30例低颅压综合征临床特点分析  

Clinical characteristics of 30 patients with intracranial hypotension syndrome

作　　者：翁思淇 蔡亚男 何思陈 黄国慧 邓紫惠 陈斌[2] 刘晓军[3] 潘速跃 冀雅彬 WENG Siqi;CAI Yanan;HE Sichen;HUANG Guohui;DENG Zihui;CHEN Bin;LIU Xiaojun;PAN Suyue;JI Yabin(Department of Neurology,Nanfang Hospital of Nanfang University,1838 North Guangzhou Avenue,Guangzhou 510515,China;Department of Anesthesiology,Nanfang Hospital Baiyun branch,23 Yuan Xia Di Road,Huangshi Street,Guangzhou 510405,China;Department of Anesthesiology,Nanfang Hospital of Nanfang University,1838 North Guangzhou Avenue,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院神经内科,广州510515 [2]南方医科大学南方医院影像科 [3]南方医科大学南方医院麻醉科 [4]南方医院白云分院麻醉科 [5]南方医院白云分院神经医学科

出　　处：《中国神经精神疾病杂志》2024年第5期263-267,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：广东省基础与应用基础研究省企联合基金-面上项目(编号:2021A1515220105);广东省基础与应用基础研究省企联合基金-面上项目(编号:2021A1515220105)。

摘　　要：目的总结自发性或继发性低颅压综合征(intracranial hypotension syndrome,IHS)患者的临床特点。方法回顾性分析2022年9月至2023年5月我院诊断为自发性或继发性IHS的患者,收集临床资料,总结影像学特点、治疗方式以及预后。结果共入组30例,自发性和继发性IHS患者占比分别为63%(19例)和37%(11例)。临床特征上,直立性头痛最为常见(29例,96.7%),最常累及枕部(12例,40.0%),其次是额顶部(9例,30.0%);头颅影像学特征中,硬脑膜强化出现率最高(17例,56.7%)。CT脊髓造影显示,脑脊液漏最常见的位置是脊柱颈段(10例)和上胸段(9例),其次是下胸段(4例)和腰段(4例)。经保守治疗和靶向硬膜外血贴手术治疗,患者总有效率90%。结论直立性头痛和头颅MRI“硬脑膜强化”对于IHS的定性诊断有强提示作用,CT脊髓造影有助于脑脊液漏点的精确定位,靶向硬膜外血贴治疗是保守治疗无效时治愈IHS的有效方法。Objective To analyze and summarize the clinical presentation of spontaneous and secondary intracranial hypotension syndrome(IHS).Methods Patients diagnosed with spontaneous or secondary IHS from September 2022 to May 2023 were retrospectively analyzed.The clinical data,imaging features,treatment methods and prognosis were collected.The correlation between intracranial pressure values and clinical characteristics of the patients was statistically analyzed.Results A total of 30 patients were enrolled,and the proportion of spontaneous and secondary IHS was 63%(19 cases)and 37%(11 cases),respectively.In terms of clinical features,orthostatic headache was the most common type(29 cases,96.7%)and most commonly involved occipital region(12 cases,40.0%),followed by frontoparietal region(9 cases,30.0%).Among the brain imaging features,dural enhancement was the most common(17cases,56.7%).According to CT angiography of spinal cord findings,cerebrospinal fluid leakage is one of the most common location of cervical spine segments(10 cases),and on the thoracic segments(9 cases),followed by the thoracic segments(4 cases)and lumbar segments(4 cases).After conservative treatment and surgical treatment,the total effective rate was 90%.Conclusion Orthostatic headache and cranial MRI"dural enhancement"have strong indication on the definitive diagnosis of IHS.CT myelography is helpful to precisely localize the site of cerebrospinal fluid leakage.Targeted epidural blood patch therapy is an effective method to cure IHS when conservative treatment is ineffective.

关 键 词：低颅压综合征 临床表现 头痛 脑脊液漏 核磁共振成像 回顾性分析 CT脊髓造影 

分 类 号：R742[医药卫生—神经病学与精神病学]