42例自发性脊髓脑脊液漏所致颅内低压的临床特点分析  

Clinical characteristics of 42 cases of spontaneous intracranial hypotension with cerebrospinal leakage

作　　者：江云[1] 王谨[1] 龚向阳[1] 张峭巍[1] 何非方[1] 胡兴越[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院神经内科,浙江杭州310016

出　　处：《浙江大学学报（医学版）》2014年第1期83-88,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省科技计划项目(2009C33126);浙江省医药卫生科技计划项目(2009A111)

摘　　要：目的:分析自发性脊髓脑脊液漏所致自发性颅内低压(SIH)的临床特点。方法:对42例保守治疗无效的自发性脊髓脑脊液漏所致SIH患者的临床资料和影像学表现进行回顾性分析,并按病程长短分为短病程组(n=27)和长病程组(n=15),比较两组患者的临床表现和影像学特征。结果:直立性头痛是SIH患者最典型的临床表现,出现率92.9%(39/42);在长病程组中头痛的发生比例明显低于短病程组(80%与100%,P=0.040)。与短病程组比较,长病程组的腰椎穿刺压力≥60.0 mm H2O的患者数明显增加(60.0%与20.8%,P=0.019),平均腰椎穿刺压力增高[(64.7±42.1)mm H2O与(40.0±33.8)mm H2O,P=0.038)],硬膜下出血的发生率升高(50.0%与11.6%,P=0.018)。所有患者接受CT脊髓造影检查均发现脑脊液漏点,38例为多发漏点,4例仅表现为单个漏点。结论:SIH的临床表现多样,随病程延长,其临床表现和腰椎穿刺压力可有部分改善,影像学检查如颅脑MRI、CT脊髓造影能帮助诊断;病程延长后硬膜下出血的发生概率增加,需积极干预。Objective： To review the clinical characteristics of spontaneous intracranial hypotension （ SIH ） with cerebrospinal fluid （CSF） leakage. Methods： Clinical data of 42 SIH patients with cerebrospinal leakage, whose diagnosis met the criteria of the International Headache Classification, were retrospectively reviewed. Thepatients were divided into short （ n = 27） and long （ n = 15 ） course groups. The clinical data and imaging features were compared between two groups. Results： Thirty-nine patients（92. 9% ） had orthostatic headache. Compared with the short course group, the frequency of headache were significantly lower in patients with long disease duration （80% vs 100%, P = 0 .040 ） ; the ratio of high CSF opening pressure （ ≥ 60.0 mm H2O）, the average CSF opening pressure, and the frequencies of subdural hematoma were higher in long course group than those in short course group [60.0% vs 20.8%,（64.7 ±42.1） vs （40.0 ±33.8）mm H2O,and 50.0% vs 11.6%;P= 0. 019,0.038 and 0. 018, respectively ]. Forty-two patients underwent CT myelography ; definite focal CSF leakage sites were found in all patients and multiple sites of CSF leakage in 38 patients. Conclusion： All SIH do not necessarily show the typical clinical manifestations, and cranial MRI and CT myelography are helpful in the diagnosis. Because of higher risk of subdural hemorrhage, patients with long disease duration require active intervention.

关 键 词：颅内低压 病因学 脊髓造影术 磁共振成像 脊椎穿刺 回顾性研究 

分 类 号：R741.04[医药卫生—神经病学与精神病学]