老年原发性低颅压综合征诊治体会（附46例报告）

Experience of Diagnosis and Treatment of Senile Primary Intracranial Hypotension Syndrome （a Report of 46 Cases）

【目的】探讨老年原发性低颅压综合征（PIH）的临床特点，提高对该病的诊治水平，减少误诊发生。【方法】对近15年在本院住院确诊为PIH的46例老年患者的临床资料及诊治过程进行回顾性分析，并结合文献对此类患者的临床特点、发病机制、诊断、鉴别诊断以及治疗进行探讨。【结果】46例PIH均表现为直立性头痛，且脑脊液压力≤60mmHzO，结合脑脊液常规生化检查及头颅影像学检查可确诊；通过改变体位、饮食、静脉补液等处理后，46例患者头痛症状均能有效缓解；其中13例患者治疗1周内症状消失出院，23例患者治疗1～2周疗效显著出院，10例患者治疗3周左右痊愈出院。所有患者出院前经复查腰穿脑脊液压力恢复正常，所有患者随访半年时间均无复发。【结论】针对头痛的老年人，临床医生必须警惕老年PIH，通过详细的病史采集及辅助检查并排除其他明确原因有助于减少该病的漏诊及误诊；一旦确诊则可通过综合应用各种治疗手段，有效地纠正病因、缓解症状及改善预后。

[Objective] To explore the clinical features of senile primary intracranial hypotension syndrome（PIH）, and improve the level of diagnosis and treatment, and decrease the misdiagnosis rate. [[Methods] Clinical data and the course of diagnosis and treatment of 46 senile patients diagnosed as PIH in our hospital in recent 15 years were analyzed retrospectively. Clinical features, pathogenesis, diagnosis, differential diagnosis and treatment of the patients were ex- plored with literatures. [Results]The manifestations of 46 PIH patients were all erect headache, and cerebrospinal fluid （CSF） pressure was below 60mmHzO. PIH could be diagnosed by CSF routine biochemical examination combined with head imaging. The symptoms of headache were effectively alleviated by changing position, diet and intravenous fluid infu- sion. The sympton3.s of 13 patients disappeared within one week after treatment and they discharged from hospital. After 1~2 weeks of treatment, 23 patients had obvious efficacy and discharged from hospital. After about 3 weeks of treat- ment, 10 patients were cured and discharged from hospital. All patients were reexamined by lumbar puncture for CSF pressure before discharge. No recurrence was found in all patients during half a year of follow up. [Conclusion]It is ad- vised that clinical doctors should pay a close attention to old people with headache. Detailed history-taking, assistant ex- amination and the exclusion of other confirmed pathogenesis are helpful to decrease the misdiagnosis and missed diagnosis of the disease. When the disease is diagnosed, the comprehensive treatments can effectively remedy the cause, alleviate the symptoms and improve the prognosis.