Zabek Mateusz Miroslaw, Turek Grzegorz
Medical Division, Cardinal Stefan Wyszynski University, Warsaw, Poland.
Department of Neurosurgery, Brodno Masovian Hospital, Warsaw, Poland.
Surg Neurol Int. 2022 May 20;13:215. doi: 10.25259/SNI_360_2022. eCollection 2022.
Spontaneous intracranial hypotension (SIH) is a rare disease characterized by a decrease in the volume and pressure of cerebrospinal fluid (CSF) resulting from its leakage through the dura mater. SIH is curable, but it can lead to serious clinical sequelae or even death if not treated properly.
A 37-year-old female with headaches occurring in standing position and increasing especially during verticalization. Magnetic resonance imaging showed an image characteristic of SIH. Conservative treatment was applied in the form of bed rest. CT myelography scan located the site of CSF leakage. As the conservative treatment proved inefficient, it was decided to perform an epidural fistula sealing using the patient's venous blood, administered under computed tomography guidance. The performed procedure completely resolved the patient's complaints, allowing her to be discharged home.
Patients with suspected SIH should remain in the supine position until a definitive diagnosis is made. Sealing the meningeal fistula with venous blood under computed tomography guidance should be considered in case of conservative treatment failure.
自发性颅内低压（SIH）是一种罕见疾病，其特征是脑脊液（CSF）通过硬脑膜渗漏导致脑脊液容量和压力降低。SIH是可治愈的，但如果治疗不当，可能会导致严重的临床后遗症甚至死亡。
一名37岁女性，站立时出现头痛，尤其是在直立过程中头痛加剧。磁共振成像显示出SIH的典型影像特征。采用卧床休息的方式进行保守治疗。CT脊髓造影扫描确定了脑脊液漏出的部位。由于保守治疗效果不佳，决定在计算机断层扫描引导下，使用患者自身静脉血进行硬膜外瘘封堵术。所实施的手术完全解决了患者的症状，使其得以出院回家。
疑似SIH的患者在确诊之前应保持仰卧位。保守治疗失败时，应考虑在计算机断层扫描引导下用静脉血封堵脑膜瘘。
