自发性低颅压合并硬膜下血肿继发昏迷1例  

Coma in spontaneous intracranial hypotension complicated with subdural hematoma:a case report

作　　者：王震 戴艳芳[2] 安彦虹[2] 马艳辉[3] 吴洁[3] 齐得州 孙晶晶 叶红[1] 高冉[1] 李军杰[1] 武力勇[1] Wang Zhen;Dai Yanfang;An Yanhong;Ma Yanhui;Wu Jie;Qi Dezhou;Sun Jingjing;Ye Hong;Gao Ran;Li Junjie;Wu Liyong(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Radiology and Nuclear Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]首都医科大学宣武医院放射与核医学科,北京100053 [3]首都医科大学宣武医院麻醉手术科,北京100053

出　　处：《中华神经科杂志》2022年第4期349-353,共5页Chinese Journal of Neurology

基　　金：国家自然科学基金(81901225,81971011)。

摘　　要：自发性低颅压可导致硬膜下积液、硬膜下血肿、脑静脉系统血栓形成等并发症,而导致昏迷者较少见。现报道1例自发性低颅压患者,以体位性头痛起病,保守治疗效果差,先后出现嗜睡、定向力障碍、小便失禁,直至昏迷。头颅影像学检查发现慢加急性硬膜下血肿,脊髓水成像示广泛硬脊膜外积液,脊髓造影发现T 6、T 7神经根脑脊液漏。经硬膜下血肿清除术和靶向硬膜外血贴治疗后,意识转清、头痛缓解,2个月后随访双侧硬膜下血肿吸收,随访5个月头痛未复发。Spontaneous intracranial hypotension can frequently result in several complications including subdural hygroma,subdural hematoma and cerebral venous thrombosis,but coma rarely.A case of spontaneous intracranial hypotension presented with orthostatic headaches was described.He experienced somnolence,disorientation,incontinence,and then coma,though received conservative treatment.Brain imaging demonstrated acute-on-chronic subdural hematoma,magnetic resonance myelography using heavily T2-weighted fast spin-echo pulse sequences showed spinal longitudinal extradural collection,and magnetic resonance myelography with intrathecal gadolinium revealed cerebrospinal fluid leak at the level of T6,T7.The patient recovered consciousness after surgical evacuation of the hematoma,and the headache disappeared after a targeted epidural blood patch.The hematoma resolved 2 months later and the patient kept free from headache during follow-up.

关 键 词：颅内低压 血肿 硬膜下 昏迷 钻孔引流术 靶向硬膜外血贴 

分 类 号：R741[医药卫生—神经病学与精神病学]