文獻回顧：自發性顱內低血壓頭痛的診斷及治療

A review of the diagnosis and management of spontaneous intracranial hypotension

自發性顱內低血壓頭痛（spontaneous intracranial hyoptention headache）典型的表現為一姿態性頭痛。症狀會在坐立直立或者站起之後幾分鐘到幾小時內發生，通常躺平可以緩解症狀，不過也有其他多樣性的非典型表現及硬腦膜下出血、昏迷及偏瘫等併發症。這個診斷最早在1938年由Schaltenbrand所描述，演進到2013年國際頭痛疾病分類（ICHD）第三版beta版提出新的診斷標準。目前硬腦膜外自體血液貼片（autologous epidural blood patch）仍然是除了保守治療之外第一線的治療方式。本篇著重在回顧近幾年自發性顱內低血壓頭痛新提出的診斷標準及對硬腦膜外自體血液貼片過去的討論。內容針對硬腦膜外自體血液貼片扮演的角色、打的地點、打的量以及重複注射合宜的間隔時間、以及如何可以提高注射的成功機會均有陳述。也建議對合併有一開始腦部核磁共振檢查沒有典型對應自發性顱內低血壓頭痛的影像學變化或者合併有腦部硬腦膜下出血的病人給予比較積極而且早期的貼片治療。

Patients with spontaneous intracranial hypotension (SIH) typically present with orthostatic headache that is temporarily relieved by lying down flat; and is exacerbated when sitting up or standing. SIH has varied symptoms and signs, which have been underestimated since they were first described by Schaltenbrand in 1938. However, these symptoms have been recognized more effectively in recent years. New diagnostic criteria were referred from The International Classification of Headache Disorders (ICHD), ICHD-3 beta edition. In this paper we review three cases from medical records and recent studies on the diagnosis and treatment of SIH. Epidural blood patch (EBP) is still the major first-line interventional treatment, and we suggest that EBP should be applied more aggressively for some SIH cases with normal initial brain magnetic resonance imaging findings or the cases complicated with bilateral subdural collection because of poor outcomes.