自发性颅内低压的诊断与治疗：硬膜外血贴疗法的作用
Diagnosis and Treatment of Spontaneous Intracranial Hypotension: Role of Epidural Blood Patching.
作者信息
Callen Andrew L, Friedman Deborah I, Parikh Simy, Rau Jill C, Schievink Wouter I, Cutsforth-Gregory Jeremy K, Amrhein Timothy J, Haight Elena, Cowan Robert P, Barad Meredith J, Hah Jennifer M, Jackson Tracy, Deline Connie, Buchanan Andrea J, Carroll Ian
机构信息
Department of Radiology (ALC), University of Colorado Anschutz Medical Campus, Denver; Yellow Rose Headache and Neurology-Ophthalmology (DIF), Dallas, TX; Department of Neurology (SP), Thomas Jefferson University, Philadelphia, PA; Bob Bove Neuroscience Institute (JCR), HonorHealth Neurology, Scottsdale, AZ; Department of Neurosurgery (WIS), Cedars Sinai Medical Center, Beverly Hills, CA; Department of Neurology (JKC-G), Mayo Clinic, Rochester, MN; Department of Radiology (TJA), Duke University, Durham, NC; Department of Anesthesia (EH), UCSF, San Francisco, CA; Departments of Neurology (RPC, MJB) and Anesthesiology (JMH, IC), Stanford University, Stanford, CA; Opos Solutions (TJ), San Mateo, CA; and Spinal CSF Leak Foundation (CD, AJB), Spokane, WA.
出版信息
Neurol Clin Pract. 2024 Jun;14(3):e200290. doi: 10.1212/CPJ.0000000000200290. Epub 2024 Apr 30.
PURPOSE OF REVIEW
This review focuses on the challenges of diagnosing and treating spontaneous intracranial hypotension (SIH), a condition caused by spinal CSF leakage. It emphasizes the need for increased awareness and advocates for early and thoughtful use of empirical epidural blood patches (EBPs) in suspected cases.
RECENT FINDINGS
SIH diagnosis is hindered by variable symptoms and inconsistent imaging results, including normal brain MRI and unreliable spinal opening pressures. It is crucial to consider SIH in differential diagnoses, especially in patients with connective tissue disorders. Early EBP intervention is shown to improve outcomes.
SUMMARY
SIH remains underdiagnosed and undertreated, requiring heightened awareness and understanding. This review promotes proactive EBP use in managing suspected SIH and calls for continued research to advance diagnostic and treatment methods, emphasizing the need for innovative imaging techniques for accurate diagnosis and timely intervention.
综述目的
本综述聚焦于诊断和治疗自发性颅内低压（SIH）的挑战，这是一种由脊髓脑脊液漏引起的病症。它强调了提高认识的必要性，并提倡在疑似病例中早期且谨慎地使用经验性硬膜外血贴（EBP）。
最新发现
SIH的诊断受到症状多变和影像学结果不一致的阻碍，包括脑部MRI正常以及脊髓开放压不可靠。在鉴别诊断中考虑SIH至关重要，尤其是在患有结缔组织疾病的患者中。早期EBP干预已显示可改善预后。
总结
SIH仍然诊断不足且治疗不充分，需要提高认识和理解。本综述提倡在管理疑似SIH时积极使用EBP，并呼吁继续开展研究以推进诊断和治疗方法，强调需要创新的成像技术来进行准确诊断和及时干预。
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