Department of Paediatric Surgery, The Royal Hospital for Sick Children, Edinburgh, United Kingdom of Great Britain and Northern Ireland.
Department of Anaesthetics, Western General Hospital, Edinburgh, United Kingdom of Great Britain and Northern Ireland.
Br J Neurosurg. 2021 Jun;35(3):251-253. doi: 10.1080/02688697.2020.1784845. Epub 2020 Jun 26.
Spontaneous intracranial hypotension (SIH) has been classified as a triad of postural headache, low CSF opening pressure (below 60mmH0) and diffuse pachymeningeal gadolinium enhancement on MRI. SIH is due to a non-iatrogenic defect in the dura somewhere along the neuraxis (usually in the spine). The resultant leak depressurizes the system and undermines the buoyancy-providing quality of CSF. In many cases the site of leak is not identified. Epidural blood patch (EBP) is a well-established treatment of SIH but is not always effective. We retrospectively analysed thirty-one cases of SIH who required at least one EBP. They were managed over a fifteen-year period at a single institution. EBP resulted in a significant improvement in headache for 77% of patients. We report in more detail on a particularly challenging outlier where severe SIH resulted in coma. Serial epidural blood patches, burr hole evacuation of chronic subdural haematomata, and infusion of 0.9% NaCl via an intradural spinal catheter were all required to enable long-term recovery.
自发性颅内低血压（SIH）已被归类为三联征，包括体位性头痛、脑脊液开放压力降低（低于 60mmH2O）和 MRI 上弥漫性厚脑膜钆增强。SIH 是由于沿神经轴的某个部位（通常在脊柱）的硬脑膜出现非医源性缺陷。由此产生的漏液会使系统减压，并破坏脑脊液提供浮力的特性。在许多情况下，漏液部位无法确定。硬膜外血贴（EBP）是 SIH 的一种成熟治疗方法，但并不总是有效。我们回顾性分析了在一家机构接受至少一次 EBP 治疗的 31 例 SIH 患者。他们在 15 年期间得到了管理。EBP 使 77%的患者头痛明显改善。我们详细报告了一个特别具有挑战性的离群值，其中严重的 SIH 导致昏迷。需要进行多次硬膜外血贴、慢性硬脑膜下血肿钻孔引流以及通过硬脊膜内导管输注 0.9%生理盐水，以实现长期康复。
