原发性颅内低压综合征15例临床分析

目的 探讨原发性颅内低压综合征发病机理、诊断和治疗方法。方法 对15例原发性颅内低压综合征的临床特点、病因和发病机理进行分析,观察常规和非常规疗效。结果 本征具有坐、立体位性头前的典型症状,多数病例采用常规治疗可痊愈,非常规治疗效果良好。结论 本征少见,易误诊,治疗方法较多,均有一定疗效。     

原发性颅内低压综合征20例报道

原发性颅内低压综合征（primary intracranial hypotension,ＰＩＨ）报道较少,临床上易误诊为神经官能症、神经性头痛、血管性头痛、前庭疾病、蛛网膜下腔出血、颅内压增高和脑膜炎等疾病,延误诊断治疗。现简述报道如下。１临床资料１．１ 一般资料１０年来我们诊治原发性颅内低压综合征２０例,其中男７例,女１３例;年龄２０～５０岁,平均３７岁;急性起病１４例,亚急性起病６例;病程８～２４天,平均１８天;病前情绪激动、精神紧张４例,感冒症状３例,无明显诱因１３例,均无脑外伤史。均符合ＰＩＨ诊断标准：①病前无腰椎穿刺史…     

颅内低压综合征误诊9例分析

对我院颅内低压综合征误诊9例分析如下。1临床资料本组男3例,女6例,年龄20~56(平均42)岁。头痛症状出现后,10 d~1个月确诊。临床表现为急性起病5例,亚急性起病4例;本组均以头痛为主要症状,其中以额枕部为重4例,以双颞部为重5例;头痛与体位有明显关系7例,与体位关系不明显2例;恶心未吐3例,恶心呕吐6例;轻度颈强7例,低热2例。本组误诊为病毒性脑炎5例,紧张性头痛3例,颈椎病1例。2结果本组经腰椎穿刺测压均<70 mm H2O、CSF常规化验正常而确诊。其中原发性颅内低压综合征6例;症状性颅内低压综合征3例,其中1例腹泻脱水所致,1例糖尿病酮症酸中毒…     

原发性颅内低压综合征一例误诊

1　病例资料男, 34岁。因午睡后出现前额持续性钝痛 2天就诊。头痛于站立时剧烈,平卧时明显缓解,无发热。查血白细胞 11×109 /L,以“感冒”予青霉素静脉滴注, 3天后症状减轻。1个月后疼痛再次发作就诊。查血常规未见异常,查体未见明显阳性体征。行头颅MRI检查示双侧顶叶、额叶脑沟内信号异常,于加权像呈浅淡异常高信号,增强扫描发现明显的弥散性硬脑膜强化,小脑半球脑膜异常强化。以脑膜炎收入院。腰椎穿刺脑脊液检查:压力 55mmH2O,外观无色透明;蛋白定性( -),红细胞 1×106 /L,白细胞 6×106 /L,蛋白0 2g/L,糖2 72mmol/L,氯123mmol/L…     

鞘内注液治疗小儿颅内低压综合征

颅内低压综合征的内科治疗起效慢 ,而鞘内注液疗法则能明显缩短住院时间 ,作于１９９６年１月～２００１年６月用此法治疗颅内低压综合征患儿１３例 ,效果良好 ,报道如下。１资料与方法１．１一般资料１３例中男９例 ,女４例。年龄６～１５岁。在采用鞘内注液治疗以前（１９９８年３月）为对照组共５例 ,腰椎穿刺测脑脊液压力后即采用静脉、口服补液 ,镇静止痛及烟酰胺等药物进行对症及促进脑脊液循环治疗 ;之后 (１９９８年３月～２００１年６月 )为观察组共８例 ,采用鞘内注射生理盐水治疗 :在诊断性腰椎穿刺测脑脊液压力后即向蛛网膜下腔…     

颅内低压综合征的观察及护理

目的通过对颅内低压综合征的观察及护理,降低或缓解症状。方法对18例患者诊断资料作回顾性分析,对其诊断治疗、护理作一探讨。结果18例患者采用病因治疗及对症护理,头痛基本消失。11例随访1年,无复发。结论通过对颅内低压患者的正确观察及护理,以便及时诊断治疗,从而减轻患者痛苦,提高治愈率。     

颅内低压综合征的观察及护理

目的 通过对颅内低压综合征的观察及护理,降低或缓解症状.方法 对18例患者诊断资料作回顾性分析,对其诊断治疗、护理作一探讨.结果 18例患者采用病因治疗及对症护理,头痛基本消失.11例随访1年,无复发.结论 通过对颅内低压患者的正确观察及护理,以便及时诊断治疗,从而减轻患者痛苦,提高治愈率.     

原发性颅内低压症17例误诊分析

原发性颅内低压症是指无明显诱因引起的颅内低压,主要表现为随体位变化的头痛,坐、立位头痛加重,平卧位头痛减轻或消失,预后良好。但如对该病认识不足,极易误诊。今收集自1989年2月至1994年8月17例误诊病例,报告如下: 1 临床资料 1.1 一般资料:本组男3例,女14例;年龄17～58岁,平均年龄30.5岁,其中20～35岁11例(占64％);急性起病16例,亚急性起病1例;就诊时间2～8天,平均5天。 1.2 症状和体征:病前感冒发热4例,腹泻1例,精神刺激1例,长期服用安定1例,病前无症状10例。本组病例全部头痛(100％),均与体位有关,坐立位头痛加重,卧位时好转,恶心呕吐14倒(82.     

颅内低压综合征43例患者护理要点

总结分析43例颅内低压综合征患者的护理，其中39例痊愈出院，无并发症发生。4例自动出院，所有病例3周内症状明显缓解，复查腰穿压力正常。笔者认为正确的体位、保持输液道的通畅及做好腰穿的护理是颅内低压综合征患者护理的关键。     

POEMS综合征(附44例文献复习)

POEMS综合征是一种罕见的多系统疾患,临床上以多发性神经病变(polyneuropathy)、脏器肿大(organomegaly)、内分泌障碍(ehdocrinopathy)、M蛋白血症(M-protein)和皮肤改变(skinchange)为其特征,简称为POEMS综合征。该征最早由Crow氏于1956年报道。1968年Fukase将其作为一个独立的综合征提出。因此,亦称Crow-Fukabe综合征。我国自1987年始有报道。现将国内报道的POEMS综合征44例做一复习。     

Intracranial hypotension and PRES: case report

We report a case of a woman presenting, 7 days after epidural analgesia for a caesarean section, to the emergency room for a worsening of the headache and tonico-clonic seizures. MRI showed alterations suggestive of the presence of intracranial hypotension (IH) as well as evidence of posterior reversible encephalopathy syndrome (PRES). She was treated with a blood patch which leads to the prompt regression of the clinical symptoms and follow-up MRI, after 15 days, showed complete resolution of radiological alterations. The possible pathogenetic relationship between IH, secondary to the inadvertent dural puncture, and PRES is discussed. We suggest that venous stagnation and hydrostatic edema, secondary to intracranial hypotension, probably played a crucial role in the pathogenesis of PRES.     

颅内孤立性纤维瘤2例

病例1:女,30岁,右侧面耳部持续性麻木2月余,可忍受,偶感头痛;CT:右侧额顶部可见4.2 cm×6.3 cm×5.5 cm分叶状肿块.病例2:女,35岁,头昏、头痛,左眼视力模糊,伴呕吐4天;CT:右侧颞部见4.0 cm×3.6 cm×3.0 cm形态不规则肿块.2例肿块T2WI均呈不均匀信号,以稍高信号为主,其内可见小条片状稍低信号,并多发点片状高信号,T1WI以等信号为主,其内多发点片状低信号,周围见大片水肿信号;增强后肿块实性部分明显强化(图1),囊变部分未见强化.     

Spontaneous intracranial hypotension syndrome: report of twelve cases

PURPOSE: To investigate clinical, MRI, and radioisotope findings and therapeutic outcome of the syndrome of spontaneous intracranial hypotension (SIH). BACKGROUND: Spontaneous intracranial hypotension is characterized by orthostatic headache, low CSF pressure, and MRI findings of diffuse pachymeningeal gadolinium enhancement without previous history of head trauma or lumbar puncture. Spontaneous CSF leakage from a spinal dural tear has been suggested as the underlying pathogenic mechanism of SIH. Most patients recover without sequelae, but subdural collections have been described in a few. METHODS: Twelve consecutive patients (10 females, 2 males, mean age 39 years) with headache related to the syndrome of spontaneous intracranial hypotension were investigated. RESULTS: Eleven patients presented orthostatic headache, one patient had continuous nonpostural headache. Additional clinical symptoms included nausea, vomiting, tinnitus, diplopia, and back pain. All the patients had low CSF opening pressure, seven had increased CSF albumin, and four had pleocytosis. Brain MRI showed diffuse pachymeningeal gadolinium enhancement. Other features included subdural fluid collections (hematoma/hygroma) in four patients, downward displacement of the brain in four patients, and enlargement of the pituitary gland in one patient. Radioisotope cisternography results indicated, in two patients, a CSF leakage site in the cervico-thoracic region, and in one patient showed limited ascent of the tracer to the cerebral convexity and early appearance of radioisotope in the bladder. All the patients had complete resolution of headache with conservative treatment. CONCLUSIONS: Patients with SIH have distinct MRI and sometimes radioisotope cisternographic abnormalities and generally respond favorably to conservative management.     

Intracranial hypotension following chiropractic spinal manipulation

We report a case of intracranial hypotension caused by chiropractic manipulation which, in contrast to previously reported cases, documents the location of the cerebrospinal fluid leak by radionuclide cisternography. Cervical spinal manipulation produced a remote lumbar dural tear in our patient. Spinal magnetic resonance imaging may falsely localize the dural tear in this condition. Although conservative management is often sufficient, precise localization is required for more invasive therapies.     

术后乳糜胸的治疗方法及手术路径

术后乳糜胸为胸部手术损伤胸导管，使淋巴液溢入胸腔而形成。我院1992年1月～2003年8月行食管癌、贲门癌手术832例，其中18例并发术后乳糜胸，占2．2％。本文就其诊断及治疗体会报告如下。     

软组织恶性黑色素瘤18例分析

目的探讨软组织恶性黑色素瘤的特点,提高其诊疗水平。方法结合相关文献,回顾性分析18例恶性黑色素瘤的临床特点。结果18例患者平均年龄36岁,13例病变位于踝和足部,疼痛性包块是其主要症状,大小为2~10 cm,起源于腱鞘或者筋膜。结论软组织恶性黑色素瘤是一种青中年少见的好发于肢体特别是足踝部的恶性肿瘤,好的治疗效果取决于早期诊断、早期治疗。