Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA.
J Clin Neurosci. 2014 Jun;21(6):1063-5. doi: 10.1016/j.jocn.2013.10.011. Epub 2013 Oct 30.
Although most patients with intracranial hypotension typically present with headaches, the rest of the clinical spectrum is characteristically non-specific and often quite variable. In a patient with concurrent pathologies that can produce a similar clinical picture, a high index of suspicion must be maintained to achieve the correct diagnosis. The authors report a patient with intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage. A 63-year-old woman with a family history of ruptured intracranial aneurysms presented after a sudden thunderclap headache and was found to have diffuse subarachnoid hemorrhage. Imaging revealed anterior communicating and superior hypophyseal artery aneurysms. Following the uneventful clipping of both aneurysms, the patient experienced a delayed return to her neurological baseline. After it was noted that the patient had an improved neurological examination when she was placed supine, further investigation confirmed intracranial hypotension from perineural cyst rupture. The patient improved and returned to her neurological baseline after undergoing a high-volume blood patch and remained neurologically intact at postoperative follow-up. Although intracranial hypotension is known to be commonly associated with cerebrospinal fluid leak, its causal and temporal relationship with subarachnoid hemorrhage has yet to be elucidated.
虽然大多数颅内低血压患者通常表现为头痛，但其余的临床谱特征是非特异性的，且通常变化多样。在同时存在可能产生类似临床表现的共存病的患者中，必须保持高度怀疑，以做出正确诊断。作者报告了一例颅内低血压患者，并发神经周围囊肿破裂和蛛网膜下腔出血。一位 63 岁的女性，有颅内动脉瘤破裂的家族史，突发闪电样头痛后就诊，发现有弥漫性蛛网膜下腔出血。影像学显示前交通动脉和垂体上动脉动脉瘤。在成功夹闭两个动脉瘤后，患者的神经功能恢复延迟。注意到患者在仰卧位时神经功能检查改善后，进一步的检查证实了神经周围囊肿破裂引起的颅内低血压。患者在接受大容量血液贴补后病情改善并恢复到神经基线，在术后随访中保持神经功能完整。虽然已知颅内低血压常与脑脊液漏有关，但它与蛛网膜下腔出血的因果关系和时间关系尚未阐明。
