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目的探讨自发性低颅内压综合征(SIH)的临床表现、脑脊液、影像学的改变,诊治及预后,提高对本病的认识。方法对20例自发性低颅内压综合征患者的临床资料进行回顾性分析。结果 20例患者均有体位性头痛,卧位时缓解或消失,腰穿压力均<0.588 kPa(60 mm H2O),其中8例呈血性CSF,蛋白增高。6例白细胞升高。17例行头CT检查正常,1例硬膜下积液,1例硬膜下血肿,1例脑室变小。MRI检查7例显示弥漫性硬脑膜增厚强化。结论 SIH患者以体位性头痛为主要症状,脑脊液压力<60 mm H2O。治疗以补充生理盐水为主,疗效不佳时可给予激素及鞘内注入生理盐水。一般预后良好。认识自发性低颅内压综合征的临床表现、脑脊液、影像学的改变至关重要。注意与颅内高压、蛛网膜下腔出血,原发性、肥厚性硬脑膜炎等鉴别。
Objective To investigate the clinical manifestations, changes of cerebrospinal fluid (CSF), radiological findings, diagnosis and treatment, and prognosis of spontaneous hypoccnoscleral pressure syndrome (SIH) and to raise awareness of the disease. Methods The clinical data of 20 patients with idiopathic hypoccnosis syndrome were retrospectively analyzed. Results All the 20 patients had postural pain and were relieved or disappeared in the supine position. The pressure of lumbar puncture was <0.588 kPa (60 mm H2O). Eight of them showed bloody CSF and increased protein. 6 cases of leukocytosis. 17 routine head CT examination was normal, 1 case of subdural effusion, 1 case of subdural hematoma, 1 case of smaller ventricles. MRI examination of 7 cases showed diffuse dura mater thickening enhancement. Conclusions SIH patients have postural headache as the main symptom, and CSF pressure is <60 mm H2O. Treatment to supplement the main saline, poor efficacy can be given hormone and intrathecal physiological saline. The general prognosis is good. Understanding of the clinical manifestations of spontaneous hypoccnographic syndrome, cerebrospinal fluid, imaging changes are crucial. Note and intracranial hypertension, subarachnoid hemorrhage, primary, hypertrophic dura meningitis and other identification.