Mokri B, Hunter S F, Atkinson J L, Piepgras D G
Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Neurology. 1998 Sep;51(3):786-90. doi: 10.1212/wnl.51.3.786.
To report that the syndrome of orthostatic headaches caused by CSF leak can be seen with persistently normal CSF pressures.
CSF leak or shunt overdrainage is known to cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPGE), typically associated with unmeasurable or very low CSF pressures.
Of 40 consecutive patients with orthostatic headaches and DPGE, all had low or unmeasurable CSF pressures, except seven patients who had consistently normal CSF pressures and are thus reported. All had undergone multiple CSF examinations.
Two patients had overdraining shunts, and five had documented CSF leaks. One refused treatment, but the other six patients responded to surgical treatment or epidural blood patch with complete resolution of symptoms and related MRI abnormalities.
Some patients with symptomatic CSF leaks may have CSF opening pressures that are consistently within normal limits. In the presence of convincing clinical features and imaging abnormalities, a normal CSF pressure should not discourage the clinician from searching for a source of CSF leak.
报告脑脊液漏导致的体位性头痛综合征可在脑脊液压力持续正常的情况下出现。
已知脑脊液漏或分流过度引流会导致体位性头痛和硬脑膜广泛钆增强（DPGE），通常与无法测量或极低的脑脊液压力相关。
在40例连续的体位性头痛和DPGE患者中，除7例脑脊液压力持续正常的患者（本文予以报告）外，其余患者脑脊液压力均较低或无法测量。所有患者均接受了多次脑脊液检查。
2例患者存在分流过度引流，5例有记录的脑脊液漏。1例拒绝治疗，但其他6例患者对手术治疗或硬膜外血贴治疗有反应，症状及相关MRI异常完全消失。
一些有症状的脑脊液漏患者的脑脊液开放压力可能始终在正常范围内。在有令人信服的临床特征和影像学异常的情况下，脑脊液压力正常不应阻碍临床医生寻找脑脊液漏的来源。
