自发性低颅压综合征临床表现、影像学特点及预后分析

Clinical analysis of spontaneous intracranial hypotension headache

目的探讨自发性低颅压综合征的临床、预后及影像学特点。方法北京协和医院2009年至2014年收治的自发性低颅压综合征患者16例,对其临床表现、实验室检测、影像学特点及预后进行分析。结果所有患者均表现为体位性头痛。13例脑脊液压力<60mm H2O,3例脑脊液压力为0。6例头颅CT提示硬膜下积液/积血,2例脑叶出血,5例存在双侧侧脑室体积减小,8例未见明显异常。头颅增强MRI检查示硬脑膜弥漫强化9例,硬膜下出血3例,硬膜下积液3例,脑组织下移4例,垂体增大2例。结论体位性头痛是自发性低颅压综合征相对典型的症状之一,多数患者预后良好。头颅增强MRI可显示弥漫性硬脑膜强化等典型的低颅压改变,头颅CT亦可提示部分改变。在详细询问病史的基础上,重视对头颅CT检查的判读,避免对头颅增强MRI检查的过度依赖,有助于该病的早期诊断。

Objective To explore the clinical and neuroimaging features of spontaneous intracranial hypotension （SIH）.Methods 16 patients diagnosed with SIH from 2009 to 2014 in Peking Union Medical College Hospital were included.Clinical manifestations, lab tests and neuroimaging results as well as prognosis were analyzed retrospectively.Results All cases had reported orthostatic headache.Pressure of cerebrospinal fluid was less than 60mmH2 O in 13 patients and 0 in 3 patients.Brain computed tomography （CT） revealed subdural hematomas/fluid accumulations in 6 patients and lobar hemorrhages in 2 patients respectively.Decreases in the size of bilateral ventricles in five patients were identified.Brain magnetic resonance imaging （MRI） with contrast demonstrated diffuse meningeal enhancement in 9 cases, sagging of the brain in 4 cases and pituitary enlargement in 2 cases.Conclusion Orthostatic headache is one of the most typical manifestations of SIH which has favorable prognosis in most patients. Brain MRI with contrast can demonstrate the diffuse meningeal enhancement and other characteristic changes due to intracranial hypotension while brain CT may also reveal some of them.Besides careful history taking, it is noted that brain CT may also provide useful information in early diagnosis of spontaneous intracranial hypotension.