一种不常见的姿势性头痛：病例报告。
An unusual postural headache: a case report.
机构信息
School of Medical and Applied Sciences, CQUniversity Sydney, Level 11, 400 Kent St, Sydney, NSW, 2000, Australia.
School of Psychology, Faculty of Society & Design, Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
出版信息
Chiropr Man Therap. 2020 Nov 13;28(1):56. doi: 10.1186/s12998-020-00347-0.
BACKGROUND
This paper presents a case of an evolving unusual thunderclap headache that presented to a chiropractor.
CASE PRESENTATION
The intense "migraine-like" headache was aggravated by standing up and relieved substantially when lying down. This low pressure, orthostatic headache was diagnosed as a spontaneous intracranial hypotension (SIH) secondary to a spontaneous tear of the dura. It was referred to the local hospital for management with autogolous blood injection to form an epidural blood patch of the defect. It resolved substantially within 3 days.
CONCLUSIONS
The significance of key features in the history and examination and how if not recognised and subsequently treated with manual therapy, the dural tear could be attributed to the treatment of the chiropractor, a treatment that would typically involve cervical manipulation. Discussion is provided of the implications of a missed diagnosis and possible subsequent chiropractic management with the evolving SIH being attributed to the chiropractic intervention rather than its true "spontaneous" nature.
背景
本文介绍了一个演变不寻常的霹雳头痛的案例，该头痛患者就诊于脊椎按摩师。
病例介绍
剧烈的“偏头痛样”头痛在站立时加重，躺下时明显缓解。这种低压性体位性头痛被诊断为自发性硬脑膜下血肿（SIH），继发于硬脑膜自发性撕裂。它被转介到当地医院进行管理，采用自体血液注射形成硬膜外血补丁来修复缺陷。它在 3 天内基本得到解决。
结论
病史和检查中的关键特征的重要性，如果没有被识别并随后通过手法治疗进行治疗，硬脑膜撕裂可能归因于脊椎按摩师的治疗，这种治疗通常涉及颈椎推拿。讨论了漏诊的影响，以及可能的后续脊椎按摩管理，将不断发展的 SIH 归因于脊椎按摩干预，而不是其真正的“自发性”性质。
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