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Rehabilitation Practice and Science

Translated Title

自發性顱內低壓：病例報告

Abstract

Spontaneous intracranial hypotension (SIH) is a syndrome with feature of low cerebrospinal fluid pressure (CSF) resulting from CSF leakage without any history of dural puncture, surgery, or penetrating trauma. The most characteristic feature of the syndrome is a postural headache. The headache is accentuated when the patient is in the upright position and relieved in the recumbent position. Associated symptoms include stiff neck, nausea, vomiting, tinnitus, hyperacusis, deafness, photophobia, diplopia, nystagmus, visual loss, vertigo, anorexia, malaise, and cranial nerves palsy. SIH is treated by bedrest with fluid supplementation, oral caffeine, intrathecal saline infusion or epidural blood patch. If postural headache persists or neurologic symptoms occur, surgical repair is indicated.A 44-year-old man came to our hospital for severe postural headache with exacerbation, which was relieved in the supine position. He denied other symptoms including stiff neck, nausea, vomiting, tinnitus, hyperacusis, deafness, photophobia, diplopia, nystagmus, visual loss, vertigo, anorexia, and malaise. Results of lumbar puncture studies were negative. Radionuclide cisternography showed direct evidence of a CSF leakage at the middle thoracic spinal level after 4 hours. On the basis of these findings, a diagnosis of SIH was made. He was treated with intravenous hydration, bed rest, NSAID and epidural blood patching, but his symptoms improved temporarily. Conscious changed later and the subsequent brain CT scan demonstrated bilateral subdural hematoma and tonsillar herniation. Finally, he died of central brain herniation. In general, the symptoms of SIH are not specific at early time and easily loss the timing of diagnosis and treatment. Early awareness of this disease, appropriate examination and treatment offer the chance of cure.

Language

Traditional Chinese

First Page

105

Last Page

112

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