自发性低颅压综合征的临床及影像学特点分析

回顾性分析17例临床诊断明确的自发性低颅压综合征(SIH)患者的临床表现及影像资料。直立性头痛是最常见的临床表现,11例伴有恶心、呕吐,1例耳鸣,2例颈项强直。腰椎穿刺结果提示全部患者脑脊液压力均低于8 kPa,10例蛋白质增高,7例白细胞计数升高,7例红细胞计数升高。全部患者均行颅脑磁共振检查,硬脑膜弥漫性强化是最常见的脑MRI表现,脊髓MRI可见硬膜外静脉丛充血扩张。提示直立性头痛和MRI的特征性表现是SIH诊断的关键,硬脑膜弥漫性强化是最常见的早期影像学表现,随疾病发展渐渐出现脑下垂和硬膜下水瘤。

Clinical and imaging features of spontaneous intracranial hypotension

Clinical manifestation and imaging data of 17 cases diagnosed as spontaneous intracranial hypotension(SIH) syndrome were retrospectivly analyzed.Orthostatic headache was the most common symptom,11 cases with nausea and vomiting,1 case tinnitus,2 cases of neck stiffness.Lumbar puncture results suggested that all cerebrospinal fluid pressure below 8 kPa,with 10 cases of protein increased,7 cases of white blood cell raised and 7 cases of red blood cell elevated.Diffuse pachymeningeal enhancement(DFE) was the most common in brain MRI,and engorgement of the spinal epidural venous plexus was observed in spinal MRI study.Orthostatic headache with typical findings on magnetic resonance imaging(MRI) were the key to diagnosis.In the brain,diffuse dural-arachnoid enhancement is the most common imaging abnormality,and DFE is the earliest MRI manifestation of SIH syndrome,while subdural fluid collections and descent of the brain are indicators of the severe hypotensive state.