Department of Neurology (MDP), Boston University School of Medicine, Boston University Medical Center, Boston, Massachusetts; Jefferson Headache Center (SKP), Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Neurology (FF-T), University of Puerto Rico School of Medicine, San Juan, Puerto Rico; UF Health Neurology Department (MTM), McKnight Brain Institute (L3-100), Gainesville, Florida; and Department of Neurology (MLR), Jacobs School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, New York.
J Neuroophthalmol. 2019 Sep;39(3):330-332. doi: 10.1097/WNO.0000000000000759.
Although lumbar punctures (LPs) are used for diagnostic evaluation in idiopathic intracranial hypertension (IIH), they can also provide relief from IIH-associated headache. Conversely, low-pressure headache secondary to LP can be debilitating. Low-volume cerebrospinal fluid (CSF) removal to a "high-normal" closing pressure (CP), approximately 18-20 cm H2O, may result in relief of IIH-associated headache with a lowered frequency of post-LP headache.
We conducted a single-center retrospective analysis from 2011 to 2016 of patients who underwent fluoroscopic LPs aiming for high-normal CPs. Inclusion criteria were as follows: 1) pre-existing diagnosis of IIH, or opening pressure (OP) and clinical findings diagnostic for IIH; 2) height and weight recorded within 1 year; 3) documented LP data parameters; and 4) one week post-LP follow-up documenting whether headache was worse, unchanged, or better.
One hundred forty-six patients met the inclusion criteria. Mean age was 34.9 years ± 11.0, and mean body mass index was 39.2 kg/m ± 10.5. Mean volume removed was 9.7 mL ± 4.6. The mean CP was 17.9 cm H2O ±2.7. The mean pressure change (OP-CP) per volume removed was 1.50 cm H2O/mL ±0.6. Headache symptoms at follow-up were improved in 64% (80/125) of patients, worse in 26% (33/125), and unchanged in 10% (12/125). Eleven patients were headache-free, and 11 patients required hospital care for post-LP headache.
Low-volume CSF removal to approximately 18 cm H2O resulted in relief of IIH-associated headache in most patients and a low incidence of post-LP headache. Although clinically variable, these data suggest that for every 1 mL of CSF removed, the CP decreases approximately 1.5 cm H2O.
尽管腰椎穿刺（LP）可用于特发性颅内高压（IIH）的诊断评估，但它也可以缓解 IIH 相关头痛。相反，LP 引起的低压性头痛可能会使人虚弱。将脑脊液（CSF）量减少到“高正常”关闭压力（CP），约 18-20cmH2O，可能会缓解 IIH 相关头痛，并降低 LP 后头痛的发生率。
我们对 2011 年至 2016 年期间在我们中心进行荧光透视 LP 以获得高正常 CP 的患者进行了单中心回顾性分析。纳入标准如下：1）存在 IIH 的既往诊断，或开放压力（OP）和临床发现诊断为 IIH；2）身高和体重在 1 年内记录；3）记录 LP 数据参数；4）LP 后一周随访记录头痛是加重、不变还是缓解。
146 名患者符合纳入标准。平均年龄为 34.9 岁±11.0，平均体重指数为 39.2kg/m±10.5。平均移除量为 9.7ml±4.6。平均 CP 为 17.9cmH2O±2.7。每移除 1 毫升体积的平均压力变化（OP-CP）为 1.50cmH2O/mL±0.6。在随访时，80/125（64%）名患者的头痛症状改善，33/125（26%）名患者的头痛症状加重，12/125（10%）名患者的头痛症状不变。11 名患者无头痛，11 名患者因 LP 后头痛需要住院治疗。
将 CSF 量减少到约 18cmH2O 可使大多数患者的 IIH 相关头痛得到缓解，且 LP 后头痛的发生率较低。尽管临床表现有所不同，但这些数据表明，每移除 1mlCSF，CP 下降约 1.5cmH2O。
