,腰穿CSF及头颅MRI检查具有诊断价值;本病预后良好,但少数并发硬膜下血肿。Objective To investigate the clinical characters and CT and MRI findings in patients with spontaneous intracranial hypotension（SIH）. Methods The clinical and imaging data in 31 cases of SIH were analyzed retrospectively. Results All the 31 patients had orthostatic headache in association with one or more of numerous symptoms including nausea, vomiting, dizziness, tinnitus, orthostatic hearing loss, gait instability, blurred vision, diplopia, interscapular pain and neck pain/stiffness. All the patients had low CSF pressure, which was below 70 rnmH20 and high CSF protein was in 12 patients, 11 had increased CSF white cells and 7, red cells. All the patients was performed by CT. On CT scans the cortical sulci and small ventricles were compressed in 8 patients. The follow up CT scans after the treatment were normal. 15 patients with SIH underwent brain Magnetic resonance imaging（MRI） investigations. MRI of the brain typically reveals diffuse pachymeningeal enhancement in 8 patients, CT and MRI documented bifmntal accentuated subdural hygromas in 4 patients and haematomas in 2 patients. After conservative treatment and except surgical evacuation of the subdural haematoma in one case, all 31 patients experienced relief of symptoms. Conclusions SIH typically pres- ents with orthostatic headache, often associated with additional symptoms. The examinations of CSF and MRI can confirm the diagnosis SIH. SIH is a relatively benign syndrome, but it may be complicated by subdural haematomas.

关 键 词：自发性低颅压综合征 腰椎穿刺 磁共振成像 

分 类 号：R741[医药卫生—神经病学与精神病学]