Takahashi Toshihide, Yanaka Kiyoyuki, Aiyama Hitoshi, Saura Minami, Kajita Michihide, Takahashi Nobuyuki, Onuma Kuniyuki, Ishikawa Eiichi
1Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Japan.
2Department of Neurology, Tsukuba Memorial Hospital, Tsukuba, Japan.
J Neurosurg Case Lessons. 2024 Feb 26;7(9). doi: 10.3171/CASE23702.
Spontaneous intracranial hypotension (SIH) is a rare condition characterized by positional headache, for which contrast-enhanced magnetic resonance imaging (MRI) is the preferred diagnostic method. Although MRI reveals characteristic findings, head computed tomography (CT) is usually the first diagnostic step, but identifying features of SIH on CT is often difficult. This study was specifically designed to evaluate the utility of head CT in detecting upper cervical epidural venous engorgement as a sign of SIH.
Of 24 patients with SIH diagnosed between March 2011 and May 2023, 10 did not undergo upper cervical CT. In the remaining 14 patients, engorgement of the upper cervical epidural venous plexus was observed. CT detection rates were consistent with MRI for spinal fluid accumulation or dural thickening. After treatment, in 92.9% of patients, the thickness of the epidural venous plexus decreased statistically significantly from 4.8 ± 1.3 mm to 3.6 ± 1.2 mm.
This study suggests that upper cervical spine CT focused on epidural venous engorgement may be helpful in the initial diagnosis of SIH and may complement conventional MRI evaluation. Extending CT imaging to the upper cervical spine will improve the diagnostic accuracy of patients with positional headaches suspected to be SIH.
自发性颅内低压（SIH）是一种以体位性头痛为特征的罕见病症，对比增强磁共振成像（MRI）是其首选诊断方法。尽管MRI可显示特征性表现，但头部计算机断层扫描（CT）通常是首要诊断步骤，然而在CT上识别SIH的特征往往困难。本研究专门设计用于评估头部CT在检测上颈段硬膜外静脉充血作为SIH征象方面的效用。
在2011年3月至2023年5月期间诊断的24例SIH患者中，10例未进行上颈段CT检查。在其余14例患者中，观察到上颈段硬膜外静脉丛充血。CT对脑脊液积聚或硬膜增厚的检测率与MRI一致。治疗后，92.9%的患者硬膜外静脉丛厚度从4.8±1.3毫米降至3.6±1.2毫米，差异有统计学意义。
本研究表明，聚焦于硬膜外静脉充血的上颈段脊柱CT可能有助于SIH的初步诊断，并可补充传统的MRI评估。将CT成像扩展至上颈段脊柱将提高疑似SIH的体位性头痛患者的诊断准确性。
