自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿诊治经验分享:一例报告  

Experience in diagnosis and treatment of spontaneous intracranial hypotension with cerebral venous thrombosis and subdural hematoma: one case report

作　　者：李红梅 刘玲春 杨顺宇 杨瑞晗 刘达 孟强 LI Hong-mei;LIU Ling-chun;YANG Shun-yu;YANG Rui-han;LIU Da;MENG Qiang(Department of Neurology,The Affiliated Hospital of Kunming University of Science and Technology,The First People's Hospital of Yunnan Province,Kunming 650032,Yunnan,China)

机构地区：[1]昆明理工大学附属医院云南省第一人民医院神经内科,650032

出　　处：《中国现代神经疾病杂志》2022年第6期486-492,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：云南省医学领军人才培养项目(项目编号:L-2017013);云南省“万人计划”项目(项目编号:YNWR-MY-2018-018)。

摘　　要：目的报告1例自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿病例,总结其临床表现及影像学特征,以提高临床医师的诊断与鉴别诊断能力,以及对相关并发症的认知程度。方法与结果男性患者,56岁,亚急性至慢性病程,以体位性头痛发病,呈渐进性加重并伴右侧肢体麻木无力。影像学检查呈弥漫性硬脑膜强化、双侧慢性硬膜下血肿、脑静脉系统血栓形成表现,经补液、抗凝、机械取栓、溶栓治疗后血栓明显减少;由于出血倾向持续增加、硬膜下血肿扩大,经停用抗凝药、开颅血肿清除术得以控制病情,硬膜下血肿体积缩小。出院后3个月,头部MRI显示脑静脉窦基本无充盈缺损,显影程度明显提高;患者体位性头痛消失,未遗留局灶性神经功能障碍。结论自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿患者通过补液、抗凝及血管内治疗虽可使脑静脉窦血栓所诱发的症状与体征有所好转,但这些措施无法遏制硬膜下血肿的进一步扩大,尽早发现脑脊液漏并及时修补漏口,更有利于痊愈。Objective venous thrombosis(CVT) and subdural hematoma(SDH), summarize its clinical manifestations and imaging features, and improve clinicians’ ability of diagnosis and differential diagnosis, as well as the recognition of the related complications.Methods and Results chronic disease course, with the onset of orthostatic headache, progressive exacerbation, and developed numbness and weakness in the right limb. Imaging findings revealed diffuse enhancement of dura mater,bilateral chronic SDH and CVT. After rehydration, anticoagulation, mechanical thrombectomy and thrombolytic therapy, the CVT was significantly reduced. Due to the continuous increasion in bleeding tendency and the expansion of SDH, after discontinuation of anticoagulant and craniotomy for hematoma removal, the condition was controlled, and the volume of SDH decreased. Follow-up 3 months after discharge, head MRI showed that there was basically no filling defect in the venous sinus, and the visualization was significantly improved;the patient’s orthostatic headache disappeared, and no focal neurological dysfunction remained.Conclusions and SDH, treated by fluid replacement, anticoagulation, and endovascular treatment, the symptoms and signs induced by venous thrombosis can be improved, these measures can’t prevent the further expansion of the SDH, early detection of leaks and repairs may be more conducive to the recovery.

关 键 词：颅内低压 颅内血栓形成 脑静脉 血肿 硬膜下 颅内 机械溶栓 

分 类 号：R741[医药卫生—神经病学与精神病学]