Wu Hung-Yi, Hseu Shu-Shya, Chen Shih-Pin, Lirng Jiing-Feng, Wang Yen-Feng, Wang Shuu-Jiun, Fuh Jong-Ling
Department of Neurology, Neurological Institute; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University Schools of Medicine, Taipei, Taiwan.
Acta Neurol Taiwan. 2016 Sep 15;25(3):95-98.
Spontaneous intracranial hypotension (SIH) is a rare type of headache. The association of SIH with malignancy and disseminated intravascular coagulation (DIC) has not previously been reported.
A 60-year-old woman had orthostatic headache for more than one month before admission. MRI of brain showed diffuse pachymeningeal enhancement with bilateral subdural hematoma. MR myelography revealed epidural fluid collection and possible CSF leakage at the level of C5 to C6. DIC due to carcinoma of unknown origin was found based on evidence of malignant pleural effusion and multiple bone metastases. After correction of coagulopathy, the patient received an epidural blood patch. Unfortunately, follow-up brain MRI showed disease progression. The patient died of acute respiratory failure four weeks after admission.
This is the first case report of an association between SIH and DIC due to malignancy. Further case studies are needed to provide further support of this association.
自发性颅内低压（SIH）是一种罕见的头痛类型。此前尚无SIH与恶性肿瘤及弥散性血管内凝血（DIC）相关联的报道。
一名60岁女性入院前出现体位性头痛达一个多月。脑部MRI显示硬脑膜弥漫性强化伴双侧硬膜下血肿。磁共振脊髓造影显示硬膜外积液及C5至C6水平可能存在脑脊液漏。基于恶性胸腔积液和多发骨转移的证据，发现不明原发癌导致的DIC。纠正凝血病后，患者接受了硬膜外血贴治疗。不幸的是，随访脑部MRI显示病情进展。患者入院四周后死于急性呼吸衰竭。
这是首例关于SIH与恶性肿瘤所致DIC相关联的病例报告。需要进一步的病例研究来为这种关联提供更多支持。
