Negoro K, Tsuda N, Morimatsu M, Kurokawa Y, Abiko S
Department of Neurology, Yamaguchi University School of Medicine.
Rinsho Shinkeigaku. 1993 Mar;33(3):327-30.
A 38-year-old woman complained for about 5 years of attacks of headache elicited by coughing, sneezing, and laughing. These attacks became more frequent and more severe. Physical examination showed a short and broad neck. Neurological examination revealed no abnormality. Magnetic resonance imaging demonstrated the Chiari malformation (type I) and the cerebral venous angioma in left frontal white matter. A posterior decompression by suboccipital craniectomy with C1 laminectomy was performed. The headache completely disappeared. Before and after the operation, we measured the intracranial subdural pressure by a small pressure transducer. The raised cranial pressure by the Valsalva's maneuver prolonged for more than one minute. Postoperatively, the raised cranial pressure by the Valsalva's maneuver decreased rapidly. We consider that the cough headache of this patient was associated with a valve-like blockage by the Chiari malformation (type I) at the foramen magunum, resulting in cranio-spinal pressure dissociation by interference with downward pulsation. We believe that there was no correlation between the cough headache and the cerebral venous angioma.
一名38岁女性主诉因咳嗽、打喷嚏和大笑引发头痛发作约5年。这些发作变得更加频繁和严重。体格检查显示颈部短而宽。神经学检查未发现异常。磁共振成像显示小脑扁桃体下疝畸形（I型）和左侧额叶白质的脑静脉血管瘤。通过枕下颅骨切除术和C1椎板切除术进行了后颅窝减压。头痛完全消失。手术前后，我们用小型压力传感器测量颅内硬膜下压力。瓦尔萨尔瓦动作引起的颅内压升高持续超过1分钟。术后，瓦尔萨尔瓦动作引起的颅内压升高迅速下降。我们认为该患者的咳嗽性头痛与枕骨大孔处小脑扁桃体下疝畸形（I型）引起的瓣膜样阻塞有关，导致通过干扰向下脉动而出现颅脊压力分离。我们认为咳嗽性头痛与脑静脉血管瘤之间没有关联。
