Pannullo S C, Reich J B, Krol G, Deck M D, Posner J B
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Neurology. 1993 May;43(5):919-26. doi: 10.1212/wnl.43.5.919.
We report seven patients with the syndrome of intracranial hypotension who were referred to Memorial Sloan-Kettering, primarily because of suspicion of meningeal tumor or infection raised by the finding of meningeal enhancement on MRI. In three patients, symptoms occurred after lumbar puncture; in four, there was no clear precipitating event. Lumbar puncture after MRI in six patients revealed low CSF pressure (six patients) and pleocytosis or high protein, or both (four patients). Three patients had subdural effusions. Six patients had measurable descent of the brain on midsagittal images. Postural headache resolved in all seven patients, six of whom had follow-up MRIs. Meningeal enhancement resolved or diminished in all six. Subdural effusions resolved spontaneously in two and were evacuated (but were not under pressure) in one. Downward brain displacement improved or resolved in all patients. The clinical syndrome and MRI abnormalities generally resolve on their own. An extensive workup is not helpful and may be misleading. Patients should be treated symptomatically.
我们报告了7例颅内低压综合征患者，他们被转诊至纪念斯隆凯特琳癌症中心，主要是因为MRI显示脑膜强化，怀疑为脑膜肿瘤或感染。3例患者在腰椎穿刺后出现症状；4例患者无明确的诱发事件。6例患者在MRI检查后进行腰椎穿刺，结果显示脑脊液压力低（6例），并有细胞增多或蛋白升高，或两者皆有（4例）。3例患者有硬膜下积液。6例患者在正中矢状位图像上显示脑有可测量的下移。所有7例患者的体位性头痛均得到缓解，其中6例进行了随访MRI检查。所有6例患者的脑膜强化均消失或减轻。2例患者的硬膜下积液自行消退，1例患者的硬膜下积液被引流（但无压力）。所有患者的脑下移均得到改善或缓解。临床综合征和MRI异常通常会自行缓解。进行广泛的检查并无帮助，甚至可能产生误导。应对患者进行对症治疗。
