自发性低颅压患者118例临床特点分析  

Spontaneous intracranial hypotension:analysis of 118 patients'clinical characteristics

作　　者：王震 夏田芯瑜 叶红[1] 吴洁[2] 齐得州 王征[3] 刘腾达 沈翀[4] 李岩[4] 戴艳芳[4] 陈忠云 李军杰[1] 武力勇[1] Wang Zhen;Xia Tianxinyu;Ye Hong;Wu Jie;Qi Dezhou;Wang Zheng;Liu Tengda;Shen Chong;Li Yan;Dai Yanfang;Chen Zhongyun;Li Junjie;Wu Liyong(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Anesthesiology and Operating Room,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Radiology and Nuclear Medicine,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麻醉手术科,北京100053 [3]首都医科大学宣武医院神经外科,北京100053 [4]首都医科大学宣武医院放射与核医学科,北京100053

出　　处：《中华神经科杂志》2023年第9期1001-1008,共8页Chinese Journal of Neurology

基　　金：国家自然科学基金(81901225,81971011)。

摘　　要：目的总结自发性低颅压患者的临床特点、影像学特点、治疗以及转归。方法收集2018年11月至2022年10月首都医科大学宣武医院诊治的自发性低颅压患者的一般资料、临床表现、辅助检查、治疗及转归进行分析。结果共收集118例自发性低颅压患者,男女比例约为4∶5,年龄为17.00~71.00[39.00(34.00,46.75)]岁,以30~49岁年龄段患者最为多见。其临床表现多为体位性头痛(117/118,99.2%),常伴随恶心(90/118,76.3%)、呕吐(70/118,59.3%)、颈部僵硬(88/118,74.6%)、耳鸣(57/118,48.3%)、耳闷/耳堵塞感(57/118,48.3%)。头颅增强磁共振成像可见硬脑膜均一弥漫性强化(97/113,85.8%),静脉窦增宽(88/113,77.9%),硬膜下积液/血肿(46/113,40.7%),鞍上池变窄(86/113,76.1%),桥前池变窄(86/113,76.1%),乳头体脑桥距离变窄(80/113,70.8%);磁共振脊髓水成像发现107/118例(90.7%)存在脑脊液漏,而CT脊髓造影和脊髓钆造影分别发现25/46例(54.3%)和20/38例(52.6%)存在脑脊液漏。腰椎穿刺结果显示脑脊液压力低于60 mmH2O(19/103,18.4%;1 mmH_(2)O=0.0098 kPa)、红细胞计数增多(44/87,50.6%)、白细胞计数增多(39/87,44.8%)、蛋白水平升高(50/87,57.5%)。31/118例(24.6%)患者经保守治疗头痛完全缓解,78/87例(89.7%)患者经单次靶向硬膜外血贴头痛完全缓解;58/87例(66.0%)患者硬膜外血贴术后发生反跳性头痛。结论自发性低颅压主要表现为体位性头痛,对体位性头痛患者推荐行头颅增强磁共振成像和脊髓水成像检查协助诊断,不推荐常规行腰椎穿刺查脑脊液压力;靶向硬膜外血贴治疗自发性低颅压的有效性和安全性较好。Objective To summarize the clinical features,radiological characteristics,therapy,and outcome of patients with spontaneous intracranial hypotension(SIH).Methods The general information,clinical manifestations,auxiliary examinations,treatment,and outcomes in consecutive patients of SIH hospitalized in the Xuanwu Hospital,Capital Medical University from November 2018 to October 2022 were analyzed.Results A total of 118 patients with a female-to-male ratio of 5∶4 were included and the ages were 17.00-71.00[39.00(34.00,46.75)]years with a preponderance in the age of 30-49 years.Almost all patients had orthostatic headaches(117/118,99.2%),accompanied by nausea(90/118,76.3%),vomiting(70/118,59.3%),neck stiffness(88/118,74.6%),tinnitus(57/118,48.3%),and ear fullness(57/118,48.3%).Brain magnetic resonance imaging(MRI)showed dural enhancement(97/113,85.8%),enlarged venous sinus(88/113,77.9%),subdural fluid collection(46/113,40.7%),decreased suprasellar cistern(86/113,76.1%),effacement of the prepontine cistern(86/113,76.1%),diminished mamillopontine distance(80/113,70.8%).The cerebrospinal fluid(CSF)leaks were detected in 90.7%(107/118)of the patients by magnetic resonance myelography but 54.3%(25/46)and 52.6%(20/38)by CT myelography and magnetic resonance myelography with gadolinium.Lumber puncture found CSF pressure<60 mmH_(2)O(1 mmH2O=0.0098 kPa)in 18.4%(19/103)of patients,increased CSF red blood cell counts in 50.6%(44/87)of patients,CSF pleocytosis in 44.8%(39/87)of patients,increased CSF protein concentrations in 57.5%(50/87)of patients.The headache completely disappeared after conservative treatment in 24.6%(31/118)of patients and after a single targeted epidural blood patch in 89.7%(78/87)of patients.A rebound headache after epidural blood patch treatment occurred in 66.0%(58/87)of patients.Conclusions The patients with SIH almost manifested with orthostatic headache,and brain MRI and magnetic resonance myelography were suggested in those patients instead of CSF pressure by lumber puncture.Targeted epidural bloo

关 键 词：颅内低压 脑脊髓液 头痛 脊髓造影术 靶向硬膜外血贴 

分 类 号：R741[医药卫生—神经病学与精神病学]