Akbar Raza Ali, Khan Adeel Ahmad, Fernandes Glen Michael, Ahmed Mohamed Ayman Zakaria, Elsotouhy Ahmed, Ali Yasir Osman Mohamed
Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
Department of Anesthesiology, Hamad Medical Corporation, Doha, Qatar.
Am J Case Rep. 2020 Sep 15;21:e925986. doi: 10.12659/AJCR.925986.
BACKGROUND Spontaneous intracranial hypotension (SIH) is a rare cause of postural headache. In most patients, the site of cerebrospinal fluid (CSF) leak is at the cervical or thoracic spinal level. The imaging modalities to establish the diagnosis of SIH include computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, CT, and MRI myelography, and radionuclide cisternography. Treatment usually consists of conservative measures, but patients unresponsive to these treatments can be treated by epidural blood patch (EBP) administration at the site of CSF leak. CASE REPORT A 25-year-old-man presented with headache aggravated upon sitting or standing and relieved by lying supine or consuming coffee. There was no history of recent trauma, lumbar puncture, or spinal anesthesia. His neurological examination was unremarkable. MRI of his head and entire spine showed features of intracranial hypotension with no obvious CSF leak. He was treated conservatively but his symptoms persisted. CT spinal myelography showed significant leakage of contrast medium at the retrospinal region between C1 and C2 spinous processes. The patient underwent cervical EBP administration under fluoroscopic guidance. His symptoms resolved completely and he remains asymptomatic more than 6 months later. CONCLUSIONS SIH is an important cause of postural headache. In patients with non-resolving symptoms, further investigations are warranted to identify potential CSF leak. Patients found to have a CSF leak at the level of the cervical spine can be safely and effectively treated by cervical EBP administration.
背景 自发性颅内低压（SIH）是体位性头痛的罕见病因。在大多数患者中，脑脊液（CSF）漏出部位位于颈椎或胸椎水平。用于确立SIH诊断的影像学检查方法包括脑部计算机断层扫描（CT）和磁共振成像（MRI）、CT脊髓造影、MRI脊髓造影以及放射性核素脑池造影。治疗通常包括保守措施，但对这些治疗无反应的患者可通过在CSF漏出部位进行硬膜外血贴（EBP）治疗。病例报告 一名25岁男性出现头痛，坐位或站立时加重，仰卧位或饮用咖啡后缓解。近期无外伤、腰椎穿刺或脊髓麻醉史。其神经系统检查无异常。头部及整个脊柱的MRI显示颅内低压特征，但无明显CSF漏出。他接受了保守治疗，但症状持续存在。CT脊髓造影显示C1和C2棘突之间的脊髓后区域有明显的造影剂漏出。患者在透视引导下接受了颈椎EBP治疗。其症状完全缓解，6个月多后仍无症状。结论 SIH是体位性头痛的重要病因。对于症状未缓解的患者，有必要进一步检查以确定潜在的CSF漏出。发现颈椎水平有CSF漏出的患者可通过颈椎EBP治疗安全有效地治愈。
