36例原发性低颅压头痛临床分析

Clinical analysis of 36 cases with spontaneous intracranial hypotension headache

目的：探讨原发性低颅压头痛的临床特点、治疗方法和预后。方法回顾性分析2009年8月至2014年9月诊治的36例原发性低颅压头痛患者的临床资料。结果36例患者中，女25例（69.4%），男11例（30.6%），年龄（39.6±11.9）岁。所有患者都有头痛症状，91.7%（33/36）的患者头痛与体位有明显关系；恶心和/或呕吐、颈部不适是主要伴随症状；脑脊液（CSF）压力（45.3±28.6）mmH2O（1 mmH2O=0.0098 kPa），女性患者CSF压力（37.3±28.2）mmH2O，男性患者CSF压力（67.4±15.4）mmH2O，女性患者CSF压力显著低于男性患者，差异有统计学意义（P＜0.05）。CSF蛋白（545.6±377.1）mg/L，IgG水平（57.4±41.1）mg/L。颅脑MRI平扫＋增强扫描异常占54.8%（17/31），主要异常是硬脑膜强化、硬脑膜下血肿、垂体饱满。脑电图检查有52.4%（11/21）出现异常，主要表现为两侧半球弥漫性散在θ波和痫样放电；全部患者经保守治疗后都明显好转出院，3例1个月内复发，继续予保守治疗后好转出院。结论典型体位性头痛，腰椎穿刺CSF压力低于60 mmH2O，CSF蛋白、IgG增高，颅脑MRI增强扫描见硬脑膜强化、垂体充血增大是原发性低颅压头痛的主要特征，该病预后良好。

Objective To explore the clinical features of spontaneous intracranial hypotension （SIH） headache. Methods Thirty-six cases with SIH headache who were admitted between August 2009 and September 2014 were retrospectively analyzed. Results Twenty-five （69.4%） of 36 cases were female, and 11 cases （30.6%） were male. The age of onset was （39.6 ± 11.9） years. All the cases had headache, among whom 91.7% （33/36） had typical postural headache. The common concomitant symptoms were nausea, vomiting and neck stiffness. The average cerebrospinal fluid （CSF） pressure was （45.3 ± 28.6） mmH2O （1 mmH2O=0.009 8 kPa） which in male was （67.4 ± 15.4） mmH2O , and in female was （37.3 ± 28.2） mmH2O, and there was significant difference （P〈0.05）. The content of CSF protein was （545.6 ± 377.1） mg/L and the level of IgG was （57.4 ± 41.1） mg/L. Seventeen cases showed abnormality on MRI scan, with diffuse pachymeningeal enhancement, subdural hematoma, hyperemia and swelling pituitary. Eleven cases （52.4%, 11/21） showed abnormal on EEG examination, with theta waves and epiletiform waves in bilateral cerebral hemisphere. All cases were cured after conservative treatment, 3 cases relapsed within 1 month and was cured again. Conclusions Typical postural headache, cerebrospinal fluid pressure less than 60 mmH2O, higher levels of CSF protein and IgG, diffuse pachymeningeal enhancement and hyperemia and swelling pituitary on MRI scan are the main features in SIH headache, and this disease has favorable prognosis.