血肿穿刺引流术联合硬膜外血贴术治疗伴硬膜下血肿及静脉性梗死的自发性低颅压综合征诊治思路:一例报告

Hematoma puncture and drainage combined with epidural blood patch in the treatment of subdural hematoma and venous cerebral infarction with spontaneous intracranial hypotension: one case report

目的 报告1例硬膜下血肿穿刺引流术结合靶向自体血硬膜外血贴术治疗自发性低颅压综合征伴硬膜下血肿和静脉性梗死病例,总结诊治思路。方法与结果 男性患者,以突发性头痛伴偏瘫发病,头痛症状平卧位好转、久站或久坐后加重。首次就诊分别以“急性脑梗死”行rt-PA静脉溶栓、脑静脉窦血栓形成行脱水降低颅内压和抗凝治疗,期间出现双侧硬膜下血肿并进行性加重,遂至首都医科大学宣武医院急诊就诊,诊断为双侧额颞顶叶硬膜下血肿伴积液、脑静脉系统血栓形成伴静脉性梗死以及自发性低颅压综合征。入院后先行软通道硬膜下血肿穿刺引流术清除血肿,病情稳定后通过靶向自体血硬膜外血贴术修补脑脊液漏口,低颅压症状迅速改善,残留血肿逐渐吸收。结论 对于体位性头痛伴突发性局灶性神经功能缺损、双侧大量硬膜下血肿的脑静脉系统血栓形成患者,应考虑自发性低颅压综合征的可能,立体定向软通道硬膜下血肿穿刺引流术结合靶向自体血硬膜外血贴术治疗有效。

ObjectiveTo report a case of subdural hematoma(SDH) puncture and drainagecombined with epidural blood patch(EBP) in the treatment of spontaneous intracranial hypotension(SIH)complicated with SDH and venous cerebral infarction, and summarize the diagnostic and treatment ideas.Methods and ResultsA male patient presented with sudden headache accompanied by hemiplegia, theheadache was relieved in recumbent position and aggravated when standing or sitting for a long time. Hewas initially diagnosed as acute cerebral infarction before hospitalization and was given rt-PA intravenousthrombolysis. And then was diagnosed as cerebral venous thrombosis(CVT), which was treated throughdehydration and anticoagulation, during which bilateral SDH occurred and progressive aggravated, and sentto Department of Emergency of Xuanwu Hospital, Capital Medical University. He was diagnosed asbilateral frontotemporal parietal SDH and effusion, CVT with venous cerebral infarction, and SIH. Softchannel twist drill craniotomy was performed firstly, then targeted autologous EBP were performed when thecondition came to steady. The patients’ symptoms improved, and residual SDH absorbed gradually.ConclusionsFor CVT patients accompanied by focal nerve dysfunction and SDH showed posturalheadache, the possibility of SIH could be considered, and stereotactic soft channel SDH puncture anddrainage combined with targeted autologous EBP can play a curative effect.