Delvaux V, Dioh A, Schoenen J
Université de Liège, Service de Neurologie, CHR de la Citadelle.
Rev Med Liege. 1999 Aug;54(8):671-6.
Chronic headaches due to intracranial hypo- or hypertension (IHS codes 7.2 and 7.1) may be difficult to diagnose. In this article, we review their principal clinical characteristics, etiologies and therapies. Intracranial hypotension may be caused by CSF linkage, e.g. after lumbar puncture. It may also be "idiopathic" in which case a CSF leak, usually at the spinal level, may be difficult to demonstrate. Postural headache is the clinical hallmark of intracranial hypotension. The diagnosis is confirmed by leptomeningeal enhancement on MRI scans. The headache of benign intracranial hypertension may be aggravated by the supine position and accompanied by transient visual obscurations and tinnitus. Papillary edema supports the diagnosis but may be absent in some cases. Increased opening pressure of the CSF will confirm the diagnosis. Etiologies such as cerebral venous thrombosis, have to be excluded by adequate imaging methods. In both hypo- and hypertension syndromes, various therapeutic strategies have been proposed.
由颅内低血压或高血压引起的慢性头痛（国际头痛疾病分类编码7.2和7.1）可能难以诊断。在本文中，我们回顾了它们的主要临床特征、病因和治疗方法。颅内低血压可能由脑脊液连通性引起，例如腰椎穿刺后。也可能是“特发性的”，在这种情况下，脑脊液漏（通常在脊髓水平）可能难以证实。体位性头痛是颅内低血压的临床标志。通过MRI扫描上的软脑膜强化来确诊。良性颅内高压性头痛可能在仰卧位时加重，并伴有短暂性视力模糊和耳鸣。视乳头水肿支持诊断，但在某些情况下可能不存在。脑脊液开放压升高将确诊。必须通过适当的影像学方法排除诸如脑静脉血栓形成等病因。在低血压和高血压综合征中，已经提出了各种治疗策略。
