Urbach Horst
Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany.
Curr Opin Neurol. 2014 Aug;27(4):414-24. doi: 10.1097/WCO.0000000000000105.
To illustrate clinical presentations, imaging findings, and diagnostic and therapeutic approaches associated with various conditions of intracranial hypotension.
Intracranial hypotension occurs spontaneously, following (lumbar) dural puncture, accidental dural opening, or excessive surgical cerebrospinal fluid drainage. The typical clinical manifestation - orthostatic headache - may be masqueraded by atypical clinical findings, including coma, frontotemporal dementia, leptomeningeal hemosiderosis-associated symptoms, and others. MRI signs are highly specific, but the imaging strategy to search for spinal cerebrospinal fluid leaks (none, computed tomography myelography, magnetic resonance myelography with gadolinium, digital subtraction myelography) is a matter of debate. The same is true for the mode of treatment (bed rest, blind, fluoroscopy or computed tomography-guided epidural blood patching, fibrin patching, surgery).
Clinical presentation as well as diagnostic and therapeutic approaches in intracranial hypotension are very heterogenous.
阐述与各种颅内低压情况相关的临床表现、影像学表现以及诊断和治疗方法。
颅内低压可自发发生，也可在（腰椎）硬膜穿刺、意外硬膜开放或过度手术引流脑脊液后出现。典型的临床表现——直立性头痛——可能被非典型临床表现所掩盖，包括昏迷、额颞叶痴呆、软脑膜含铁血黄素沉着相关症状等。MRI征象具有高度特异性，但寻找脊髓脑脊液漏的影像学策略（无、计算机断层扫描脊髓造影、钆增强磁共振脊髓造影、数字减影脊髓造影）仍存在争议。治疗方式（卧床休息、盲法、透视或计算机断层扫描引导下硬膜外血贴、纤维蛋白贴、手术）也是如此。
颅内低压的临床表现以及诊断和治疗方法非常多样。
