自发性颅内低压的诊断和治疗(附12例报道)

摘要

Objective To explore the diagnoses of spontaneous intracranial hypotension,and discuss the therapeutic efficacy of epidural blood patch therapy in spontaneous intracranial hypotension patients.Methods The clinical data of 12 patients with spontaneous intracranial hypotension,admitted to our hospital from January 2013 to December 2018,were retrospectively analyzed.The lumbar puncture results,MR imaging features of the skull and spine,and CT myelography (CTM) features of these patients were analyzed.The treatment efficacies of epidural blood patch,which included blind epidural blood patch and targeted epidural blood patch,were compared.Results The cerebrospinal fluid pressure of 12 patients was ≤ 60 mmH2O.Ten patients (83.3％) showed subdural fluid collections,enhancement of the pachymeninges,engorgement of venous structures,pituitary hyperemia,and sagging of the brain on brain MR imaging,and one of the patient showed pituitary hemorrhage.Seven patients (63.3％) showed spinal dural epithelial fluid accumulation and venous plexus expansion on spine MR imaging,and one of the patient showed dorsolateral dural discontinuous thickening of T6 and forward movement of the spinal cord caused by massive dorsal epidural effusion.Twelve patients in this group underwent CTM,and were found cerebrospinal fluid leakage.Twelve patients applied 14-times epidural blood tests;4 responded well to one-time targeted epidural blood patch therapy,with success rate of 100％;8 patients used blind epidural blood patch therapy,and 6 patients responded well to one-time therapy,with success rate of 75％,one patient improved with blind epidural blood stick twice,and one patient was ineffective twice.Conclusions Head MR imaging combined with spinal MR imaging is a non-invasive method to diagnose spontaneous intracranial hypotension.Myelogram can determine whether there is a leakage of spinal cerebrospinal fluid and accurately locate the leakage site.Epidural blood patch therapy is an effective method for treatment of patients with spontaneous intracranial hypotension.With the precise location of leak points by myelography,targeted epidural blood patch is more effective.%目的 探讨自发性颅内低压的诊断及硬膜外血贴的治疗效果. 方法 回顾性收集自2013年1月至2018年12月于广州市第一人民医院神经科住院治疗的12例自发性颅内低压患者的临床资料,总结分析患者的腰椎穿刺结果、头颅及脊柱MRI特征、CT脊髓造影(CTM)特点以及硬膜外血贴的治疗效果. 结果 12例患者的脑脊液压力均≤60 mmH2O.10例患者头颅MRI显示硬膜下积液、硬脑膜增厚强化、颅内静脉结构充盈、垂体充血增大及脑组织下垂等,其中1例显示垂体出血.7例患者脊柱MRI显示脊柱硬膜外积液和(或)静脉丛扩张,其中1例显示T6背外侧硬脊膜不连续增厚、背侧硬膜外大量积液致脊髓受压前移.12例患者CTM均显示脊髓脑脊液漏,85个漏点中40个(47％)位于颈椎,22个(26％)位于胸椎,18个(21％)位于腰椎,5个(6％)位于骶椎.12例患者共行硬膜外血贴治疗14次,其中4例行靶向硬膜外血贴治疗,初次均有效;8例行盲点硬膜外血贴治疗,6例初次有效,1例行2次盲点硬膜外血贴治疗有效,1例行2次盲点硬膜外血贴治疗无效. 结论 头颅MRI联合脊柱MRI是诊断自发性颅内低压无创的检查方法;脊髓造影能明确是否有脊髓脑脊液漏,并能准确定位漏点部位;硬膜外血贴是治疗白发性颅内低压的有效方法,其中靶向硬膜外血贴治疗可通过脊髓造影对漏点进行精确定位,从而更加有效.