Lee Chang-Joon, Shim Sung-Min, Cho Sang-Hyeon, Park Jae-Ho, Kim Young Ki
Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, Gangneung, Korea.
Korean J Fam Med. 2018 Mar;39(2):122-125. doi: 10.4082/kjfm.2018.39.2.122. Epub 2018 Mar 22.
A 34-year-old woman came to the emergency room complaining of a severe orthostatic headache. Results of a cerebrospinal fluid tap and brain computed tomography were normal. Based on her history and symptoms, she was found to have spontaneous intracranial hypotension. She was hospitalized and her symptoms improved with conservative treatment. On the next day, her headache suddenly worsened. Cisternography was performed to confirm the diagnosis and determine the spinal level of her cerebrospinal fluid leak. It revealed multiple cerebrospinal fluid leaks in the lumbar and upper thoracic regions. It was strongly believed that she had an iatrogenic cerebrospinal fluid leak in the lumbar region. An epidural blood patch was performed level by level on the lumbar and upper thoracic regions. Her symptoms resolved after the epidural blood patch and she was later discharged without any complications. In this case, an iatrogenic cerebrospinal fluid leak was caused by a dural puncture made while diagnosing spontaneous intracranial hypotension, which is always a risk and hampers the patient's progress. Therefore, in cases of spontaneous intracranial hypotension, an effort to minimize dural punctures is needed and a non-invasive test such as magnetic resonance imaging should be considered first.
一名34岁女性因严重直立性头痛前往急诊室。脑脊液穿刺和脑部计算机断层扫描结果正常。根据她的病史和症状，发现她患有自发性颅内低压。她住院并通过保守治疗症状有所改善。第二天，她的头痛突然加重。进行了脑池造影以确诊并确定脑脊液漏的脊髓节段。结果显示腰椎和上胸部区域存在多处脑脊液漏。强烈怀疑她在腰椎区域存在医源性脑脊液漏。在腰椎和上胸部区域逐层进行了硬膜外血贴疗法。硬膜外血贴疗法后她的症状得到缓解，随后出院，无任何并发症。在这种情况下，医源性脑脊液漏是由诊断自发性颅内低压时的硬膜穿刺引起的，这始终是一种风险并阻碍患者的康复进程。因此，在自发性颅内低压病例中，需要努力尽量减少硬膜穿刺，并应首先考虑使用磁共振成像等非侵入性检查。
