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首页> 外文期刊>American Journal of Case Reports >Spontaneous Intracranial Hypotension and Its Management with a Cervical Epidural Blood Patch: A Case Report
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Spontaneous Intracranial Hypotension and Its Management with a Cervical Epidural Blood Patch: A Case Report

机译：自发的颅内血管血管和宫颈硬膜外血浆的管理：案例报告

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Patient: Male, 25-year-old Final Diagnosis: Spontaneous intracranial hypotension Symptoms: Headache Medication:— Clinical Procedure: — Specialty: Anesthesiology ? Medicine, General and Internal ? Neurology ? Radiology Objective: Rare disease Background: Spontaneous intracranial hypotension (SIH) is a rare cause of postural headache. In most patients, the site of cerebrospinal fluid (CSF) leak is at the cervical or thoracic spinal level. The imaging modalities to establish the diagnosis of SIH include computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, CT, and MRI myelography, and radionuclide cisternography. Treatment usually consists of conservative measures, but patients unresponsive to these treatments can be treated by epidural blood patch (EBP) administration at the site of CSF leak. Case Report: A 25-year-old-man presented with headache aggravated upon sitting or standing and relieved by lying supine or consuming coffee. There was no history of recent trauma, lumbar puncture, or spinal anesthesia. His neurological examination was unremarkable. MRI of his head and entire spine showed features of intracranial hypotension with no obvious CSF leak. He was treated conservatively but his symptoms persisted. CT spinal myelography showed significant leakage of contrast medium at the retrospinal region between C1 and C2 spinous processes. The patient underwent cervical EBP administration under fluoroscopic guidance. His symptoms resolved completely and he remains asymptomatic more than 6 months later. Conclusions: SIH is an important cause of postural headache. In patients with non-resolving symptoms, further investigations are warranted to identify potential CSF leak. Patients found to have a CSF leak at the level of the cervical spine can be safely and effectively treated by cervical EBP administration.
机译：患者：男性，25岁的最终诊断：自发颅内低血压症状：头痛药物： - 临床手术： - 专业：麻醉学？医学，一般和内部？神经病学？放射学目标：罕见疾病背景：自发的颅内低血压（SIH）是一种罕见的姿势头痛的原因。在大多数患者中，脑脊液（CSF）泄漏的部位处于宫颈或胸腔脊髓水平。建立SIH诊断的成像方式包括大脑，CT和MRI MyELography的计算机断层扫描（CT）和磁共振成像（MRI）和放射性核素内景。治疗通常由保守措施组成，但可以通过CSF泄漏部位的硬膜外血栓（EBP）施用对这些治疗的患者无反应。案例报告：一名25岁的男子坐在坐着或站立并通过躺着仰卧或消费的咖啡来加重头痛。近期创伤，腰椎穿刺或脊髓麻醉的历史。他的神经学检查是不起眼的。他的头部和整个脊柱的MRI显示出颅内低血压的特征，没有明显的CSF泄漏。他保守治疗，但他的症状持续存在。 CT脊柱脊髓术在C1和C2棘突之间的转向区域处显示出对比介质的显着泄漏。患者在荧光透视引导下接受了宫颈EBP给药。他的症状完全解决，他在6个月后仍然是无情的。结论：SIH是姿势头痛的重要原因。在患有非解决症状的患者中，有权进一步调查来确定潜在的CSF泄漏。发现在颈椎水平下发现CSF泄漏的患者可以通过宫颈EBP施用安全有效地治疗。

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