CAJ | 학술논문

目的：探讨自发性低颅压综合征的临床特点,以减少误诊误治。方法回顾性分析西京医院门急诊2011年7月—2014年7月收治的12例自发性低颅压综合征的临床资料。结果12例均有体位性头痛,伴头晕、恶心、呕吐、颈部疼痛、耳鸣、听力下降,均无颅脑外伤史、手术史等。6例由外院转入,曾误诊为小脑扁桃体下疝2例,枕神经痛、硬膜下出血、病毒性脑炎、脑膜脑炎各1例,误诊率50%。入院后12例结合临床表现、脑脊液检查(压力均<60 mmH2O,白细胞数增高4例,蛋白增高5例)以及头颅MRI检查结果(7例正常,4例硬膜下积液,3例“脑下沉”改变,2例硬脑膜明显强化)综合分析,确诊自发性低颅压综合征。确诊后11例给予保守治疗症状好转,1例行人工硬脑膜覆盖术症状缓解,出院,随访预后均良好。结论对以体位性头痛就诊的中年女性首先要考虑该病,详细询问病史、认真查体、及时行腰椎穿刺脑脊液检查并结合影像学改变综合分析,及早确诊并治疗,避免误诊误治。
목적：탐토자발성저로압종합정적림상특점,이감소오진오치。방법회고성분석서경의원문급진2011년7월—2014년7월수치적12례자발성저로압종합정적림상자료。결과12례균유체위성두통,반두훈、악심、구토、경부동통、이명、은력하강,균무로뇌외상사、수술사등。6례유외원전입,증오진위소뇌편도체하산2례,침신경통、경막하출혈、병독성뇌염、뇌막뇌염각1례,오진솔50%。입원후12례결합림상표현、뇌척액검사(압력균<60 mmH2O,백세포수증고4례,단백증고5례)이급두로MRI검사결과(7례정상,4례경막하적액,3례“뇌하침”개변,2례경뇌막명현강화)종합분석,학진자발성저로압종합정。학진후11례급여보수치료증상호전,1례행인공경뇌막복개술증상완해,출원,수방예후균량호。결론대이체위성두통취진적중년녀성수선요고필해병,상세순문병사、인진사체、급시행요추천자뇌척액검사병결합영상학개변종합분석,급조학진병치료,피면오진오치。
Objective To explore the clinical characteristics in spontaneous intracranial hypotension syndrome in or-der to avoid misdiagnosis and mistreatment. Methods We retrospectively analyzed 12 cases of SIH in outpatient and emer-gency departments in Xijing Hospital from July 2011 to July 2014. Results All the 12 patients of SIH suffered severe head-ache postural, with dizziness, nausea, vomiting, pain, tinnitus, hearing loss, without any history of trauma and surgery. 6 cases were misdiagnosed in other hospital;misdiagnosis cases were 2 cases of tonsillar herniation, 1 case of occipital neural-gia, 1 case of subdural hematoma, 1 case of viral encephalitis, 1 case of meningoencephalitis, and misdiagnosis rate was 50%upon admission. Combined with clinical manifestations, cerebrospinal fluid test ( CSF pressure<60 mmH2 O, cell count was higher in 4 cases, the protein of 5 cases increased) and MRI examination ( MRI showed that 7 cases were normal, 4 cases had subdural fluid collection, 2 cases had diffuse pachy meningeal gadolinium enhancement, 3 cases had brain sagging) all the 12 patients were then diagnosed with spontaneous intracranial hypotension syndrome. 11 cases were successfully treated with con-servative therapy, 1 case had surgical repair and his condition was alleviated, and the follow-up showed good prognosis. Con-clusion Middle-aged women with orthostatic headache should be suspected with spontaneous intracranial hypotension syn-drome. Clinicians should have a detailed and better understanding of history, make carefully examinations, timely lumbar puncture for cerebrospinal fluid examination combined with imaging examination, and make early diagnosis and treatment in order to avoid misdiagnosis and mistreatment.