CAJ | 학술논문

目的：探讨自发性低颅压综合征的临床、预后及影像学特点。方法北京协和医院2009年至2014年收治的自发性低颅压综合征患者16例，对其临床表现、实验室检测、影像学特点及预后进行分析。结果所有患者均表现为体位性头痛。13例脑脊液压力＜60mmH2 O，3例脑脊液压力为0。6例头颅 CT 提示硬膜下积液／积血，2例脑叶出血，5例存在双侧侧脑室体积减小，8例未见明显异常。头颅增强 MRI 检查示硬脑膜弥漫强化9例，硬膜下出血3例，硬膜下积液3例，脑组织下移4例，垂体增大2例。结论体位性头痛是自发性低颅压综合征相对典型的症状之一，多数患者预后良好。头颅增强 MRI 可显示弥漫性硬脑膜强化等典型的低颅压改变，头颅 CT 亦可提示部分改变。在详细询问病史的基础上，重视对头颅 CT 检查的判读，避免对头颅增强 MRI 检查的过度依赖，有助于该病的早期诊断。
목적：탐토자발성저로압종합정적림상、예후급영상학특점。방법북경협화의원2009년지2014년수치적자발성저로압종합정환자16례，대기림상표현、실험실검측、영상학특점급예후진행분석。결과소유환자균표현위체위성두통。13례뇌척액압력＜60mmH2 O，3례뇌척액압력위0。6례두로 CT 제시경막하적액／적혈，2례뇌협출혈，5례존재쌍측측뇌실체적감소，8례미견명현이상。두로증강 MRI 검사시경뇌막미만강화9례，경막하출혈3례，경막하적액3례，뇌조직하이4례，수체증대2례。결론체위성두통시자발성저로압종합정상대전형적증상지일，다수환자예후량호。두로증강 MRI 가현시미만성경뇌막강화등전형적저로압개변，두로 CT 역가제시부분개변。재상세순문병사적기출상，중시대두로 CT 검사적판독，피면대두로증강 MRI 검사적과도의뢰，유조우해병적조기진단。
[ Abstract] Objective To explore the clinical and neuroimaging features of spontaneous intracranial hypotension (SIH).Methods 16 patients diagnosed with SIH from 2009 to 2014 in Peking Union Medical College Hospital were included.Clinical manifestations, lab tests and neuroimaging results as well as prognosis were analyzed retrospectively.Results All cases had reported orthostatic headache.Pressure of cerebrospinal fluid was less than 60mmH2 O in 13 patients and 0 in 3 patients.Brain computed tomography (CT) revealed subdural hematomas/fluid accumulations in 6 patients and lobar hemorrhages in 2 patients respectively.Decreases in the size of bilateral ventricles in five patients were identified.Brain magnetic resonance imaging (MRI) with contrast demonstrated diffuse meningeal enhancement in 9 cases, sagging of the brain in 4 cases and pituitary enlargement in 2 cases.Conclusion Orthostatic headache is one of the most typical manifestations of SIH which has favorable prognosis in most patients. Brain MRI with contrast can demonstrate the diffuse meningeal enhancement and other characteristic changes due to intracranial hypotension while brain CT may also reveal some of them.Besides careful history taking, it is noted that <br> brain CT may also provide useful information in early diagnosis of spontaneous intracranial hypotension.