Hoshino M, Okayama K, Kubo H, Tei H, Watanabe H
Department of Neurology, Ohmiya Red Cross Hospital.
Rinsho Shinkeigaku. 1990 Feb;30(2):174-8.
A 43-year-old man with no history of trauma or neurosurgical procedure was admitted our hospital because of orthostatic headache made worse in upright position. Spinal fluid pressure was 0 mmH2O, and CT scan revealed wide cortical sulci and ventricles. In the 26th hospital day he had severe headache and CT scan revealed bilateral subdural hematoma, then neurosurgical procedure was done. About 2 months later, he was relieved of the headache and spinal fluid pressure returned to normal. We performed lumbar isotope cisternography and isotope choroid plexography in our case when low spinal fluid pressure and normalized pressure. Isotope cisternography revealed the radioactivity counts decreased rapidly in low pressure and normal in normal pressure. On the other hand isotope choroid plexography was almost no difference between low and normal pressure. Our data suggest that primary low spinal fluid pressure syndrome is not caused by hypoproduction, but by an undetectable leak from a minute tear in a spinal root sleeve or hyperabsorption at the spinal arachnoid membrane.
一名43岁男性，无外伤史及神经外科手术史，因直立位时体位性头痛加重而入住我院。脑脊液压力为0 mmH₂O，CT扫描显示脑沟和脑室增宽。在住院第26天，他出现严重头痛，CT扫描显示双侧硬膜下血肿，随后接受了神经外科手术。约2个月后，他头痛缓解，脑脊液压力恢复正常。在患者脑脊液压力降低及恢复正常时，我们对其进行了腰椎同位素脑池造影和同位素脉络丛造影。同位素脑池造影显示，在低压时放射性计数迅速下降，在正常压力时则正常。另一方面，同位素脉络丛造影在低压和正常压力之间几乎没有差异。我们的数据表明，原发性低脑脊液压力综合征并非由脑脊液分泌减少引起，而是由脊髓神经根袖微小撕裂处不可检测到的渗漏或脊髓蛛网膜的过度吸收所致。
