自发性低颅压合并颅内静脉窦血栓、脊柱硬膜外血肿一例  

Spontaneous intracranial hypotension complicated with cerebral venous thrombosis and spinal epidural hematoma:a case report

作　　者：张丹[1] 支楠[2] 林岩[2] 张峭巍[3] 胡兴越[1] Zhang Dan;Zhi Nan;Lin Yan;Zhang Qiaowei;Hu Xingy ue(Department of Neurology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;department of Neurology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Radiology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院神经内科,杭州310016 [2]上海交通大学医学院附属仁济医院神经内科,200127 [3]浙江大学医学院附属邵逸夫医院放射科,杭州310016

出　　处：《中华神经科杂志》2020年第7期528-530,共3页Chinese Journal of Neurology

摘　　要：自发性低颅压可出现颅内静脉窦血栓、颅内硬膜下血肿等并发症。脊柱硬膜外血肿在自发性低颅压患者中较少报道。报告1例确诊自发性低颅压的患者,以直立位头痛起病,并发颅内静脉窦血栓,出现癫痫发作、癫痫持续状态、脑实质出血。检查发现合并腰段脊柱硬膜外血肿,无明显脊髓压迫症状。经卧床、补液、抗凝、抗癫痫治疗后,患者头痛、颅内静脉窦血栓情况好转。出院3周后患者再次出现头痛,平卧时无法完全缓解,头颅影像提示新发双侧颅内硬膜下血肿。停用抗凝治疗,经2次硬膜外血贴治疗后,患者颅内硬膜下血肿吸收,头痛无再发。Spontaneous intracranial hypotension patients may have complications,such as cerebral venous thrombosis and intracranial subdural hematoma,while complicating with spinal epidural hematoma is rarely reported.A spontaneous intracranial hypotension patient,who started with orthostatic headache,followed by cerebral venous thrombosis,manifested as seizure,status epilepticus,and parenchymal hemorrhage,was admitted to Sir Run Run Shaw Hospital.Spinal evaluation showed lumbar epidural hematoma,without spinal cord compression symptoms.The patient improved with bed rest,fluid infusion,antiepileptic drug,and anticoagulation therapy.Three weeks after discharge,headache recurred without complete remission after lying flat.Cranial neuroimaging showed bilateral subdural hematoma.Anticoagulation was ceased.Subdural hematoma absorbed after treated with two epidural blood patches.The patient was headache-free during follow-up.

关 键 词：自发性低颅压 颅内静脉窦血栓 血肿 硬膜外 脊髓 硬膜外血贴治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]