原发性低颅压综合征的临床及影像学特点

目的探讨原发性低颅压综合征的临床及影像学特点。方法回顾性分析24例原发性低颅压综合征患者的临床资料。结果本组男8例,女16例;多以急性或亚急性起病。所有患者均表现为体位相关性头痛,即座位或站立位时头痛,平卧时减轻或明显缓解;头痛一般位于前额,也可位于后枕部及颞部;头痛性质均为胀痛。24例患者腰穿脑脊液检查示压力均≤60 mmH2O(1 mmH2O=0.0098 kPa)。本组24例患者行头颅CT检查发现,21例正常,2例脑肿胀,1例脑肿胀并蛛网膜下腔出血。14例患者行头颅MRI检查发现,10例脑下坠,8例静脉窦扩张(以上矢状窦扩张为主),6例脑室、脑池变小,9例硬膜下积液;4例行增强扫描检查发现,3例弥漫性硬脑膜强化。结论原发性低颅压综合征临床表现为急性或亚急性起病的体位性头痛,常伴有恶心、呕吐,脑脊液压力常≤60 mmH2O。头颅CT、MRI检查可有助诊断。

Clinical and imaging features of spontaneous intracranial hypotension

Objective To explore the clinical and imaging characteristics of spontaneous intracranial hypotension.Methods The clinical data of 24 patients with spontaneous intracranial hypotension was analysis retrospectively.Results There were 8 males and 16 females in this group.Most of them were acute or subacute onset.The performance of all the patients was position correlated headache—headache at the standing or seat position while relief at the supine position.The headache generally located in the forehead,and sometimes located in the posterior occipital or temporal.The nature of headache was distending pain.The CSF examination of 24 patients showed all the CSF pressure≤60 mmH2O(1 mmH2O=0.0098 kPa).The CT examination of 24 patients showed 21 cases of normal,2 cases of brain swelling,1 case of brain swelling and subarachnoid hemorrhage.The MRI examination of 14 patients showed 10 cases of brain tenesmus,8 cases of sinus expansion(often was above sagittal sinus expansion),6 cases of decrescent ventricle and cistern,9 cases of subdural effusion;4 patients of them added enhance scanning and found 3 cases of diffuse dural strengthening.Conclusions The clinical manifestation of spontaneous intracranial hypotension are position correlated headache with acute or subacute onset,and nausea,vomiting with CSF pressure often≤60 mmH2O.CT and MRI examination is helpful to the diagnosis.