自发性低颅压综合征12例临床特点及误诊原因分析

Analysis of the Clinical Characteristics and Misdiagnosis Causes in 12 patients with Spontaneous Intracranial Hypotension Syndrome

目的探讨自发性低颅压综合征的临床特点,以减少误诊误治。方法回顾性分析西京医院门急诊2011年7月—2014年7月收治的12例自发性低颅压综合征的临床资料。结果 12例均有体位性头痛,伴头晕、恶心、呕吐、颈部疼痛、耳鸣、听力下降,均无颅脑外伤史、手术史等。6例由外院转入,曾误诊为小脑扁桃体下疝2例,枕神经痛、硬膜下出血、病毒性脑炎、脑膜脑炎各1例,误诊率50%。入院后12例结合临床表现、脑脊液检查(压力均<60 mm H2O,白细胞数增高4例,蛋白增高5例)以及头颅MRI检查结果(7例正常,4例硬膜下积液,3例"脑下沉"改变,2例硬脑膜明显强化)综合分析,确诊自发性低颅压综合征。确诊后11例给予保守治疗症状好转,1例行人工硬脑膜覆盖术症状缓解,出院,随访预后均良好。结论对以体位性头痛就诊的中年女性首先要考虑该病,详细询问病史、认真查体、及时行腰椎穿刺脑脊液检查并结合影像学改变综合分析,及早确诊并治疗,避免误诊误治。

Objective To explore the clinical characteristics in spontaneous intracranial hypotension syndrome in order to avoid misdiagnosis and mistreatment. Methods We retrospectively analyzed 12 cases of SIH in outpatient and emergency departments in Xijing Hospital from July 2011 to July 2014. Results All the 12 patients of SIH suffered severe headache postural,with dizziness,nausea,vomiting,pain,tinnitus,hearing loss,without any history of trauma and surgery. 6cases were misdiagnosed in other hospital; misdiagnosis cases were 2 cases of tonsillar herniation,1 case of occipital neuralgia,1 case of subdural hematoma,1 case of viral encephalitis,1 case of meningoencephalitis,and misdiagnosis rate was 50%upon admission. Combined with clinical manifestations,cerebrospinal fluid test（ CSF pressure 60 mm H2 O,cell count was higher in 4 cases,the protein of 5 cases increased） and MRI examination（ MRI showed that 7 cases were normal,4 cases had subdural fluid collection,2 cases had diffuse pachy meningeal gadolinium enhancement,3 cases had brain sagging） all the 12 patients were then diagnosed with spontaneous intracranial hypotension syndrome. 11 cases were successfully treated with conservative therapy,1 case had surgical repair and his condition was alleviated,and the follow-up showed good prognosis. Conclusion Middle-aged women with orthostatic headache should be suspected with spontaneous intracranial hypotension syndrome. Clinicians should have a detailed and better understanding of history,make carefully examinations,timely lumbar puncture for cerebrospinal fluid examination combined with imaging examination,and make early diagnosis and treatment in order to avoid misdiagnosis and mistreatment.