自發性顱內低壓合併硬腦膜下血腫復發病例報告與文獻回顧

Spontaneous Intracranial Hypotension Complicated With Recurrent Subdural Hematomas : A Case Report and Literature Review

44 歲男性因突然發生姿勢性頭痛而來本院求診，臨床理學檢查、神經學檢查上沒有顯著異常。影像學檢查發現雙側硬腦膜下出血、典型自發性顱內低壓特徵以及頸椎有腦脊髓液外漏。病患雖然在住院期間接受顱骨鑽孔引流手術及多次腰椎硬膜上血液注射，但是硬腦膜下出血仍然復發，並且由於意識變差必須接受第二次顱骨鑽孔引流手術。姿勢性頭痛是腦脊髓液外漏造成自發性顱內低壓所引起頭痛的特徵。雖然一般認為此疾病不會危及性命，但接受加護病房照顧和早期外科手術引流在某些個案是必須的。關於腦脊液外漏的處理，目前爭議仍存在：部份專家主張精確定位，並設法進行導引式硬膜上血液注射，或甚至直接外科手術修補；另一部份學者則認為不必特別定位，只要進行多次腰椎硬膜上血液注射就足夠治療病人。

A 44-year-old male was admitted due to the sudden onset of postural headache with no significant abnormalities on physical and neurological examination. The image study showed bilateral subdural hemorrhage, characteristic findings of spontaneous intracranial hypotension and cerebral spinal fluid leakage on the cervical spine. During hospitalization, the patient’s subdural hematoma recurred in spite of initial burr hole drainage and multiple epidural blood patches, and a second surgical drainage was indicated due to conscious deterioration. Postural headache is characteristic in spontaneous intracranial hypotension caused by cerebral spinal fluid leakage. Although this disease is often considered not life threatening, critical care and early surgical intervention are required in complicated cases. There is still controversy on the management of cerebrospinal fluid leakage: some experts insist on accurate localization and directed epidural blood patches, or even surgical repair; others advocate that multiple lumbar epidural blood patches are sufficient to heal patients.