原发性低颅压的MR影像学诊断

原发性低颅压（ｓｐｏｎｔａｎｅｏｕｓｉｎｔｒａｃｒａｎｉａｌｈｙｐｏｔｅｎｓｉｏｎ;ＳＩＨ）是一种较少见的临床上以体位性头痛为主要表现的综合征,由Ｓｃｈａｌｔｅｎｂｒａｎｄ在１９３８年首次报道。近年来,随着医学影像技术的不断发展,以及对本病认识的不断提高,有关其影像表现的报道逐渐增多。为了对本病有一全面的了解,本文对其病因、发病机制、临床表现、ＭＲ影像诊断等作一综述,以供参考。１　ＳＩＨ的病因和发病机制Ｓｃｈａｌｔｅｎｂｒａｎｄ于１９３８年提出了ＳＩＨ的三个可能发病机制：①ＣＳＦ的产生过少;②…     

自发性低颅压综合征4例误诊分析

自发性低颅压综合征 (SIH)是指原因不明 ,预后良好 ,颅压低于 70mmH2 O的一组少见征候群 ,临床以起立时剧烈头痛、呕吐及颈部强直为主要表现 ,当平卧时头痛很快消失或减轻为特征[1] 。由于临床较为少见 ,故极易造成误诊。现将我院 1999年 6月～ 2 0 0 1年 7月误诊的 4例SIH报道如下。1　临床资料1.1　一般资料　男 1例 ,女 3例 ;年龄 2 4～ 4 3岁 ,平均 36 .2岁。均为急性起病 ,病程 5～ 2 4天 ,平均 13.5天。除外颅脑损伤、开颅术、分流术 ,无脑脊液漏 ,病前无腰椎穿刺以及糖尿病与尿毒症史。1.2　临床表现　均表现为剧烈头痛、恶心、…     

低颅压综合征21例临床分析

分析自发性低颅压与继发性低颅压的差异。对10例自发性低颅压与11例继发性低颅压在病因、脑脊液、影像学方面进行回顾性分析与比较。结果自发性低颅压者经治疗后临床表现消失，脑脊液恢复正常，预后良好；继发性低颅压综合征病因相对明确。血性脑脊液发生率较低。影像学易确诊，治疗及预后随原发病而定。     

自发性低颅压综合征17例临床分析

<正>选择2005年1月~2011年1月我科收治的自发性低颅压综合征(spontaneous intracranial hypotension symptom,SIHS)患者17例,均符合2004年国际头痛分类第2版诊断标准中关于SI HS的诊断[1],并排除继发性颅内低压。全面收集患者的临     

脑转移瘤低场MR诊断与鉴别诊断

目的:总结脑转移瘤低场MRI表现。材料与方法:分析经增强或手术病理证实的脑转移瘤13例。使用嘉恒公司0.35T扫描仪,行常规轴位、矢状位、冠状位加增强扫描。对肿瘤的部位,形态、大小、边界、信号、周围水肿等进行总结分析。结果:MR定位准确率100%。肿瘤大多呈圆形、椭圆形、结节状、环形。10例呈长T1长T2信号,3例呈等T1长T2信号。水肿呈不规则指状。多位于皮髓交界区,亦可见于脑干、小脑等部位。结论:脑转移瘤低场MRI表现经平扫加增强多具有特征性表现。基本能做出比较正确的诊断。     

自发性低颅压并发静脉窦血栓1例并文献复习

目的 探讨自发性低颅压(SIH)并发静脉窦血栓形成(CVST)的可能性,促进早期确诊.方法 报道1例SIH并发CVST的患者,并复习相关文献.结果 本例患者SIH在前,CVST在后,经检查除外了其他可能的危险因素,故考虑SIH是CVST的危险因素.若SIH出现头痛性质的变化或出现其他中枢神经系统损害的症状体征,要想到CVST的可能.结论 对SIH的诊断应结合临床症状及特异性的影像学表现来确立.确诊SIH的患者要警惕CVST的发生.对已然发生CVST的患者应积极抗凝治疗,但脱水治疗应适量.     

以反复自发性颅内出血为表现的原发性低颅压综合征

目的探讨原发性低颅压（spontaneous intracranial hypotension,SIH）综合征临床特点及误诊原因,提高诊断率。方法回顾分析我院诊治的1例SIH综合征临床资料,结合相关文献进行复习讨论。结果本例以反复自发性颅内出血为主要临床表现,而且整个病程中均无SIH综合征的特征性体位性剧烈头痛,行头颅CT和MRI增强扫描诊断为SIH综合征,给予对症治疗症状缓解出院,随访14个月无复发。结论对慢性硬膜下血肿特别是复发性慢性硬膜下血肿要特别警惕SIH综合征可能,必要时行颅脑MRI增强扫描,以免贻误病情。     

低颅压综合征25例临床分析

低颅压综合征临床较少见,容易误诊,现收集昆明医学院第一附属医院1980～1991年临床确诊的14例及我科近5年来收治的11例,共25例分析如下。     

低场MR动态增强对肝脏占位病变的诊断价值探讨

目的：探讨低场MR动态增强对肝脏占位病变的应用价值。方法：应用0．2T永磁型磁共振仪对24例肝脏占位性病变先行TIW1、T2WI平扫，再使用FMPSPGR(快速多层面扰相位梯度回波)序列，进一步对其中28个占位灶作同层块动态增强扫描。造影剂为磁显葡胺(Gd-DTPA)0．2mmol／kg。结果：在上下5～8cm范围内可显示肝脏占位病变的动态强化方式，有助于定性诊断。结论：低场MR动态增强可作为肝脏占位病变定性诊断的补充方法。     

特发性低颅压头痛的临床及影像学特点

目的:探讨特发性低颅压头痛的临床及影像学特点.方法:回顾性分析29例特发性低颅压头痛患者的临床表现、腰椎穿刺结果、头颅MRI特征以及治疗方法.结果:28例患者存在体位性头痛,卧位时缓解,1例患者出现体位性头晕;28例腰穿压力低,其中压力为0 mm H2O者9例,蛋白增高是较常见的脑脊液改变;26例行头颅MRI检查,其中16例可见异常,9例为硬膜下出血或积液,9例为硬脑膜强化;除1例患者因硬膜下出血转至外科手术治疗外,其余均经保守治疗后痊愈.结论:熟悉特发性低颅压头痛的临床特点、脑脊液改变和头颅MRI特征,有利于早期诊断和治疗.     

Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a case-control study

We performed whole-spine heavily T2-weighted magnetic resonance (MR) myelography using a single-shot fast spin-echo pulse sequence in 17 patients (8 M/9 F) with spontaneous intracranial hypotension (SIH) to detect abnormal cerebrospinal fluid (CSF) collections. In addition, a group of age- and sex-matched controls were recruited. Follow-up MR myelography was also done at 3 weeks. MR myelography showed three kinds of abnormal CSF collections in 15 patients with SIH (88%): epidural fluid collection (n = 15, 88%), C1-2 extraspinal collections (n = 6, 35%) and CSF collections along nerve roots in the lower cervical or upper thoracic spines (n = 6, 35%). One patient (6%) showed a meningeal diverticulum. In contrast, none of the controls showed these findings. Overall, MR myelography results helped in early diagnosis of SIH in four (24%) patients whose initial brain MRIs failed to show typical SIH findings. Follow-up MR myelography results were compatible with the clinical changes with kappa statistics of 0.52 and an agreement rate of 76%. Our study showed heavily T2-weighted MR myelography provided a rapid, non-invasive and high yield method to diagnose and follow-up patients with SIH. Whether the CSF collections along the nerve roots represent the ongoing leakage sites warrants further study.     

Diagnostic criteria for headache due to spontaneous intracranial hypotension: a perspective

The clinical and radiographic manifestations of spontaneous intracranial hypotension are highly variable and many patients do not satisfy the 2004 International Classification of Headache Disorders criteria. We developed new diagnostic criteria for spontaneous intracranial hypotension based on cases we have seen reflecting the variable manifestations of the disorder. These criteria provide a basis for change when the classification criteria are next revised. The diagnostic criteria consist of A, orthostatic headache; B, the presence of at least one of the following: low opening pressure (≤ 60 mm H(2) O), sustained improvement of symptoms after epidural blood patching, demonstration of an active spinal cerebrospinal fluid leak, cranial magnetic resonance imaging changes of intracranial hypotension (eg, brain sagging or pachymeningeal enhancement); C, no recent history of dural puncture; and D, not attributable to another disorder.     

The timing of MRI determines the presence or absence of diffuse pachymeningeal enhancement in patients with spontaneous intracranial hypotension

The timing and clinical relevance of diffuse pachymeningeal enhancement (DPE) in the magnetic resonance imaging (MRI) examination of patients with spontaneous intracranial hypotension (SIH) remain undetermined. We reviewed 53 consecutive SIH patients (30 F/23 M, mean age of onset 41.7 ± 11.3 years) in a tertiary hospital. Thirteen (24.5%) patients did not have DPE on their initial cranial MRIs. They had significantly shorter latency between the time of MRI examinations and the time of headache onset compared with those with DPE (6.5 ± 4.4 vs. 20.4 ± 16.3 days, t -test, P  < 0.001). Eight of these 13 patients received a follow-up MRI (mean duration 30.3 ± 16.6 days, range 6–59 days) and six of them revealed DPE. Among patients with DPE, the enhancement disappeared as early as 25 days after headache onset. The outcome did not differ between patients with and without DPE. The presence of DPE was associated with the timing of the MRI examination.     

Orthostatic headache and bilateral abducens palsy secondary to spontaneous intracranial hypotension

Spontaneous intracranial hypotension (SIH) is a well-documented syndrome characterized typically by a benign, self-limited course. Patients typically present with postural or exertional headaches that can be temporarily relieved by lying in a supine or recumbent position. A 35-year-old Caucasian male suffered orthostatic headache that developed to a bilateral abducens palsy. We ordered relative rest and the patient improved and completely recovered after 3 months. Although SIH is considered as a benign and self limited process it could also be associated with disabling complications. We should be aware of the possible complications and inform our patients. SIH can present with headache and bilateral abducens palsy even when the headache is improving.     

三维增强MR血管造影在颅内动脉瘤诊断中的价值探讨

目的：评价三维增强MR血管造影（3D CE-MRA）在颅内动脉瘤诊断中的价值及准确性。方法：选择51例动脉瘤患者中同时行3D CE-MRA、三维时间飞越法MR血管造影（3D TOF-MRA）检查的27例动脉瘤患者，所有患者经DSA检查确诊。比较3D CE-MRA和3D TOF-MRA在显示动脉瘤及动脉瘤形态、瘤颈、载瘤动脉及瘤腔血栓能力上的优劣。结果：27例患者检出29个动脉瘤，3D CE-MRA和3D TOF-MRA的敏感性分别是100%（29/29），86%（25/29）。在动脉瘤形态，瘤颈形状及载瘤血管的显示上3D CE-MRA优于3D TOF-MRA（P<0.01），瘤腔血栓的显示上二者无差异（P>0.05）。结论：3D CE-MRA是一种快速有效、无创的诊断颅内动脉瘤的方法。     

Assessment of CSF flow dynamics using PC-MRI in spontaneous intracranial hypotension

(Headache 2012;52:808‐819) Aim.— Spontaneous intracranial hypotension (SIH) is caused by spontaneous cerebrospinal fluid (CSF) leaks and is known to cause orthostatic headaches. Phase‐contrast magnetic resonance imaging (PC‐MRI) is a non‐invasive technique that can be used to quantify variation in CSF flow. The aim of this study was to assess CSF flow dynamics using PC‐MRI in SIH. Materials and Methods.— Twenty‐five patients with a definitive diagnosis of SIH and 25 healthy subjects were evaluated with PC‐MRI. Magnetic resonance (MR) images were acquired using a 1.5‐T unit with an 8‐channel head coil. Differences between SIH patients and control subjects were assessed statistically using Wilcoxon's rank sum test, Spearman's rho test, or Pearson's chi‐square test, as appropriate. Results.— CSF flow volumes toward the third ventricle, CSF flow volumes toward the fourth ventricle, the absolute stroke volume, the peak systolic velocity, and the peak diastolic velocity in SIH patients were significantly smaller than those in control subjects (P < .0001). On the other hand, the net CSF flow volume (P = .9227) and the net CSF flow direction (P = .2472) for SIH patients and control subjects were not significantly different. Conclusions.— The results obtained by CSF flow analysis were directly related to values of CSF opening pressure, determined by lumbar puncture, and clinical findings, such as headache scores. Thus, CSF flow analysis with PC‐MRI, which has a short performance time and is non‐invasive, may contribute to assessment of SIH patients.     

A case of spontaneous intracranial hypotension with typical magnetic resonance images

Spontaneous intracranial hypotension (SIH) is a rare syndrome defined by postural headache, associated with a low cerebrospinal fluid pressure, without history of previous dural trauma or invasive treatment on rachis. We reported a case of a patient with postural headache caused by SIH identified by magnetic resonance images and treated with saline solution infusion with complete remission of symptoms.     

Comparisons between heavily T2-weighted MR and CT myelography studies in two patients with spontaneous intracranial hypotension

Our previous study demonstrated that heavily T2-weighted magnetic resonance (MR) myelography could successfully detect abnormal cerebrospinal fluid (CSF) collections in patients with spontaneous intracranial hypotension (SIH); however, its ability to demonstrate ongoing CSF leakage sites is uncertain. Currently, computed tomographic (CT) myelography is still considered the study of choice for such a purpose. In this study, we compared the results of the two imaging modalities in two patients with SIH. CSF leakages, such as C1-2 extraspinal collections, CSF along nerve root sleeves, and epidural fluid collections were noted on both studies with minor discrepancies. CSF collection along nerve root sleeves demonstrated by MR myelography was the most likely ongoing leakage site in comparison with CT myelography. Targeted epidural blood patches in both patients resulted in complete headache resolution. Non-invasive, non-contrasted and time-saving MR myelography is a promising study for patients with SIH. Further large-scale validation studies are needed.     

3D-CISS序列对颅内表皮样囊肿的诊断价值

目的评价MR 3D稳态构成干扰序列(CISS)对颅内表皮样囊肿的诊断价值.方法回顾性分析12例手术病理证实的颅内表皮样囊肿(EC)的3D-CISS影像表现,并与常规MR T1WI、T2WI进行对照.结果常规MRI发现病灶11例,8例信号强度与脑脊液相似,难与蛛网膜囊肿鉴别,11例均不能辩认肿瘤的确切边界.3D-CISS发现病灶12例,均表现为高信号脑脊液中的低信号充盈缺损,信号不均,10例呈沿脑池脑室匐行生长,3例包绕三叉神经,1例推挤三叉神经使之移位,1例部分包绕基底动脉.结论较之常规MR,3D-CISS在发现病灶、显示肿瘤的生长方式及复杂的信号特点方面更敏感,对表皮样囊肿的诊断与鉴别诊断更可靠,并能清楚显示肿瘤与周围重要结构的关系,为临床提供更丰富的信息,是表皮样囊肿的最佳检查序列.     

Reversible cerebral vasoconstriction in spontaneous intracranial hypotension

Myelography showed an opening pressure of 0 cm H2O and multiple thoracic meningeal diverticula in a 52-year-old woman suffering from orthostatic headaches of instantaneous onset. MR-angiography showed severe segmental arterial stenosis of the anterior and posterior circulation, which resolved over a 4-day period following an epidural blood patch. Spontaneous intracranial hypotension should be considered in the differential diagnosis of reversible cerebral vasoconstriction.