疑似腦脊髓液滲漏之顱內低壓中醫診治

Diagnosis and Treatment of Intracranial Hypotension with Suspected Cerebrospinal Fluid Leakage

"自發性顱內低壓頭痛（spontaneous intracranial hypotension, SIH）是無侵入性治療卻由於顱內壓下降所致姿態性頭痛。腦脊髓液流失可導致腦壓降低，因腦部結構向下牽引而產生持續性全頭瀰漫性疼痛或鈍痛。西醫目前治療多採用為硬腦膜上血液貼片（epidural blood patch），但其治療仍可能有少數頭痛後遺症。本案車禍飛躍後直接撞擊後枕及頸背部，氣機循環阻滯，經脈氣機運行不利所致SIH典型症狀如姿態性頭鈍痛、頸部僵硬、單側流鼻水、耳鳴等現象，本文以中醫傷科筋膜診治思維進行針刺治療，並搭配傳統中醫理論，認為督脈、膀胱經、小腸經氣滯血瘀、經氣不利，由於廚師工作肌肉張力不平均及車禍後恐懼難眠牽連三焦經、膽經筋膜紊亂，合併腎精氣不足出現頻尿、語言及記憶遲鈍，故以理氣活血，養血梳理經脈運行，補益腎氣填精為治療原則，改善語言及記憶遲鈍，搭配針刺鬆解闊背肌、前額及頭部筋膜以促進眼周及腦脊髓液的循環，改善顱內低壓枕部姿態性頭部鈍痛、頸部僵硬、胸悶、複視、耳鳴等問題，並衛教三角肌、棘上肌、上斜方肌之肌肉訓練以防止頸部筋膜被拉扯影響局部血液循環及硬腦膜修復。"

Spontaneous intracranial hypotension (SIH) headache is a postural headache caused by a decrease in intracranial pressure without invasive treatment. Loss of cerebrospinal fluid can lead to lower cerebral pressure. Due to the traction of the brain structure, it produces persistent diffuse or dull pain in the whole head. The treatment of western medicine is epidural blood patch currently, but its treatment may still have a few headache sequelae. In this case, after the car accident, the direct impact on the occipital and the back of the neck, the circulation of the qi movement is inhibited, and the typical symptoms of SIH caused by the poor circulation of the qi movement of the meridian, such as postural headache, neck stiffness, unilateral runny nose, tinnitus, etc. In this paper, the acupuncture treatment is based on the thinking of diagnosis and treatment of fascia in the department of traumatology. Under TCM theory, qi stagnation and blood stasis at governor meridian, bladder meridian, small intestine meridian was diagnosed. Heavy work loading of chef also caused uneven muscle tension on this patient, and sleep disturbance also appeared due to terrified by car accident while comes along with fascia disorders of the triple jiao meridian and gall bladder meridian. Insufficient kidney essence and qi leads to frequent urination, slow speech speed and poor memory function. So the treatment principle is to regulate qi and promote blood circulation, nourish blood, regulate the movement of meridians, and replenish kidney qi and fill essence to improve language and memory function. With acupuncture to loosen the latissimus muscles, forehead and head fascia to promote the circulation of eye and cerebrospinal fluid, and improve the dull head pain, neck stiffness, chest tightness, diplopia, tinnitus caused by intracranial low pressure. Muscle training was taught to this patient, including deltoid muscle, supraspinatus muscle, and upper trapezius muscle to prevent the neck fascia from being pulled and affecting local blood circulation and dural repair, which restore fascia tension and improve blood circulation in the brain.