Aidi S, Chaunu M P, Biousse V, Bousser M G
Department of Neurology, Lariboisière Hospital, 2 Rue Ambroise Paré, 75012 Paris, France.
Headache. 1999 Sep;39(8):559-64. doi: 10.1046/j.1526-4610.1999.3908559.x.
To emphasize the diagnostic importance of change in the headache pattern which pointed to cerebral venous thrombosis in two patients after lumbar puncture and high-dose intravenous methylprednisolone for suspected multiple sclerosis.
Both patients had a diagnostic lumbar puncture for suspected multiple sclerosis and were treated with high-dose intravenous methylprednisolone. Both developed a postlumbar puncture headache that was initially postural, typical of low cerebrospinal fluid pressure. Three days later, the headache became constant, lost its postural component, and was associated with bilateral papilledema. Magnetic resonance imaging of the brain disclosed superior sagittal and lateral sinuses thrombosis. The diagnostic difficulties of such cases and the potential role of lumbar puncture and corticosteroids as risk factors for cerebral venous thrombosis are discussed.
When a typical postdural puncture headache loses its postural component, investigations should be performed to rule out cerebral venous thrombosis, particularly in the presence of other risk factors.
强调头痛模式改变在诊断中的重要性，这种改变在两名疑似多发性硬化症的患者接受腰椎穿刺和大剂量静脉注射甲基泼尼松龙后提示脑静脉血栓形成。
两名患者均因疑似多发性硬化症接受了诊断性腰椎穿刺，并接受了大剂量静脉注射甲基泼尼松龙治疗。两人均出现了腰椎穿刺后头痛，起初为体位性，是典型的低脑脊液压力性头痛。三天后，头痛变为持续性，失去了体位性成分，并伴有双侧视乳头水肿。脑部磁共振成像显示上矢状窦和外侧窦血栓形成。讨论了此类病例的诊断困难以及腰椎穿刺和皮质类固醇作为脑静脉血栓形成危险因素的潜在作用。
当典型的硬膜穿刺后头痛失去其体位性成分时，应进行检查以排除脑静脉血栓形成，尤其是在存在其他危险因素的情况下。
