自发性低颅压8例临床特点分析  

Analysis of the clinical characteristics of 8 cases of spontaneous intracranial hypotension

作　　者：胡阳 王燕波[2] 徐丽英[2] 龚涛[1] 陆军[3] 陈涓[4] 陈玉辉[1] Hu Yang;Wang Yanbo;Xu Liying;Gong Tao;Lu Jun;Chen Juan;Chen Yuhui(Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiovascular and Cerebrovascular Medicine,Fourth People′s Hospital of Datong,Datong 037006,China;Department of Neurosurgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院神经内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]山西大同市第四人民医院心脑血管一科,大同037006 [3]北京医院神经外科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [4]北京医院放射科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华全科医师杂志》2023年第8期849-853,共5页Chinese Journal of General Practitioners

基　　金：中央高水平医院临床课题(BJ-2019-200)。

摘　　要：目的:分析自发性低颅压(SIH)患者的临床特点。方法:该研究为回顾性病例系列研究。收集2017年5月至2022年3月于北京医院就诊的SIH患者的临床资料,包括性别、年龄、症状、体征、影像学表现、治疗与转归等,分析其临床特点。结果:最终纳入SIH患者8例,女性6例,男性2例,年龄(33.5±7.3)岁。6例急性起病,1例亚急性起病,1例慢性起病。4例发病前有诱因,3例为劳累、1例为运动。8例均有体位性头痛。3例伴有颈部疼痛。6例伴有自主神经功能紊乱表现,1例伴有视物模糊、颈抵抗,1例伴双耳耳鸣。8例血常规、肝肾功能及电解质、凝血功能均未见明显异常。腰椎穿刺结果显示,7例脑脊液压力≤60 mmH 2O(1 mmH 2O=0.0098 kPa),其中2例低至测不出;1例脑脊液压力正常(90 mmH 2O)。脑脊液常规结果示4例红细胞增多,2例白细胞增多。8例脑脊液生化结果均正常。8例均进行了头部MRI平扫,6例发现异常,其中1例硬膜下血肿,1例蛛网膜下腔出血,1例脑组织下沉,2例颅内静脉窦扩张,1例颅内静脉窦扩张合并硬膜下血肿。8例均进行了头部MRI增强扫描,5例呈现出弥漫性硬脑膜强化。3例进行了数字减影脊髓造影和计算机断层脊髓造影检查,2例发现硬脑膜脑脊液漏口。1例进行了磁共振水成像检查,未发现脑脊液漏口。8例患者随访38.5(10.3,63.0)个月,保守治疗后,6例头痛缓解或消失,1例出院1周后复发入院,行非靶向硬膜外血贴片(EBP)后未再复发,1例保守治疗失败后行非靶向EBP,头痛缓解,2个月后复发,行胸椎3~4间隙靶向EBP,头痛消失,未再复发。结论:SIH多发于青年人,核心症状为体位性头痛,可伴随多种临床症状,影像学表现多样。SIH患者多可采取保守治疗,若效果不好可行非靶向或靶向EBP。Objective To analyze the clinical characteristics of patients with spontaneous low intracranial pressure(SIH).Methods The study is a retrospective series.The clinical data of patients with SIH who visited Beijing Hospital from May 2017 to March 2022,including gender,age,symptoms,signs,imaging findings,treatment and outcome,were collected and their clinical characteristics were analyzed.Results Finally,8 patients with SIH,6 females and 2 males,aged(33.5±7.3)years,were included.There were 6 cases of acute onset,1 case of subacute onset,and 1 case of chronic onset.Four cases had pre-onset triggers,3 cases were exertional and 1 case was exercise.All 8 cases had orthostatic headache.Three cases were accompanied by neck pain.Six cases were accompanied by autonomic dysfunction,1 case with blurred vision and neck resistance,and 1 case with tinnitus in both ears.There were no obvious abnormalities in blood routine,liver and kidney function,electrolytes,and coagulation function in 8 cases.The results of the lumbar puncture showed that the cerebrospinal fluid pressure was≤60 mmH2O(1 mmH2O=0.0098 kPa)in 7 cases,and 2 cases were so low that they were undetectable.One patient had normal cerebrospinal fluid pressure(90 mmH2O).The routine results of cerebrospinal fluid showed 4 cases of an increased number of red blood cells and 2 cases of leukocytosis.The biochemical results of cerebrospinal fluid in all 8 cases were normal.All 8 patients underwent non-contrast MRI scan of the head,and 6 cases found abnormalities,including 2 cases of subdural hematoma,1 case of subarachnoid hemorrhage,1 case of brain tissue sinking,and 3 cases of intracranial venous sinus dilation(including 1 case with subdural hematoma).All 8 patients underwent MRI enhancement scan of the head,and 5 patients showed diffuse dural enhancement.Three patients underwent digital subtraction angiography myelogram and computed tomography myelogram,and 2 cases found dural cerebrospinal fluid leakage.One patient underwent magnetic resonance water imaging and no cereb

关 键 词：低颅压性头疼 脑脊液漏 自体硬膜外血贴片 

分 类 号：R741[医药卫生—神经病学与精神病学]