自發性低腦瘠髓液壓力性頭痛

Spontaneous Low Cerebrospinal Fluid Pressure Headache

目的：自發性低腦脊髓液壓力性頭痛是一種少見的神經系統疾患，然而其臨床症狀又是以一般人常犯的頭痛為主要表徵。我們報告一位具有典型臨床徵狀、影像學檢查及實驗室數據的自發性低腦脊髓液壓力性頭痛的案例。個案報告：這是一位39歲女性患者，其臨床表現為端坐性頭痛持續兩個星期，對於一般症狀治療並無明顯改善。經腦部影像學檢查及腦脊髓液檢驗後證實低腦脊髓液壓力性頭痛之診斷。而其臨床症狀也在經過硬腦膜外血液附著術後得以緩解。結論：由此案例我們可以學習到詳細的病史詢問及神經學檢查是診斷自發性低腦脊隨壓力性頭痛重要依據，其重要性在於此診斷的治療方式有別於其他常見的頭痛型式。由於此疾患之臨床症狀經正確診斷及治療後有極高的比率可治癒，早日減輕病患的痛苦，因此我們建議臨床醫師在評估頭痛患者時應將此診斷納入鑑別診斷。

Purposes: Spontaneous low cerebrospinal fluid (CSF) pressure is a less well known syndrome, but the patients always present with a very common symptom of headache. We reported a case of spontaneous low CSF headache with her typical clinical features and laboratory findings. Case Report: This is a 39-year-old female, presented with orthostatic headache for two weeks and was intractable to symptomatic treatment. Spontaneous low CSF pressure headache was diagnosed based on her symptoms, low CSF pressure and related brain image findings. Her symptoms were subsided after the epidural blood patching. Conclusions: Obtaining a detailed history of headache and neurological examination is necessary for the diagnosis making of spontaneous low CSF headache. Because of the management different from the other types of headache, with its high treatable rate, it’s important to include this syndrome into the differential diagnosis during the assessment of patients with headache.