自发性低颅压头痛临床特征及误诊分析  

Clinical Characteristics and Misdiagnosis Analysis of Headache Due to Spontaneous Intracranial Hypotension

作　　者：张东平 丁雅倩 ZHANG Dong-ping;DING Ya-qian(Department of Neurology,the First People's Hospital of Mengcheng County,Mengcheng,Anhui 233500,China)

机构地区：[1]蒙城县第一人民医院神经内科,安徽蒙城233500

出　　处：《临床误诊误治》2022年第9期9-13,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨自发性低颅压头痛(SIH)的临床特征及误诊原因、防范措施。方法对2019年1月—2022年1月收治的曾误诊的5例SIH的临床资料进行回顾性分析。结果本组2例以头痛伴发热起病,误诊为病毒性脑膜炎;2例因头痛伴眩晕、耳鸣入院,误诊为偏头痛发作;1例表现为头痛、呕吐伴颈项强直,误诊为蛛网膜下腔出血。误诊时间为3~7 d。5例均根据临床特征、脑脊液检查结果及头颅MRI表现,结合相关诊断标准确诊为SIH,其中1例合并脑静脉窦血栓形成。5例确诊后予以相应治疗,皆头痛缓解后出院。结论SIH临床症状复杂,影像学表现多样,极易误诊。提高对该病认识,仔细病史询问和体格检查,及时行相关检查及认真病情分析,或可减少或避免SIH误诊误治。Objective To investigate clinical characteristics,causes of misdiagnosis and preventive measures of headache due to spontaneous intracranial hypotension(SIH).Methods Clinical data of 5 patients with SIH who had been misdiagnosed between January 2019 and January 2022 was retrospectively analyzed.Results Two patients were misdiagnosed as viral meningitis because of headache with fever initially,2 patients were misdiagnosed as migraine because of headache with dizziness and tinnitus,and 1 patient was misdiagnosed as subarachnoid hemorrhage because of headache with vomit and stiff-neck.The duration of misdiagnosis was 3-7 d.All patients were diagnosed with SIH based on clinical characteristics,cerebrospinal fluid examination,cranial magnetic resonance imaging(MRI)findings and relevant diagnostic criteria.One of them was complicated by cerebral venous sinus thrombosis.After corresponding treatments,the headache was relieved and all five patients were discharged.Conclusion Due to complicated clinical manifestations and diverse imaging features,SIH is more likely to be misdiagnosed.Misdiagnosis and mistreatment of SIH may be reduced or avoided by improving the knowledge of the disease,inquiring about the detailed history or performing physical examination carefully,performing relevant examinations and analyzing the condition of SIH in a timely manner.

关 键 词：头痛 低颅压 自发性 误诊 脑炎 病毒性 偏头痛 

分 类 号：R741[医药卫生—神经病学与精神病学]