自发性低颅内压综合征20例分析

Analysis of 20 Patients with Spontaneous Intracranial Hypotension Syndrome

目的探讨自发性低颅内压综合征(SIH)的临床表现、脑脊液、影像学的改变,诊治及预后,提高对本病的认识。方法对20例自发性低颅内压综合征患者的临床资料进行回顾性分析。结果 20例患者均有体位性头痛,卧位时缓解或消失,腰穿压力均<0.588 kPa(60 mm H2O),其中8例呈血性CSF,蛋白增高。6例白细胞升高。17例行头CT检查正常,1例硬膜下积液,1例硬膜下血肿,1例脑室变小。MRI检查7例显示弥漫性硬脑膜增厚强化。结论 SIH患者以体位性头痛为主要症状,脑脊液压力<60 mm H2O。治疗以补充生理盐水为主,疗效不佳时可给予激素及鞘内注入生理盐水。一般预后良好。认识自发性低颅内压综合征的临床表现、脑脊液、影像学的改变至关重要。注意与颅内高压、蛛网膜下腔出血,原发性、肥厚性硬脑膜炎等鉴别。

Objective To investigate the clinical manifestations of patients with spontaneous intracranial hypotension （SIH） syndrome,the changes of cerebrospinal fluid （CSF） and imaging features, measures of diagnosis and treatment, and prognosis of patients, in hopes of improving the understanding of this disease. Methods A retrospective analysis of clinical data of 20 cases of SIH syndrome was taken. Results All 20 patients had orthostatic headache, which eased or disappeared when lying position. Their lumbar puncture fluid pressures were all less than 0.588 kPa（60 mm H2O）. 8 cases showed bloody CSF and increased protein. 6 cases were with leukocytosis. The routine head CT examination showed that 17 was normal,1 case with subdural effusion, 1 case with subdural hematoma, 1 case with smaller ventricle. MRI examination showed that 7 cases were with diffuse thickening and enhancement of the dura mater. Conclusion The postural headache is the main symptom of SIH patients. CSF pressure is less than 60 mm H2O. The treatment is mainly saline supplement. If it has poor efficacy,hormones and intrathecal injection of saline may be given. The prognosis is good in general. The awareness of the clinical manifestations of spontaneous intracranial pressure syndrome, CSF and imaging changes is essential. The identifications with intraeranial hypertension, subarachnoid hemorrhage, primary and hypertrophic dura mater should be paid more attention on.