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目的探讨自发性低颅压综合征(SIH)的临床特点和影像学改变。方法回顾性分析31例SIH患者的临床及影像资料。结果所有患者均有体位性头痛,可伴有恶心、呕吐、头晕、耳鸣、听力丧失、行走不稳、一过性视物模糊、复视、颈肩部疼痛、颈强直;CSF压力均<70mmH2O,蛋白升高12例,WBC增多11例,RBC增多7例;全部患者行头颅CT检查,8例见脑肿胀,脑沟变浅,脑室变窄,临床症状消失后复查均恢复正常;15例行头颅MRI检查,8例行增强检查示硬脑膜弥漫性强化,头颅CT及MRI检查见4例硬膜下积液、2例硬膜下血肿;全部患者采用内科综合疗法,1例行硬膜下血肿清除术,均痊愈。结论SIH的临床表现多样,体位性头痛是特征性症状,腰穿CSF及头颅MRI检查具有诊断价值;本病预后良好,但少数并发硬膜下血肿。
Objective To investigate the clinical features and imaging changes of spontaneous intracranial hypotension syndrome (SIH). Methods The clinical and imaging data of 31 patients with SIH were retrospectively analyzed. Results All patients had positional headache with nausea, vomiting, dizziness, tinnitus, hearing loss, unstable walking, transient blurred vision, diplopia, neck and shoulder pain, and neck stiffness. CSF pressure was <70 mmH2O , Protein increased in 12 cases, WBC increased in 11 cases, RBC increased in 7 cases; all patients underwent head CT examination, 8 cases of brain swelling, shallow sulcus, ventricular narrowing, disappeared after clinical symptoms returned to normal; 15 cases Line skull MRI examination, 8 cases of enhanced examination showed diffuse dura mater, head CT and MRI examination showed 4 cases of subdural effusion, 2 cases of subdural hematoma; all patients with medical therapy, 1 case of dura mater Hematoma removal surgery, were cured. Conclusions The clinical manifestation of SIH is diverse. The orthostatic headache is a characteristic symptom. Lumbar penetrating CSF and cranial MRI have diagnostic value. The prognosis of this disease is good, but a few of them have subdural hematoma.