自发性低颅压综合征的临床表现及影像学特点

摘要

目的 分析自发性低颅压综合征(SIH)的临床表现及影像学特点.方法 回顾性分析12例临床诊断明确的SIH患者的临床表现及影像资料.结果 12例患者均有直立性头痛,11例伴有恶心、呕吐,7例头晕,1例耳鸣,1例复视,1例反复癫痫大发作,1例颈项强直.腰椎穿刺结果提示12例患者脑脊液压力均低于60 mm H2O,10例蛋白质增高,2例白细胞计数升高,2例红细胞计数升高.6例行颅脑CT平扫,1例见脑室变窄、硬膜下积液.12例患者均行颅脑MRI检查,6例示硬脑膜弥漫性强化,1例小脑幕强化、上矢状窦扩张,1例硬膜下积液,2例脑下垂,2例垂体增大,2例脑池变窄.结论 直立性头痛是SIH最典型的临床症状,硬脑膜弥漫性强化是最常见的影像学表现,脑脊液容量减低是SIH临床及影像学的病理生理基础.%Objectives To investigate the clinical and imaging characteristics of spontaneous intracranial hypotension (SIH).Methods The clinical and imaging data of 12 SIH patients were analyzed retrospectively.Results All 12 patients had orthostatic headache,11 complicated with nausea and vomiting,7 by dizziness,1 by tinnitus,1 by diplopia,1 by grand mal epilepsy,1 by neck stiffness.Lumbar puncture suggested that all had low cerebrospinal fluid (CSF) pressure (below 60 mm H2O),10 had increased CSF protein，2 raised CSF white blood cells and 2 elevated red blood cells.Six patients were given plain CT rnscan,cerebral ventricle narrowing and subdural effusion was seen in 1.All patients underwent brain MRI examinations,diffuse dural enhancement was seen in 6,tentorial enhancement and superior sagittal sinus expansion in 1,subdural effusion in 1,cerebral ptosis in 2,enlarged pituitary gland in 2,cistern narrowing in 2.Conclusions Orthostatic headache is the most typical clinical symptoms of SIH,and diffuse dural enhancement is the commonest imaging findings;the reduction of cerebrospinal fluid capacity is the pathophysiological basis for SIH clinic and imaging.