低颅压综合征合并双侧慢性硬膜下血肿的临床特征分析  

Clinical features of patients with syndrome of intracranial hypotension complicated by bilateral chronic subdural hematoma

作　　者：张劲楠 曾涛[1] 王明圣 徐子军[2] 高亮[1] Zhang Jinnan;Zeng Tao;Wang Mingsheng;Xu Zijun;Gao Liang(Department of Neurosurgery,Shanghai Tenth People's Hospital Affiliated to Tongji University,Shanghai 200072,China;Department of Radiology,Shanghai Tenth People's Hospital Affiliated to Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属上海市第十人民医院神经外科,上海200072 [2]同济大学附属上海市第十人民医院放射科,上海200072

出　　处：《中华神经医学杂志》2022年第12期1238-1244,共7页Chinese Journal of Neuromedicine

摘　　要：目的:探讨低颅压综合征(SIH)合并双侧慢性硬膜下血肿(CSDH)的临床特征。方法:选择同济大学附属上海市第十人民医院神经内外科自2016年1月至2020年10月收治的16例SIH合并双侧CSDH患者(SIH组)进行研究,总结SIH合并双侧CSDH的临床特征,并与同期收治的32例非SIH所致双侧CSDH患者(非SIH组)进行病例对照研究,比较2组患者间人口学特征、初始症状、基础病史、CT影像特征等方面的差异。结果:(1)16例SIH组患者中有13例(81.3%)具有典型的体位性头痛症状,3例(18.6%)的CT影像上可见假性蛛网膜下腔出血表现,80.0%(12/15)的MRI影像上表现出硬脑膜弥漫性均匀强化,33.3%(5/15)的有脑下垂征象,27.3%(3/11)的脊髓MRI检查示椎管内脑脊液漏征象。10例患者行钻孔引流术治疗,有6例在术后出现病情恶化,其中4例接受了包括去骨瓣减压术在内的多次额外手术,1例患者因合并恶性肿瘤,病情恶化后放弃治疗于院内死亡。(2)SIH组患者的年龄、肌体无力比例、病程、高血压史比例、头部外伤史比例、年龄校正的共病指数、CT影像上双侧血肿总厚度及厚度差、钻孔引流术中血肿压力增高比例均明显低于非SIH组,体位性头痛比例、CT影像上均匀血肿比例均明显高于非SIH组,差异均有统计学意义(P<0.05)。结论:依据年龄、初始症状及CT影像特征等可在一定程度上甄别出由SIH所致的双侧CSDH患者,建议行头颅及脊髓MRI明确诊断SIH。Objective To explore the clinical features of patients with syndrome of intracranial hypotension(SIH)complicated by bilateral chronic subdural hematoma(CSDH).Methods A case-control study was conducted;16 patients with SIH complicated with bilateral CSDH(SIH group)and 32 patients with bilateral CSDH(non-SIH group)admitted to Department of Neurology and Neurosurgery,Shanghai Tenth People's Hospital Affiliated to Tongji University from January 2016 to October 2020 were selected.The differences of demographic characteristics,initial symptoms,medical history and CT image features between the two groups were compared.Results(1)In 16 patients from the SIH group,13(81.3%)complained of typical postural headache symptoms,3(18.6%)showed fake subarachnoid hemorrhage on CT,80.0%(12/15)showed dural diffuse enhancement on MRI,and 33.3%(5/15)showed signs of brain droop.Spinal MRI showed 27.3%patients(3/11)had signs of intracranial cerebrospinal fluid leakage.Of the 10 patients underwent bilateral trepanation and drainage,6 experienced postoperative deterioration(4 received multiple additional surgeries including decompressive craniectomy,and 1 severe patient died in hospital after giving up treatment due to malignant tumor).(2)SIH group had significantly younger age,and significantly lower percentages of patients with limb weakness symptoms,hypertension,head trauma histories and increased hematoma pressure during trepanation and drainage,significantly lower age-adjusted comorbidities index,significantly decreased total and differential thickness of bilateral hematoma on CT,significantly shorter disease course,and statistically higher proportion of patients with postural headache and hematoma uniform density than non-SIH group(P<0.05).Conclusion According to age,initial symptoms and CT features,bilateral CSDH patients caused by SIH can be identified to a certain extent,and cranial and spinal MRI is recommended for definitive diagnosis of SIH.

关 键 词：慢性硬膜下血肿 自发性低颅压综合征 临床特征 

分 类 号：R651.15[医药卫生—外科学]