低颅压性头痛的临床影像学特征分析  

The analysis of clinical imaging features of intracranial hypotension headache

作　　者：曾焕忠[1] 林菡[2] 区俊兴[1] ZENG Huan-zhong(Department of radiology,Houjie hospital,Dongguan,Guangdong,523945,China)

机构地区：[1]东莞市厚街医院放射科,广东东莞523945 [2]东莞市厚街医院神经内科,广东东莞523945

出　　处：《齐齐哈尔医学院学报》2019年第12期1496-1498,共3页Journal of Qiqihar Medical University

摘　　要：目的探讨低颅压性头痛的临床和影像学表现特点。方法收集2015年8月-2018年7月在本院经临床脑脊液压力测定证实为低颅压性头痛的5例患者的临床和影像学资料,重点分析其临床表现及影像学特征。结果5例患者均为女性,年龄29~42岁,中位年龄37岁,脑脊液压力35~60mm H2O,临床典型症状表现为体位性头痛5例,伴有颈肩背痛4例,恶心、呕吐3例,头晕3例,合并焦虑症2例,甲状腺功能亢进1例,贫血1例;磁共振(MRI)表现为双侧大脑半球和小脑半球凸面、大脑镰、小脑幕区硬脑膜弥漫性增厚,T1WI呈等信号4例,低信号1例,T2WI和T2-Flair均呈高信号;增强扫描增厚硬脑膜呈弥漫性均匀性明显强化,颅内静脉窦扩张5例,硬膜下积液3例,垂体增大3例,脑组织下移、大脑大静脉与直窦夹角变小3例,颈段脑脊液漏1例。结论低颅压性头痛的典型临床表现为体位性头痛,影像学表现为硬脑膜弥漫性均匀性增厚并强化、颅内静脉窦扩张具有一定特征性,对低颅压性头痛患者需行全脊柱MRI检查,排除有无脑脊液漏。Objective To investigate the clinical imaging features of intracranial hypotension headache.Methods The clinical and imaging data of 5 patients with intracranial hypotension headache confirmed by clinical cerebrospinal fluid pressure measurement from August 2015 to July 2018 were collected,and their clinical manifestations and imaging characteristics were analyzed emphatically. Results All the 5 patients were female,aged between 29 and 42 years( median age 37 years). Cerebrospinal fluid pressure was 35 ~ 60 mm H2 O. The typical clinical symptoms were postural headache in 5 cases,neck-shoulder pain in 4 cases,nausea and vomiting in 3 cases,dizziness in 3 cases,anxiety in 2 case,hyperthyroidism in 1 case and anemia in 1 case. The MRI manifestations were bilateral cerebral hemisphere and cerebella hemisphere convex surface,falx cerebri and cerebellum tentorial dural diffuse thickening. T1 WI showed equal enhance signal in 4 cases,low signal in 1 case.Both T2 WI and T2-Flair showed high signal.Enhanced scanning showed diffuse homogeneity of the thickened dura mater,5 Cases of Intracranial Venous Sinus Expansion,3 cases of subdural effusion,3 cases of pituitary enlargement,3 cases of brain tissue downward movement,the angle between the galen vein and the Straight sinus decreased in 3 cases,and 1 case of cervical cerebrospinal fluid leakage. Conclusions The typical clinical manifestation of intracranial hypotension headache is postural headache.The imaging manifestations of intracranial hypotension headache are diffuse homogeneous thickening and enhancement of dura mater and expansion of intracranial venous sinus.The patients with intracranial hypotension headache need to be examined by whole spine MRI to exclude cerebrospinal fluid leakage.

关 键 词：低颅压性头痛 脑脊液 磁共振成像 

分 类 号：R741[医药卫生—神经病学与精神病学]