原发性低颅压的诊治和护理

目的探讨原发性低颅压的诊治和护理策略。方法应用同位素脑池造影和脊髓造影后CT薄层扫描确定脑脊液漏口的位置，然后在相应阶段进行硬膜外血液修补治疗，并进行随诊观察。结果同位素脑池造影没有发现脑脊液漏的直接征象，但放射性核素过早在膀胱内出现，并难以升达枕大孔和基底池到达脑部，显示有脑脊液漏的间接征象；脊髓造影后进行CT薄层扫描显示脑脊液漏发生在T4阶段，17ml自体血注人病人的硬膜外腔，3d后病人症状缓解，临床治愈。结论同位素脑池造影能够提供脊髓脑脊液漏的间接证据，脊髓造影后CT薄层扫描能够准确的确定脑脊液的漏口位置，硬膜外血液修补是治疗该病最为有效的方法。

Primary Intracranial Hypotension:Diagnosis, Treatment and Nursing

Objective Primary intracranial hypotension(PIH) is character ized by orthostatic headache without previous history of head trauma or lumbar p uncture. The majority, if not all, of the cases of PIH result from spontaneous c erebrospinal fluid (CSF) leaks. Precise determination of the spinal level of a c erebrospinal fluid leak is important in the diagnosis and treatment of spontaneo us intracranial hypotension. We also talked about the experience of nursing the PIH patient. Methods Radionuclide cisternography and computed tomographic(CT) m yelography were applied to get precise determination of the leakage, and then ep idual blood patch was adopted in the treatment at the corresponding spinal level . Results No direct evidence of a focal leak was found by radionuclide cisterno graphy, but early bladder visualization was detected as early as 8 min. Radiois otope could hardly reach the brain convexities even at 12 hours. These signs are the indirect evidences of CSF leakage. Postmyelography CT scans demonstrated a focal CSF leak at the T-4 level. 17 ml autologous blood was injected into the ep idural space, and the patient was fully recovered 3 days following the procedure . Conclusion Radionuclide cisternography can provide indirect evidence of CSF l eakage. Nevertheless, CT myelography is able to precisely locate the site of th e leakage. Epidural blood patch is the most effective treatment method.