低颅压综合征临床及MRI表现

Clinical and Imaging Manifestations of Intracranial Hypotension

目的探讨低颅压综合征的临床及MRI表现,为临床诊断及治疗提供依据。方法回顾性分析华中科技大学同济医学院附属同济医院2014年至2016年收治的13例低颅压综合征患者临床表现及影像学特点。结果所有患者均表现为体位性头痛,脑脊液压力≤60 mm H_2O。头颅CT发现硬膜下积液3例,脑肿胀1例。头颅MRI平扫及增强发现硬脑膜增厚强化9例,硬膜下积液4例,颅内静脉窦增宽3例,垂体饱满和小脑扁桃体下移各1例。脊髓蛛网膜下腔成像发现有脑脊液漏1例。结论低颅压综合征典型的临床症状为体位性头痛,并且通常为首发症状。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,脊髓蛛网膜下腔成像在部分患者中可发现脊髓硬脊膜瘘而明确病因;动态复查头部MRI有助于判断疾病转归。

Objective To explore the clinical and imaging presentations of intracranial hypotension （IH）.Methods This study is a retrospective analysis of 13 patients diagnosed with intracranial hypotension from 2014 to 2016 at Wuhan Tongji Hospital.Their clinical data include manifestations,imaging results as well as prognoses.Results The onset symptom of all patients was orthostatic headache with cerebral fluid pressure less than 60 mmH2O.Brain computed tomography revealed subdural fluids in 3 patients,and one of which had severe brain edema.Meningeal thickening and abnormal leptomeningeal enhancement were detected in 9 patients by brain contrast magnetic resonance imaging （MRI）.Moreover,subdural effusion was detected in 4 patients and 3 patients with venous sinus widening.One patient was noted to have pituitary enlargement and one patient with cerebellar tonsil descent.Furthermore,one patient had CSF leakage in cervical spinal cord by magnetic resonance myelography （MRM）.Conclusion Orthostatic headache is a common symptom in intracranial hypoteasion which was observed in all patients and initial onset symptoms.The prognosis for most patients with intracranial hypotension was good and cerebral MRI can provide useful information with special imaging features such as meningeal thickening and enhancement.