Yokoi Misaki, Kenzaka Tsuneaki, Asano Mari, Sugimoto Ryu, Nishisaki Hogara
Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3495, Hyogo, Japan.
Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe 652-0032, Hyogo, Japan.
Reports (MDPI). 2024 Dec 16;7(4):115. doi: 10.3390/reports7040115.
: Symptoms of spontaneous intracranial hypotension include orthostatic headaches due to decreased cerebrospinal fluid (CSF) levels. Here, we present a 24-year-old female admitted to an obstetrics and gynecology department with primary complaints of lower abdominal pain and dysmenorrhea with subsequent diagnosis of spontaneous intracranial hypotension (SIH). : The patient had experienced nausea and lower abdominal pain independent of her menstrual cycle 5 days before admission, for which she visited the emergency department 3 days later. On admission, her symptoms were temporarily relieved by administering analgesics; thus, she was discharged. However, later, the symptoms worsened. Consequently, she returned to the emergency department for further evaluation, including blood tests, imaging, and endoscopy, which revealed no nausea- or abdominal pain-related organic abnormalities. On day 10, she developed a headache, aggravated by lying in the supine position and improved by sitting. Additional history revealed a diagnosis of SIH owing to the worsening abdominal pain in the supine position. An In CSF cavity scintigram showed no spinal fluid leakage; early intrabladder radioisotope (RI) accumulation was observed, and the residual 24 h CSF cavity RI was >30%. At a referral specialist hospital, an epidural saline infusion test was performed, which improved her headache and lower abdominal pain. Blood patch therapy improved her lower abdominal pain, headache, and dysmenorrhea. : The final diagnosis was SIH, with symptoms attributed to CSF depletion. The patient also experienced rare paradoxical postural-related headaches and lower abdominal pain, aggravated by lying in the supine position, contributing to the final diagnosis.
自发性颅内低压的症状包括由于脑脊液（CSF）水平降低引起的体位性头痛。在此，我们报告一名24岁女性，因下腹痛和痛经为主诉入住妇产科，随后被诊断为自发性颅内低压（SIH）。该患者在入院前5天经历了与月经周期无关的恶心和下腹痛，3天后前往急诊科就诊。入院时，通过给予镇痛药，她的症状暂时缓解；因此，她出院了。然而，后来症状加重。因此，她返回急诊科进行进一步评估，包括血液检查、影像学检查和内镜检查，这些检查均未发现与恶心或腹痛相关的器质性异常。在第10天，她出现头痛，仰卧位时加重，坐位时改善。进一步询问病史发现，由于仰卧位时下腹痛加重，诊断为SIH。脑脊液腔闪烁造影显示无脑脊液漏；观察到膀胱内早期放射性同位素（RI）积聚，24小时脑脊液腔RI残留量>30%。在转诊的专科医院进行了硬膜外盐水输注试验，这改善了她的头痛和下腹痛。血液补片疗法改善了她的下腹痛、头痛和痛经。最终诊断为SIH，症状归因于脑脊液耗竭。患者还经历了罕见的与体位相关的矛盾性头痛和下腹痛，仰卧位时加重，这有助于最终诊断。
