Kinoshita Y, Terashita T, Terada T, Nakai K, Itakura T
Department of Neurological Surgery, Wakayama Medical College.
No Shinkei Geka. 1997 May;25(5):437-42.
Intracranial hypotension causes the postural headache that sometimes follows lumbar puncture. When postural headache and associated symptoms occur after lumbar puncture, the diagnosis is usually obvious. However, similar symptoms may occur after minor trauma or without an obvious precipitating cause (spontaneous intracranial hypotension: SIH). SIH is rare, but is now increasingly recognized as a cause of postural headache. We encountered two cases of SIH showing typical neuroradiological findings. Case 1 is a 47-year-old man who was admitted with severe frontalgia. CT scan revealed vague visualization of bilateral Sylvian fissures and slit ventricles. Spinal fluid pressure was 6cm H2O in the lateral recumbent position. Cerebrospinal fluid (CSF) showed slight lymphocytic pleocytosis. We treated him as having viral meningitis. His headache improved gradually and he was discharged 2 weeks later with slight occipitalgia. One week after discharge, he complained of severe headache again and plain CT showed bilateral subdural hematoma. The subdural hematoma in both sides was evacuated and his headache improved after the operation. Follow-up CT scans two months later showed normalization of ventricle size and cisterns. Case 2 is a 52-year-old woman who was admitted with severe occipitalgia. CT scan on admission showed slit ventricles and the disappearance of the suprasellar cistern and the Sylvian fissure. Spinal fluid pressure was 3cm H2O. Gd-enhanced MRI showed remarkable meningeal enhancement and effacement of the optic chiasm suggesting brain sagging. Her headache improved 2 weeks later after strict bed rest and oral pain relief drugs. The follow-up MRI showed disappearance of abnormal meningeal enhancement and normalization of optic chiasma effacement. SIH is one of the important differential diagnoses of patients complaining of postural headache. Meningeal enhancement of gadolinium-enhanced MRI is an important finding to diagnose SIH. We have to consider SIH when diagnosing postural headache.
颅内低压会导致有时在腰椎穿刺后出现的体位性头痛。当腰椎穿刺后出现体位性头痛及相关症状时，诊断通常较为明显。然而，轻微创伤后或无明显诱发原因（自发性颅内低压：SIH）时也可能出现类似症状。SIH较为罕见，但如今越来越被认为是体位性头痛的一个病因。我们遇到了两例表现出典型神经放射学表现的SIH病例。病例1是一名47岁男性，因严重额部疼痛入院。CT扫描显示双侧外侧裂和裂隙脑室模糊不清。侧卧位时脑脊液压力为6cm H₂O。脑脊液显示轻度淋巴细胞增多。我们将其当作病毒性脑膜炎进行治疗。他的头痛逐渐改善，2周后出院时仍有轻微枕部疼痛。出院1周后，他再次抱怨严重头痛，平扫CT显示双侧硬膜下血肿。双侧硬膜下血肿被清除，术后他的头痛有所改善。两个月后的随访CT扫描显示脑室大小和脑池恢复正常。病例2是一名52岁女性，因严重枕部疼痛入院。入院时CT扫描显示裂隙脑室以及鞍上池和外侧裂消失。脑脊液压力为3cm H₂O。钆增强MRI显示明显的脑膜强化以及视交叉受压提示脑下垂。经过严格卧床休息和口服止痛药物治疗2周后，她的头痛有所改善。随访MRI显示异常脑膜强化消失且视交叉受压恢复正常。SIH是主诉体位性头痛患者的重要鉴别诊断之一。钆增强MRI的脑膜强化是诊断SIH的一项重要发现。在诊断体位性头痛时我们必须考虑到SIH。
