Schievink W I, Wijdicks E F, Meyer F B, Sonntag V K
Cedars-Sinai Neurosurgical Institute, Los Angeles, California 90048, USA.
Neurosurgery. 2001 Mar;48(3):513-6; discussion 516-7. doi: 10.1097/00006123-200103000-00009.
An excruciating headache of instantaneous onset is known as a thunderclap headache. A subarachnoid hemorrhage is the prototypical cause, but other serious disorders may also present with a thunderclap headache, including cerebral venous sinus thrombosis, carotid artery dissection, and pituitary apoplexy. We report a group of patients with thunderclap headaches as the initial manifestation of spontaneous intracranial hypotension caused by a spinal cerebrospinal fluid leak.
Among 28 patients with spontaneous intracranial hypotension due to a documented spinal cerebrospinal fluid leak, four (14%) initially experienced an excruciating headaches of instantaneous onset.
The mean age of the four patients (two men and two women) was 35 years (range, 24-45 yr). Nuchal rigidity was present in the three patients who sought early medical attention, and they underwent emergency computed tomographic scanning, lumbar puncture, and cerebral angiography to rule out an aneurysmal subarachnoid hemorrhage. The delay between the onset of headache and diagnosis of intracranial hypotension ranged from 4 days to 5 weeks. A fourth patient did not seek medical attention until 1 month after the ictus.
Spontaneous intracranial hypotension should be included in the differential diagnosis of thunderclap headache, even when meningismus is present.
起病迅速且极为剧烈的头痛称为霹雳样头痛。蛛网膜下腔出血是典型病因，但其他严重疾病也可能表现为霹雳样头痛，包括脑静脉窦血栓形成、颈动脉夹层和垂体卒中。我们报告一组以霹雳样头痛为自发性颅内低压最初表现的患者，其病因是脊髓脑脊液漏。
在28例因记录在案的脊髓脑脊液漏导致自发性颅内低压的患者中，4例（14%）最初经历了起病迅速且极为剧烈的头痛。
这4例患者（2男2女）的平均年龄为35岁（范围24 - 45岁）。3例早期就医的患者存在颈项强直，他们接受了急诊计算机断层扫描、腰椎穿刺和脑血管造影以排除动脉瘤性蛛网膜下腔出血。头痛发作至颅内低压诊断的延迟时间为4天至5周。第4例患者在发病1个月后才就医。
即使存在颈项强直，霹雳样头痛的鉴别诊断中也应考虑自发性颅内低压。
