Srimanee Duangpol, Pasutharnchat Nath, Phanthumchinda Kammant
Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2009 Nov;92(11):1538-43.
Spontaneous Intracranial Hypotension (SIH) is an uncommon headache syndrome. Patients classically present with orthostatic headache, tinnitus, and diplopia. The authors reported a 43 year-old man who presented with orthostatic headache, tinnitus, and hearing impairment for 3 months. Physical examination was unremarkable except for auditory impairment. The audiogram revealed minimal low-frequency neurosensori hearing loss suggesting a cochlear lesion. Computed tomography of the brain revealed bilateral thin chronic subdural hematomas. He underwent burr-hole surgery. Headache and auditory symptoms persisted and reevaluation of this syndrome was performed MRI of the brain showed diffuse smooth enhanced dura mater low lying position of midbrain, pons, medullar and cerebellar tonsil, as well as enlarged pituitary gland compatible with low CSF pressure syndrome. MRI of the whole spine could not demonstrate the site of CSF leakage. The patient was much improved after conservative treatments with hydration and bed rest. One year after treatment, he had no headache and only mild tinnitus was reported.
自发性颅内低压（SIH）是一种罕见的头痛综合征。患者典型表现为体位性头痛、耳鸣和复视。作者报告了一名43岁男性，出现体位性头痛、耳鸣和听力障碍3个月。体格检查除听觉障碍外无异常。听力图显示低频轻度神经感觉性听力损失，提示耳蜗病变。脑部计算机断层扫描显示双侧慢性硬膜下薄层血肿。他接受了钻孔手术。头痛和听觉症状持续存在，对该综合征进行了重新评估。脑部MRI显示硬脑膜弥漫性光滑强化，中脑、脑桥、延髓和小脑扁桃体低位，以及垂体增大，符合低脑脊液压力综合征。全脊柱MRI未能显示脑脊液漏出部位。经补液和卧床休息等保守治疗后，患者病情明显改善。治疗一年后，他没有头痛，仅报告有轻度耳鸣。
