Ferrante E, Riva M, Gatti A, Brioschi A M, Guccione A, Colombo N, Vanini M, Veronese S
Department of Neurology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, Milan, Italy.
Clin Neurol Neurosurg. 1998 Mar;100(1):33-9. doi: 10.1016/s0303-8467(97)00107-8.
Intracranial hypotension (IH) is essential or, more frequently, secondary. This syndrome is characterized by severe postural headache and low opening cerebrospinal fluid (CSF) pressure; although other symptoms may exist. In this study five patients are investigated. Neuroimaging showed: on computerized tomography scan (CT), poor visualization of the cerebral sulci with small ventricles; on magnetic resonance imaging (MRI), subdural fluid collections with enhancement on the convexity, along the tentorium and in the upper cervix after administration of contrast medium and downward displacement of the brain. Radionuclide cisternography was normal in the two patients who underwent this treatment as well as the meningeal biopsy in another patient. In all patients the opening CSF pressure was low or unmeasurable. The clinical syndrome spontaneously recovered contextually to normalization of neuroradiological findings. The possible pathogenesis (dural border cell layer tear) was discussed and the importance of diagnostic confirmation with MRI and measurement of CSF pressure when IH is thought to be present was underlined.
颅内低压（IH）可为原发性，但更常见的是继发性。该综合征的特征为严重的体位性头痛和脑脊液（CSF）初压降低；尽管可能存在其他症状。在本研究中，对5例患者进行了调查。神经影像学检查显示：在计算机断层扫描（CT）上，脑沟显示不清且脑室较小；在磁共振成像（MRI）上，硬膜下积液在注入造影剂后在脑凸面、沿小脑幕及上颈部有强化，且脑向下移位。接受该检查的2例患者放射性核素脑池造影正常，另1例患者进行了脑膜活检。所有患者的脑脊液初压均较低或无法测量。临床综合征在神经放射学检查结果恢复正常的同时自发缓解。讨论了可能的发病机制（硬脑膜边界细胞层撕裂），并强调了当怀疑存在颅内低压时，通过MRI进行诊断确认及测量脑脊液压力的重要性。
