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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<60mm H2O,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。
Objective To investigate the clinical features, prognosis and imaging features of spontaneous intracranial hypotension. Methods Sixty-six patients with spontaneous intracranial hypotension syndrome admitted from 2009 to 2014 in Peking Union Medical College Hospital were analyzed. Their clinical manifestations, laboratory tests, imaging features and prognosis were analyzed. Results All patients presented with positional headache. 13 cases of cerebrospinal fluid pressure <60mmH2O, 3 cases of cerebrospinal fluid pressure of 0.6 cases of head CT showed subdural effusion / hemorrhage, 2 cases of cerebral lobe hemorrhage, 5 cases of bilateral lateral ventricle volume decreased, 8 cases did not Obvious abnormalities. Head enhanced MRI showed dura mater diffuse enhancement in 9 cases, 3 cases of subdural hemorrhage, subdural effusion in 3 cases, brain tissue down 4 cases, 2 cases of pituitary enlargement. Conclusion Postural headache is one of the typical symptoms of spontaneous intracranial hypotension syndrome. Most patients have a good prognosis. Skull enhancement MRI can show diffuse dura enhancement and other typical low intracranial pressure changes, head CT may also prompt some changes. On the basis of detailed medical history, we should pay attention to the interpretation of craniocerebral CT examination and avoid over-reliance on cranial enhancement MRI, which is helpful for the early diagnosis of the disease.