不典型自发性低颅压综合征四例分析  

Analysis of 4 Patients with Atypical Spontaneous Intracranial Hypotension Syndrome

作　　者：汪效松[1] 张旭[1] 周瑞玲[1] 陈名峰[1] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院神经内科,福州350001

出　　处：《临床误诊误治》2012年第11期82-84,共3页Clinical Misdiagnosis & Mistherapy

基　　金：福建省卫生厅人才培养基金资助项目(闽卫人函[2010]57号)

摘　　要：目的总结不典型自发性低颅压综合征的诊治要点。方法对我院2009年10月—2011年10月收治的4例临床表现不典型低颅压综合征临床资料进行回顾性分析。结果本组4例均无明显体位性头痛,表现为复视2例,眩晕发作和精神异常各1例。4例腰椎穿刺发现脑脊液压力均<60 mmH2O,3例脑脊液红细胞计数增多,2例脑脊液蛋白升高。颅脑、脊柱MRI检查示双侧额、顶、颞部慢性硬膜下血肿1例,双侧半卵圆中心多发少量脱髓鞘1例,部分脑膜呈线状强化、胸段脊膜异常强化1例,未见明显异常1例;2例行核素脑脊液显像检查,结果示胸髓脑脊液漏及脑脊液循环障碍各1例。4例均确诊为不典型自发性低颅压综合征,予相应治疗后1周～1个月症状均消失,随访1～2年无复发。结论不典型自发性低颅压综合征易漏诊,临床医师应提高对本病认识,及早行腰椎穿刺检查,必要时可结合颅脑MRI、核素脑脊液显像等检查,以提高检出率。Objective To analyze clinical characteristics of atypical spontaneous intracranial hypotension syndrome. Methods Clinical data of 4 patients with atypical spontaneous intracranial hypotension syndrome during October 2009 and October 2011 in our hospital were retrospectively analyzed. Results 4 patients did not suffer from obvious posture headache. Clinical manifestation of 2 patients was diplopia, 1 patient with vertigo and 1 patient with emotional disturbance; cerebrospinal fluid pressure in 4 patients were 〈60 nanH20, eerebrospinal fluid red blood cell count in 3 patients increased and elevated cerebrospinal fluid protein in 2 patients was elevated; magnetic resonance imaging of 1 patient showed bilateral frontal, temporal and top of chronic subdural hematoma, 1 patient with multiple small amounts demyelination in bilateral centrum ovale ; centrum ovale majus, 1 patient with linar reinforcement in part meninges and 1 patient with normal results. Examination of radionuclide eistemography of 1 patient showed cerebrospinal fluid leak and 1 patient with eerebrospinal fluid circulation disorder. The d patients were definitely diagnosed as having atypical spontaneous intraeranial hypotension syndrome, and patients＇symptoms were alleviated after corresponding treatment. There was no recurrence after 1 -2 year follow-ups. Conclusion Atypical spontaneous intracranial hypotension syndrome can be easily misdiagnosed, so clinicians should improve the understanding of this disease. Lumbar puncture should be performed if necessary and be combined with results of cranial magnetic resonance enhancement imaging and radionuelide eistemography in order to increase the detection rate.

关 键 词：颅内低压 腰椎穿刺 

分 类 号：R741[医药卫生—神经病学与精神病学]