自发性低颅压综合征75例临床分析

Clinical analysis of 75 cases of spontaneous intracranial hypotension

目的自发性低颅压综合征患者的临床特征及文献回顾。方法回顾性分析解放军总医院第七医学中心神经外科2011年1月~2021年1月收治的75例自发性低颅压综合征患者临床资料,分析性别和年龄分布差异,总结影像学特征。结果患者平均年龄(43.67±10.30)岁,男性24例(32.0%),女性51例(68.0%),平均住院日(8.79±6.12)d;典型直立性头痛卧位好转者56例(75.0%);女性颈椎病占比高于男性(P=0.02)。所有患者均进行了核磁检查(增强58例,77.3%):符合核磁诊断自发性低颅压综合征者32例(42.7%),其中垂体增大15例(20.0%),脑膜强化28例(37.3%),硬膜下积液/出血9例(12.0%),小脑扁桃体下垂者6例(8.0%);腰椎穿刺57例:<60 mmH2O 43例(84.3%),≥60 mmH2O 8例(15.7%),未记录结果者6例;误诊1例,74例均予以输液(2000~3000 ml/d)及对症治疗,出院时头痛完全好转52例(69.3%),改善19例(25.3%),未改善4例(5.3%)。结论自发性低颅压综合征发病高峰在30~50岁,女性占比约男性的2倍,女性颈椎病占比高于男性;头颅增强核磁是明确诊断的有效检查;通过保守补液治疗绝大多数患者症状得以好转。

Objective To investigate the clinical features of patients with spontaneous hypotension syndrome.Methods The clinical data of 75 patients with idiopathic hypocranial pressure syndrome admitted to Department of Neurosurgery,Seventh Medical Center,PLA General Hospital from January 2011 to January 2021 were retrospectively analyzed.The differences in gender and age distribution were analyzed,and the imaging characteristics were summarized.Results The mean age of the patients was(43.67±10.30)years,and there were 24 males(32.0%)and 51 females(68.0%).The mean hospital stay was(8.79±6.12)days.The majority(56/75,75.0%)cases of typical orthostatic headache were improved in the decubitus position.The rate of cervical spondylosis in females was higher than that in males(P=0.02).All patients underwent magnetic resonance imaging[58(77.3%)cases underwent contrast-enhanced examination],which suggested spontaneous hypotension syndrome in 32 cases(42.7%).There was pituitary enlargement in 15(20.0%)cases,meningeal enhancement in 28(37.3%),subdural effusion/hemorrhage in 9(12.0%),and decent of cerebellar tonsils in 6(8.0%).Fifty-seven cases underwent lumbar puncture,of which 43(84.3%)had a cranial pressure<60 mmH2O,8(15.7%)had a cranial pressure≥60 mmH2O,and 6 had no cranial pressure recorded.One case was misdiagnosed.Seventy-four cases were treated with infusion(2000-3000 ml/d)and symptomatic treatment,of which 52(69.3%)were completely improved,19(25.3%)were improved,and 4(5.3%)were not improved at discharge.Conclusion The onset peak age of spontaneous intracranial hypotension is between 30 and 50 years old,and the proportion of females is about twice that of males.The rate of cervical spondylosis in females is higher than that in males.Cranial enhanced MRI is an effective test for definite diagnosis.The vast majority of patients recover better with conservative rehydration.