67例原发性低颅压综合征临床、脑脊液和影像学特点

·医护论坛·

2011年12月第8卷第36期

中国医药导报CHINA MEDICAL HERALD

原发性低颅压综合征（SIH ）是一组原因不明的、侧卧位时脑脊液压力低于70mm H 2O 所产生的一系列症状，发病率约为5/10万，其主要临床表现为体位性头痛，即坐位或站立位时加重，卧位时有所减轻或消失。该病可伴有恶心、呕吐、眩晕、耳鸣、视力障碍、颈项强直等，临床上极易误诊为脑膜炎、蛛网膜下腔出血、脑供血不足、颈椎病、血管性头痛等。为探讨SIH 的临床、脑脊液和影像学特征，本研究对本院2006年1月~2011年10月后收治的、经腰穿证实的67例SIH 患者的临床资料进行回顾性分析，现报道如下：

1临床资料

67例SIH 患者中，男31例，女36例；年龄16~74岁，平

均36.6岁；病程2~120d ；发病前均无外伤及腰穿病史，12例病前有上呼吸道感染史，7例有旅游等过度疲劳史。67例均行头颅影像学检查，其中，51例行头颅CT 检查，54例行头颅MRI 检查，16例行头颅MRA 检查，12例行头颅MRV 检查，

17例行颈脊椎MRI 检查，40例行脑电图检查，所有患者均

常规进行了腰穿脑脊液检查及心电图、胸片、血常规、血生化等检查。2结果

2.1临床症状

所有患者均表现为急性、亚急性起病，其中，53例为急性起病，并有20例表现为清晨起床时突然出现的头痛。所有患者均以头痛为首发症状，头痛最常见部位为枕部27例，其次为前额部24例和顶部、颞部和全头痛14例；性质多为胀

67例原发性低颅压综合征临床、脑脊液

和影像学特点

曹辉，林兴建*

南京医科大学附属脑科医院神经内科，江苏南京

210029

[摘要]目的：探讨原发性低颅压综合征（spontaneous intracranial hypotension ，SIH ）的临床、脑脊液（CSF ）和影像学特点，以提高该病的诊断。方法：对67例SIH 患者的临床特点和脑脊液、影像学检查等客观资料进行总结，并结合文献

对其临床特点、发病机制、诊断及鉴别诊断进行分析。结果：本组患者均为急性、亚急性起病，均有体位性头痛，以枕部胀痛最为常见，可伴有恶心、呕吐、头晕、耳鸣、行走不稳、复视、颈肩部疼痛等，查体可有颈强直，脑神经麻痹等体征。CSF 压力均<70mm H 2O （1cm H 2O=0.098kPa ），可有糖及蛋白含量升高、白细胞轻度增高，并可出现血性CSF 。影像学特点可见脑结构下移并可见硬膜下血肿或积液，MRI 增强显示硬脑膜增厚并弥漫性强化。给予大量补液及对症支持治疗，效果良好。结论：SIH 临床表现复杂多变，体位性头痛是SIH 特征性症状，结合腰穿和影像学检查有助于该病的诊治。

[关键词]原发性低颅压综合征；脑脊液；影像学[中图分类号]R743[文献标识码]B

[文章编号]1673-7210（2011）12（c ）-178-03

Clinical,cerebrospinal fluid and imaging features of 67cases with sponta 鄄neous intracranial hypotension

CAO Hui,LIN Xingjian *

Department of Neurology,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China

[Abstract]Objective:To investigate the clinical,cerebrospinal fluid (CSF)and imaging features of spontaneous intracra 鄄nial hypotension in order to improve the diagnosis.Methods:The clinical features,cerebrospinal fluid,imaging and other objective data of 67cases with SIH were summarized.The clinical features,pathogenesis,diagnosis and differential diagno 鄄sis of SIH were reviewed with literatures.Results:With acute or subacute onset,the patients all had postural headache,with occipital pain the most common,accompanied with nausea,vomiting,dizziness,tinnitus,unsteady gait,double vision,neck and shoulder pain.Neck stiffness,cranial nerve palsy and other signs might be found by physical examination.CSF pressures were lower than 70mm H 2O (1cm H 2O=0.098kPa),sugar and protein content as well as white cell count of CSF might increase slightly,and bloody CSF might appeared.Imaging features showed brain structures down and subdural hematoma or effusion.Enhanced MRI showed diffuse dural thickening and enhancement.All patients had good prognosis after given a lot of fluid and supportive treatment.Conclusion:SIH has complex clinical manifestations,and postural headache is characteristic.Lumbar puncture and imaging test are helpful to diagnosis and treatment of SIH.[Key words]Spontaneous intracranial hypotension;Cerebrospinal fluid;Imaging

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