原发性低颅压综合征18例临床、脑脊液和影像学特点分析

Analysis of the clinical,cerebrospinal fluid and imaging characteristics in 18 patients with spontaneous intracranial hypotension syndrome

目的探讨原发性低颅压综合征的临床、脑脊液和影像学特点。方法回顾性分析18例原发性低颅压综合征的临床资料。结果原发性低颅压综合征以体位性头痛、恶心、呕吐、头晕、耳鸣为主要表现,部分伴有神经系统体征,腰穿脑脊液压力均低于70mmH2O,27%患者红细胞增多,33%脑脊液蛋白增高,影像学检查可见硬膜增厚、强化、硬膜下积液和硬膜下血肿等表现,给予大量补液治疗及对症支持治疗,效果良好。结论体位性头痛、腰穿脑脊液压力低为原发性低颅压综合征的主要临床特点,影像学可呈现硬膜增厚强化等特征性改变,治疗以大量补液为主。

Objective To explore the clinical, cerebrospinal fluid and imaging characteristics in spontaneous intracranial hypotension syndrome（SIH）. Methods Clinical data of eighteen patients with SIH were analyzed retrospectively. Results The mainly clinical characteristics of SIH were position headache, nausea and vomiting, dizzy and tinnitus. Some of the patients had neurological signs and all patients had low cerebrospinal fluid （CSF） pressure （〈70 mmH2O）. 27% of them had increased RBC and 33% had increased CSF protein. MRI and CT showed diffuse pachymeningeal gadolinium enhancement, subdural fluid collection and hematoma; Given large fluid infusion and supportive treatment, these patients had good prognosis. Conclusions The clinical charateratics of SIH include position headache and low CSF pressure. The imaging examinations show mark changes such as diffuse pachymeningeal gadolinium enhancement and large fluid infusion is the main and effective treatment.