特发性低颅压头痛的临床特点及预后因素分析

Clinical Features of and Prognosis Factors for Spontaneous Intracranial Hypotension

目的总结特发性低颅压头痛临床特点及预后因素。方法对2010年12月1日-2014年2月1日的特发性低颅压综合征住院患者进行连续登记。在患者首次就诊时,研究者收集其基本信息及临床特点,安排常规检查及腰椎穿刺脑脊液检查。患者均接受固定体位及补液治疗。治疗1周后随访。在治疗前和随访时应用视觉模拟评分法（VAS）评估患者头痛的严重程度。结果共纳入110例特发性低颅压头痛患者,其中男39例（35.5%）,女71例（64.5%）;发病年龄17-91岁,平均（42.0±12.4）岁。除体位相关的头痛外,较为常见的临床表现为恶心68例（61.8%）,呕吐63例（57.3%）,头昏40例（36.4%）,颈部疼痛27例（24.5%）,耳鸣23例（20.9%）。入组时VAS评分为（7.46±0.86）分,1周后随访VAS评分为（3.45±2.17）分,平均改善百分比为53.75%。入院筛查抗核抗体阳性患者预后改善更好。结论特发性低颅压头痛可伴有多种脑干或小脑症状、脑膜刺激症状,脑脊液可呈现类似病毒感染的表现,但通常血清病毒筛查阴性,如不能通过影像学寻找到脑脊液漏破口,则可予以适当补液,并辅助以体位治疗,大多数患者能够得到明显改善。

Objective To summarize the clinical features of and prognosis factors for spontaneous intracranial hypotension（SIH）. Methods We continuously registered hospitalized patients diagnosed with SIH from December 1st, 2010 to February 1st, 2014. Etiology information and clinical features were collected at the first day of admission. Routine blood test and lumbar puncture were done as soon as possible. Every patient got position and fluid infusion therapy. During the one-week follow-up, headache level was evaluated with Visual Analogue Scale（VAS）. Results There were 110 patients included, and among them, 39（35.5%） were male and 71（64.55%） were female. The age of onset was between 17 and 91 years old with a mean onset age of（42.0±12.4）. Besides postural headache, common signs were nausea（68 cases, 61.8%）, vomiting（63 cases, 57.3%）, dizziness（40 cases, 36.4%）, neck pain（27 cases, 24.5%）, and tinnitus（23 cases, 20.9%）. VAS at baseline was（7.46±0.86）, and at the last follow-up, VAS was（3.45±2.17）, with an average improvement of 53.75%. Patients with ANA marker positive had better prognosis. Conclusions SIH can accompany serious brain stem and cerebellum signs, and even meningeal irritation. Cerebrospinal fluid（CSF） changes are similar to virus infection with negative serum virus screening. If CSF leak cannot be found on imaging, patients can improve through fluid infusion therapy and postural treatment.