自发性低颅压综合征26例临床及影像学特点

摘要

Objective To discuss the clinical and imaging characteristics of spontaneous intracranial hypotension(SIH).Methods We studied the clinical,imaging and follow-up data of 26 patients with SIH.Results We found 84.6%patients showing orthostatic headache , as about 61.5%patients with nausea , 30.8%patients with neck stiffness, 23.1%patients with tinnitus, 15.4%patients with hypacusia and 7.7%patients with photophobia .One case appeared oculomotor paralysis .The cerebrospinal fluid pressure of about 78.9% patients were less than 60mmH2 O.65.2%patients had positive MRI findings , in which the diffused enhancement of endocranium was the most characteristic feature .Other clinical manifestations were subdural effusion , brain sinking and the pituitary gland enlargement in sequence .Conclusion As to diagnose SIH, orthostatic headache , the cerebrospinal fluid pressure which is less than 60mmH2 O and special MRI images are of great importance .Besides contrast enhancement MRI is one of the major choices to diagnose SIH .%目的探讨自发性低颅压综合征（ SIH）临床症状及影像学特点。方法分析26例临床确诊的SIH患者的临床、影像学与随访资料。结果84．6％的患者存在直立位头痛，伴随恶心（61．5％）、颈强直（30．8％）、耳鸣（23．1％）、听力减退（15．4％）、畏光（7．7％）等症状。1例患者出现动眼神经麻痹。78．9％患者侧卧位脑脊液压力＜60mmH2 O。头颅MRI检查总体阳性率为65．2％，弥漫性硬脑膜强化最具特征，其它表现依次为硬膜下积液、脑下沉和垂体增大。结论直立位头痛症状、侧卧位脑脊液压力＜60mmH2 O及MRI特征性表现对于诊断SIH最具意义。头颅MRI增强检查是临床诊断SIH的主要检查方式之一。