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自发性颅内低压(SIH)表现为位置性头痛,轻微脑膜征和NRI显示弥散性脑膜增强。既往报告病例神经病学检查无异常,本文报道2例伴双侧外展神经麻痹的SIH。 例1,女性,43岁,既往健康。头痛伴恶心及双侧耳鸣,头痛直立时加重,平卧后减轻,2周后出现复视。体检仅发现双侧外展受限,24小时后右侧外展神经麻痹,左侧无改变。MRI增强扫描见弥散性硬脑膜增强影,以额顶区明显。腰穿测压60mmH_2O,CSF淋巴细胞稍增多,糖及蛋白正常,细胞学及多项培养阴性。莱姆血清学,血管紧张素转化酶及抗核抗体等正常。强的松治疗头痛逐渐减轻,外展神经麻痹
Spontaneous intracranial hypotension (SIH) manifested as positional headache, mild meningeal signs and NRI showed diffuse meningeal enhancement. Previously reported cases of neurological examination without abnormalities, this article reports 2 cases with bilateral abducens nerve paralysis of SIH. Example 1, female, 43 years old, past health. Headache with nausea and bilateral tinnitus, headache increased erect, after supine relief, diplopia after 2 weeks. Physical examination found only bilateral abduction limited, 24 hours after the right abducens nerve paralysis, left no change. MRI enhanced scan to see diffuse dural enhancement shadow, to the frontal area significantly. Waist wear pressure measurement 60mmH_2O, CSF lymphocytes increased slightly, normal sugar and protein, cytology and a number of culture negative. Lyme serology, angiotensin converting enzyme and antinuclear antibodies and other normal. Prednisone treatment of headache gradually reduce the outreach nerve paralysis