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目的:探讨自发性低颅压综合征(Spontaneous Intracranial Hypotension,SIH)的临床和影像学特征,提高诊治水平。方法:对自发性低颅压2例报告并文献复习。结果:2例自发性低颅压均有典型的直立性头痛以及头颅核磁共振(MRI)增强扫描所示的硬脑膜广泛异常强化。其中1例虽然腰椎穿刺并无颅内压降低,但颈部MRI抑脂相提示脑脊液外漏。结论:脑脊液漏可能是导致自发性低颅压的主要原因,腰椎穿刺测压不是诊断的唯一依据,典型的临床表现和影像学征象有助于诊断,内科保守治疗无效时应考虑硬膜外血液补片法治疗。
Objective: To investigate the clinical and radiological features of Spontaneous Intracranial Hypotension (SIH) and to improve the diagnosis and treatment of SIH. Methods: Two cases of spontaneous low intracranial pressure and literature review. RESULTS: Two cases of spontaneous intracranial hypotension had typical upright headache and extensive abnormalities of the dura indicated by enhanced MRI of the skull. One of the cases did not have a decrease in intracranial pressure despite lumbar puncture, but MRI of the neck showed leakage of cerebrospinal fluid. Conclusions: Cerebrospinal fluid leakage may be the main reason leading to spontaneous low intracranial pressure. Lumbar puncture manometry is not the only basis for diagnosis. Typical clinical manifestations and imaging signs are helpful for diagnosis. When conservative treatment is ineffective, epidural blood should be considered Patch treatment.