腰穿脑脊液测压在自发性颅内低压性头痛的价值再评估
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摘要
目的观察自发性颅内低压(SIH)患者中脑脊液压力,并探讨影响SIH患者的脑脊液压力的相关因素。方法收集194例SIH患者临床和影像资料,分析性别、年龄、血压、体重指数(BMI)、病程、脑脊液蛋白含量、头颅MRI增强表现、脑脊液漏点、硬膜下血肿与脑脊液压力的相关性。结果 194例患者中,共有93(47.94%)例患者的脑脊液压力≤60 mmH_2O,101(52.06%)例患者的脑脊液压力>60 mmH_2O。相关性分析显示:SIH患者病程、年龄、收缩压、BMI、性别、脑脊液蛋白含量、头颅MRI增强表现阳性及脑脊液漏点与脑脊液压力相关(r分别=0.47、0.17、0.19、0.21、-0.21、-0.40、-0.16、-0.19,P均<0.05)。多元线性回归分析显示,仅病程和脑脊液蛋白含量与脑脊液压力存在相关性(t分别=-2.59、2.41,P均<0.05)。结论 SIH患者的脑脊液压力不一定都低于60 mmH_2O。SIH患者的脑脊液压力与病程和脑脊液蛋白含量相关。
Objective To observe cerebrospinal fluid pressure in patients with spontaneous intracranial hypotension(SIH)and explore the factors of the cerebrospinal fluid pressure. Methods Clinical and imaging materials of 194 SIH patients were collected to analyze the relationship between the factors including gender,age,blood pressure,BMI,course of disease,CSF protein content,cephalic contrast-enhanced MRI,CSF leakage lesions and subdural hematoma and CSF pressure. Results Of 194 patients,93(47.94%)cases had cerebrospinal fluid pressure lower than 60 mmH_2O and 101(52.06%)cases had cerebrospinal fluid pressure higher than 60 mmH_2O. Correlation analysis showed that CSF pressure were correlated with the course of disease,age,systolic pressure,BMI,gender,CSF protein content,cephalic contrastenhanced MRI and CSF leakage lesions(r =0.47,0.17,0.19,0.21,-0.21,-0.40,-0.16,-0.19,P<0.05).Multiple linear regression analysis showed that the course of disease and the content of CSF protein were related with CSF pressure(t=-2.59,2.41,P<0.05). Conclusions The cerebrospinal fluid pressure of SIH patients is not necessarily lower than60 mmH_2O.Cerebrospinal fluid pressure in patients with SIH is correlated with course of disease and CSF protein content.
Objective To observe cerebrospinal fluid pressure in patients with spontaneous intracranial hypotension(SIH)and explore the factors of the cerebrospinal fluid pressure. Methods Clinical and imaging materials of 194 SIH patients were collected to analyze the relationship between the factors including gender,age,blood pressure,BMI,course of disease,CSF protein content,cephalic contrast-enhanced MRI,CSF leakage lesions and subdural hematoma and CSF pressure. Results Of 194 patients,93(47.94%)cases had cerebrospinal fluid pressure lower than 60 mmH_2O and 101(52.06%)cases had cerebrospinal fluid pressure higher than 60 mmH_2O. Correlation analysis showed that CSF pressure were correlated with the course of disease,age,systolic pressure,BMI,gender,CSF protein content,cephalic contrastenhanced MRI and CSF leakage lesions(r =0.47,0.17,0.19,0.21,-0.21,-0.40,-0.16,-0.19,P<0.05).Multiple linear regression analysis showed that the course of disease and the content of CSF protein were related with CSF pressure(t=-2.59,2.41,P<0.05). Conclusions The cerebrospinal fluid pressure of SIH patients is not necessarily lower than60 mmH_2O.Cerebrospinal fluid pressure in patients with SIH is correlated with course of disease and CSF protein content.
引文
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11 Arshed S,Enakuaa S,Nai Q,et al.A rare case of orthostatic headache due to spontaneous intracranial hypotension[J].Clin Case Rep,2015,4(2):192-194.
12 Armon C,Evans RW.Addendum to assessment:Prevention of post-lumbar puncture headaches:report of the Therapeutics and technology assessment subcommittee of the American academy of neurology[J]. Neurol,2005,65(4):510-512.
13 Fishman RA,Dillon WP. Dural enhancement and cerebral displacement secondary to intracranial hypotension[J].Neurology,1993,43(3):609-611.
14 Miyazawa K,Shiga Y,Hasegawa T,et al.CSF hypovolemia vs intracranial hypotension in spontaneous intracranial hypotension syndrome[J].Neurol,2003,60(6):941-947.
15 梅育嘉,罗杰峰,许红玉.脑脊液蛋白含量的非实验室影响因素及logistic回归预测模型[J].广西医学,2018,40(5):581-597.
2 Chazen JL,Talbott JF,Lantos JE,et al.MR myelography for of spinal CSF leak in spontaneous intracranial hypotension[J].Am J Neuroradiol,2014,35(10):2007-2012.
3 Silberstein SD,Marcelis J. Headache associated with changes in intracranial pressure[J]. Headache,1992,32(2):84-94.
4 Peeraully T,Rosenberg ML.Spontaneous intracranial hypotension without intracranial hypotension[J].J Neuroophthalmol,2011,31(3):248-251.
5 江云,王谨,龚向阳,等.42例自发性脊髓脑脊液漏所致颅内低压的临床特点分析[J].浙江大学学报(医学版),2014,43(1):83-88.
6 Puget S,Kondageski C,Wray A,et al.Chiari-like tonsillar herniation associated with intracranial hypotension in Marfan syndrome[J]. J Neurosurg,2007,106(1 suppl):48-52.
7 Spelle L,Boulin A,Tainturier C,et al.Neuroimaging features of spontaneous intracranial hypotension[J].Neuroradiology,2001,43(8):622-627.
8 Koch KK,Moran TJ. Spontaneous intracranial hypotension:trendelenberg just may be the answer[J].Mil Med,2015,180(3):e369-371.
9 Park ES,Kim E. Spontaneous intracranial hypotension:clinical presentation,imaging features and treatment[J].J Korean Neurosurg Soc,2009,45(1):1-4.
10 Kranz PG,Tanpitukpongse TP,Choudhury KR,et al.How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension?[J]. Cephalalgia,2016,36(13):1209-1217.
11 Arshed S,Enakuaa S,Nai Q,et al.A rare case of orthostatic headache due to spontaneous intracranial hypotension[J].Clin Case Rep,2015,4(2):192-194.
12 Armon C,Evans RW.Addendum to assessment:Prevention of post-lumbar puncture headaches:report of the Therapeutics and technology assessment subcommittee of the American academy of neurology[J]. Neurol,2005,65(4):510-512.
13 Fishman RA,Dillon WP. Dural enhancement and cerebral displacement secondary to intracranial hypotension[J].Neurology,1993,43(3):609-611.
14 Miyazawa K,Shiga Y,Hasegawa T,et al.CSF hypovolemia vs intracranial hypotension in spontaneous intracranial hypotension syndrome[J].Neurol,2003,60(6):941-947.
15 梅育嘉,罗杰峰,许红玉.脑脊液蛋白含量的非实验室影响因素及logistic回归预测模型[J].广西医学,2018,40(5):581-597.