合并自發性低顱壓綜合征的硬膜下血腫5例報告并文獻復習

李承俊 劉鵬輝 王芳玉 方文華 梅文忠 林元相

【摘要】目的探討合并自發性低顱壓綜合征（SIH）的硬膜下血腫的病因、臨床表現、影像學特征及治療策略。方法回顧性分析2018年1月—2021年12月福建醫科大學附屬第一醫院收治的5例合并自發性低顱壓綜合征的硬膜下血腫患者的臨床資料，總結其臨床表現、影像學特征及治療策略，并對相關文獻進行復習。結果4例患者存在典型的體位性頭痛，2例患者頭顱計算機斷層掃描（CT）顯示假性蛛網膜下腔出血，4例患者頭顱核磁共振成像（MRI）增強掃描顯示彌漫性硬腦膜強化，4例患者采取臥床休息、靜脈及口服補液等保守治療后頭痛消失，1例患者行左側鉆孔外引流手術，術中顱內壓（ICP）1 mmHg，血腫壓力低，術后引流不佳，但術后嚴格按照低顱壓綜合征的保守治療方案，最終患者預后良好。結論合并自發性低顱壓綜合征的硬膜下血腫典型的臨床表現為體位性頭痛，硬膜下血腫多為雙側，影像學特征主要為頭顱MRI增強掃描顯示彌漫性硬腦膜強化。治療策略應根據患者的情況個體化選擇保守治療、硬膜外血補片及鉆孔外引流治療。

【關鍵詞】低顱壓綜合征；硬膜下血腫；診斷；治療

【中圖分類號】R651【文獻標志碼】B【文章編號】16727770（2024）02023205

Spontaneous intracranial hypotension complicated with subdural hematoma： report of 5 cases and literature review LI Chengjun， LIU Penghui， WANG Fangyu， et al. Department of Neurosurgery， The First Affiliated Hospital of Fujian Medical University， Fuzhou 350005， China

Corresponding author： LIN Yuanxiang

Abstract： ObjectiveTo investigate the pathogenesis， clinical manifestations，imaging features and treatment strategies of subdural hematoma in patients with spontaneous intracranial hypotension（SIH）. MethodsThe clinical data of 5 patients with intracranial hypotension syndrome complicated by subdural hematoma admitted to the First Affiliated Hospital of Fujian Medical University from January 2018 to December 2021 were analyzed retrospectively. The clinical manifestations， imaging features and treatment strategies were summarized， and the related literature were reviewed. Results4 patients had typical orthostatic headache. 2 patients showed pseudosubarachnoid hemorrhage on head computer tomography（CT）. 4 patients showed diffuse dural enhancement on brain magnetic resonance imaging（MRI） scan. Headache disappeared after conservative treatment such as bed rest， intravenous and oral rehydration in 4 patients. 1 patient underwent left burr hole drainage operation and the intraoperative intracranial pressure（ICP） was 1 mmHg. The hematoma pressure was low， and postoperative drainage was poor. However， strict adherence to a conservative treatment plan for low ICP syndrome after surgery resulted in a good prognosis for the patient. ConclusionsThe typical clinical manifestations of intracranial hypotension syndrome complicated with subdural hematoma are orthostatic headache. Subdural hematomas are mostly bilateral， and the imaging features are mainly diffuse dural enhancement on enhanced brain MRI scan. The treatment strategy is based on individualized selection of conservative treatment， epidural blood patch and extradural drainage according to the patients condition.

Key words： spontaneous intracranial hypotension; subdural hematoma; diagnosis; treatment

自發性低顱壓綜合征（spontaneous intracranial hypotension，SIH）是一種少見的神經系統疾病，由腦脊液量減少引起，主要的原因為腦脊液漏，其典型的臨床癥狀為體位性頭痛，但仍有一些患者會出現諸如顱神經麻痹、精神狀態改變和運動障礙等不典型的表現，使得臨床容易誤診、漏診［14］。……