原发性低颅压综合征33例临床分析

目的探讨原发性低颅压综合征(PIH)的临床、脑脊液(CSF)和影像学特点。方法回顾性分析33例PIH患者的临床资料。结果所有患者均有体位性头痛,可伴恶心、呕吐、头晕、耳鸣、行走不稳、复视、颈肩部疼痛、颈强直;CSF压力均<70mmH2O,蛋白升高11例,WBC增多9例,RBC增多7例;28例行头颅CT检查,21例正常,3例双侧脑室系统缩小,3例硬膜下积液,1例硬膜下血肿;22例行头颅MRI检查,5例硬膜下积液,2例硬膜下血肿,8例硬脑膜增厚并弥漫性强化,1例"脑下垂"改变;给予大量补液及对症支持治疗,效果良好。结论体位性头痛是PIH特征性症状,腰穿CSF及头颅MRI检查具有诊断价值,预后良好。

Clinical analysis of 33 cases of primary intracranial hypotension

Objective To investigate the clinic,cerebrospinal fluid and imaging characteristics in primary intracranial hypotension(PIH).Methods The clinical information of 33 cases of PIH were retrospectively analyzed.Results All the 33 patients had orthostatic headache in association with one or more of numerous symptoms including nausea,vomiting,dizziness,tinnitus,gait instability,diplopia interscapular pain and neck pain/stiffness.All the patients had low CSF pressure(<70mmH2O)and high CSF protein in 11 patients,9 patients had increased CSF white cells and increased red cells in 7 patients.In 28 cases scaned by brain CT,21 cases were normal,3 cases had atrophy of bilateral cerebral ventricle system,3 cases had subdural collection of fluid,1 case had subdural hematoma.In 22 cases by brain MRI,5 cases had subdural collection of fluid,2 cases had subdural hematoma,8 cases were pachymeningeal thickening and diffuse pachymeningeal enhancement,1 case was "sagging" of the brain.Given large fluid infusion and supportive treatment,these patients had good prognosis.Conclusion PIH typically presents with position headache,the examinations of CSF and MRI can confirm PIH,PIH usually has a good prognosis.