Samii C, Möbius E, Weber W, Heienbrok H W, Berlit P
Department of Neurology with Clinical Neurophysiology, Alfried-Krupp Krankenhaus, Essen, Germany.
J Neurol. 1999 Mar;246(3):162-4. doi: 10.1007/s004150050327.
Cerebrospinal fluid (CSF) leakage may occur spontaneously, iatrogenically or from spinal trauma. Postural headache is the cardinal symptom; dizziness, diminished hearing, nausea and vomiting are additional symptoms. In neurological examinations cranial nerve palsies may be found. Due to low CSF pressure neuroimaging studies may reveal dural enhancement and vertical displacement of the brain. We describe a patient with the history of an uncomplicated lumbar discectomy at the level L4-5 and the typical clinical symptoms of intracranial hypotension. MRI of the craniocervical junction showed typical features of a Chiari type-I malformation. After neurosurgical ligation of a CSF leak at L4-5 caused by lumbar disc surgery, the patient was free of orthostatic headache. A repeated MRI showed a striking reduction of the previous downward displacement of the cerebellar tonsils and pons.
脑脊液（CSF）漏可能自发出现、医源性发生或由脊柱创伤引起。体位性头痛是主要症状；头晕、听力减退、恶心和呕吐是其他症状。在神经系统检查中可能发现颅神经麻痹。由于脑脊液压力低，神经影像学研究可能显示硬脑膜强化和脑的垂直移位。我们描述了一名有L4 - 5节段单纯腰椎间盘切除术病史且有颅内低压典型临床症状的患者。颅颈交界区的MRI显示了典型的Chiari I型畸形特征。在神经外科结扎由腰椎间盘手术导致的L4 - 5节段脑脊液漏后，患者的体位性头痛消失。重复MRI显示小脑扁桃体和脑桥先前向下移位明显减轻。
