论文部分内容阅读
目的探讨自发性低颅压综合征(SIH)临床症状、脑脊液、影像学特点及治疗预后。方法分析38例临床确诊的SIH患者的临床表现、脑脊液、影像学、治疗与随访资料。结果全部患者存在直立位头痛,伴随恶心或呕吐68.4%、颈强直78.9%、头晕或眩晕47.4%、耳鸣或听力下降7.9%、视觉症状(视力障碍、畏光、复视)10.5%。94.7%患者侧卧位脑脊液压力<60mmH2O。头颅MRI检查总体阳性率73.3%,弥漫性硬脑膜增厚及强化最常见,其他表现依次为硬膜下积液、脑下沉和垂体增大等。结论直立位头痛症状、侧卧位脑脊液压力<60mmH2O及MRI特征性表现对于诊断SIH最具意义,头颅MRI增强检查是临床诊断SIH主要的无创检查方式之一。治疗以脚高头低卧床休息及补液治疗为主,大多数预后好,少数需硬脑膜修补治疗。
Objective To investigate the clinical symptoms, cerebrospinal fluid (CSF), imaging characteristics and prognosis of spontaneous intracranial hypotension syndrome (SIH). Methods The clinical manifestations, cerebrospinal fluid, imaging, treatment and follow-up data of 38 clinically diagnosed SIH patients were analyzed. Results All patients had upright headache accompanied by 68.4% of nausea or vomiting, 78.9% of neck stiffness, 47.4% of dizziness or dizziness, 7.9% of tinnitus or hearing loss, and 10.5% of visual symptoms (visual impairment, photophobia and diplopia). 94.7% of patients with lateral cerebrospinal fluid pressure <60mmH2O. Head MRI examination of the overall positive rate of 73.3%, diffuse dural thickening and strengthening the most common, followed by other manifestations of subdural fluid, brain subsidence and pituitary enlargement. Conclusion The upright headache symptom, lateral pressure of cerebrospinal fluid in the lateral position <60mmH2O and the characteristic features of MRI are of most significance for the diagnosis of SIH. MRI enhanced MRI is one of the main noninvasive methods for clinical diagnosis of SIH. Treatment of high foot low bed rest and rehydration therapy, most of the prognosis is good, a few need to dura repair treatment.