Higgins J Nicholas, Axon Patrick R, Macfarlane Robert
Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
Cambridge Skull Base Unit, Addenbrooke's Hospital, Cambridge, United Kingdom.
J Neurol Surg Rep. 2020 Oct;81(4):e59-e65. doi: 10.1055/s-0040-1722268. Epub 2020 Dec 31.
Spontaneous intracranial hypotension describes the clinical syndrome brought on by a cerebrospinal fluid (CSF) leak. Orthostatic headache is the key symptom, but others include nausea, vomiting, and dizziness, as well as cognitive and mood disturbance. In severe cases, the brain slumps inside the cranium and subdural collections develop to replace lost CSF volume. Initial treatment is by bed rest, but when conservative measures fail, attention is focused on finding and plugging the leak, although this can be very difficult and some patients remain bedbound for months or years. Recently, we have proposed an alternative approach in which obstruction to cranial venous outflow would be regarded as the driving force behind a chronic elevation of CSF pressure, which eventually causes dural rupture. Instead of focusing on the site of rupture, therefore, investigation and treatment can be directed at locating and relieving the obstructing venous lesion, allowing intracranial pressure to fall, and the dural defect to heal. The case we describe illustrates this idea. Moreover, since there was a graded clinical response to successive interventions relieving venous obstruction, and eventual complete resolution, it also provides an opportunity to consider particular symptoms in relation to cerebral venous insufficiency in its own right.
自发性颅内低压描述的是由脑脊液（CSF）漏引起的临床综合征。直立性头痛是关键症状，但其他症状包括恶心、呕吐、头晕，以及认知和情绪障碍。在严重情况下，大脑会在颅骨内下沉，形成硬膜下积液以替代丢失的脑脊液量。初始治疗是卧床休息，但当保守措施无效时，重点就会放在寻找并封堵漏口上，尽管这可能非常困难，而且一些患者会数月或数年卧床不起。最近，我们提出了一种替代方法，即认为颅静脉流出道阻塞是脑脊液压力慢性升高的背后驱动力，最终导致硬脑膜破裂。因此，与其关注破裂部位，不如将检查和治疗方向指向定位并解除阻塞性静脉病变，使颅内压降低，硬脑膜缺损愈合。我们描述的这个病例就说明了这一观点。此外，由于对缓解静脉阻塞的连续干预有分级的临床反应，最终完全缓解，这也为单独考虑与脑静脉功能不全相关的特定症状提供了机会。
