自发性低颅压综合征和肥厚性硬脑膜炎的临床及影像特征比较

Comparison of spontaneous intracranial hypotension and hypertrophic pachymeningitis in clinical and magnetic resonance imaging features

目的 比较自发性低颅压综合征（SIH）和肥厚性硬脑膜炎（HP）的临床及影像特征,为二者鉴别提供参考.方法 收集作者医院收治的8例SIH患者和6例HP患者临床特征及影像学资料并进行对比分析.结果 （1）SIH：亚急性起病5例,急性起病3例;所有患者均以体位性头痛为核心表现.6例脑脊液压力低于60 mmH2O,余2例分别为70和90 mmH2O;脑脊液红细胞计数轻度增高1例,蛋白轻度增高2例（分别为0.71和0.84 g/L）,余5例脑脊液常规、生化均正常.头颅MRI结果示弥漫均匀硬脑膜增厚强化.（2）HP：急性起病2例,缓慢起病4例;所有患者均以头痛为核心表现并伴有其他神经系统受累的症状体征,其中表现为慢性每日头痛5例,发作性头痛1例.脑脊液压力在正常范围（90～150 mmH2O）5例,另1例压力为75 mmH2O;5例白细胞数轻度增高[（8～12）×106/L],4例蛋白增高（1.1～2.7 g/L）.4例红细胞沉降率增高（26～62 mm/h）,3例C-反应蛋白增高（13.4～36.1 μg/mL）,2例类风湿因子增高.头颅MRI结果示硬脑膜局限性增厚强化3例,硬脑膜弥漫增厚强化3例.结论 SIH和HP虽为不同性质的两种疾病,但临床表现、影像改变存在很多相似之处.早期进行影像学检查,收集详尽的临床资料进行对比分析,必要时行纵向随访追踪,将有助于二者的鉴别.

Objective To identify the differences between spontaneous intracranial hypotension （SIH） and hypertrophic paehymeningitis （HP） in clinical and magnetic resonance imaging （MRI） features. Methods The clinical and MRI informations of 8 SIH patients and 6 HP patients, who were admitted to our department from 2005-08-01 to 2010-02-28, were collected and analyzed. Results In SIH, there were 5 subacute onset cases and 3 acute onset cases. All SIH patients had specific orthostatic headache and entire diffuse and even dural enhancement in contrasted MRI. Cerebrospinal fluid （CSF） examinations showed that the pressure was lower than 60 mmH2O in 6 cases, and 70 mmH20 and 90 mmH2O in other 2 cases, respectively. The routine and biochemistry of CSF were normal in 5 patients, and the number of red blood cell was lightly increased in one. In HP, there were 2 acute onset cases and 4 chronic onset cases. One HP patient had paroxysmal headache, and other 5 HP patients all had persistent chronic daily headache. In addition, every HP patient had neurological symptoms and signs beside headache. MRI showed focal （3 cases） or diffuse （3 cases） thickened and enhancement dura. The CSF pressure was normal in 5 patients （90-150 mmH2O）, and as low as 75 mmH2O in one patient. In CSF routine and biochemistry examination, the number of white blood cell was lightly increased in 5 cases [ （8-12） × 10^6/L], and protein level was high in 4 cases （1.1-2.7 g/L）. In blood examinations, high blood sedimentation rate （26-62 mm/h）, high C-reactive protein （13.4-36.1 μg/miD, and high rheumatoid factor were observed in 4 cases, 3 cases, and 2 cases, respectively, conclusions Though SIH and HP were different etiological diseases, they own some similarities in their clinical and MIS, i features. Early imaging, detailed clinical data, and necessary longitudinal follow-up would contribute to distinguish the SIH and HP.