摘要
目的:探讨原发性低颅压综合征(spontaneous intracranial hypotension,SIH)的临床、脑脊液(CSF)和影像学特点,以提高该病的诊断。方法:对67例SIH患者的临床特点和脑脊液、影像学检查等客观资料进行总结,并结合文献对其临床特点、发病机制、诊断及鉴别诊断进行分析。结果:本组患者均为急性、亚急性起病,均有体位性头痛,以枕部胀痛最为常见,可伴有恶心、呕吐、头晕、耳鸣、行走不稳、复视、颈肩部疼痛等,查体可有颈强直,脑神经麻痹等体征。CSF压力均<70 mm H2O(1 cm H2O=0.098 kPa),可有糖及蛋白含量升高、白细胞轻度增高,并可出现血性CSF。影像学特点可见脑结构下移并可见硬膜下血肿或积液,MRI增强显示硬脑膜增厚并弥漫性强化。给予大量补液及对症支持治疗,效果良好。结论:SIH临床表现复杂多变,体位性头痛是SIH特征性症状,结合腰穿和影像学检查有助于该病的诊治。
Objective：To investigate the clinical,cerebrospinal fluid（CSF） and imaging features of spontaneous intracranial hypotension in order to improve the diagnosis.Methods：The clinical features,cerebrospinal fluid,imaging and other objective data of 67 cases with SIH were summarized.The clinical features,pathogenesis,diagnosis and differential diagnosis of SIH were reviewed with literatures.Results：With acute or subacute onset,the patients all had postural headache,with occipital pain the most common,accompanied with nausea,vomiting,dizziness,tinnitus,unsteady gait,double vision,neck and shoulder pain.Neck stiffness,cranial nerve palsy and other signs might be found by physical examination.CSF pressures were lower than 70 mm H2O（1 cm H2O=0.098 kPa）,sugar and protein content as well as white cell count of CSF might increase slightly,and bloody CSF might appeared.Imaging features showed brain structures down and subdural hematoma or effusion.Enhanced MRI showed diffuse dural thickening and enhancement.All patients had good prognosis after given a lot of fluid and supportive treatment.Conclusion：SIH has complex clinical manifestations,and postural headache is characteristic.Lumbar puncture and imaging test are helpful to diagnosis and treatment of SIH.
出处
《中国医药导报》
CAS
2011年第36期178-180,共3页
China Medical Herald
关键词
原发性低颅压综合征
脑脊液
影像学
Spontaneous intracranial hypotension
Cerebrospinal fluid
Imaging
