自發性顱內低壓頭痛使用硬腦膜外血液貼片治療發現硬腦膜外液體─病例報告

Cerebrospinal fluid in the epidural space accidental finding in spontaneous intracranial hypo-tension headache cured by epi-dural blood patch - case report

自發性顱內低血壓頭痛(SIH)是一種體位性(姿勢性)頭痛，大多因腦脊髓液(CSF)在脊椎段發生滲漏造成，通常在核磁共振成像(MRI)可發現滲漏。本病例報告一名自發性顱內低血壓頭痛患者，在MRI上發現於胸部脊柱椎體(T1)以下後硬膜外腔腦脊髓液滲漏，並接受了腰椎穿刺以排除腦膜炎。此病患經過保守治療之後無效、在核磁共振檢查之後第5天，患者在腰椎硬膜外血液貼片(LEBP)治療時，於腰椎硬膜外腔(L3-4)中發現了一些腦脊髓液並接受腰椎硬膜外血貼片治療改善病情。我們討論了自發性低顱內壓頭痛的病理生理學、提出的病因和治療方法、腰椎硬膜外血液貼片治療的安全性以及一位在脊椎目標滲漏區間遠處發現硬脊膜外腦脊髓液滲漏之罕見病例。

 

Spontaneous intracranial hypotension headache (SIH) is a phenomenon com-bined with postural headaches, cerebrospinal fluid (CSF) leakage often at spine level on magnetic resonance imaging (MRI). We present a patient with SIH with CSF leakage blow thoracic (T1) spine vertebral level presence of posterior epidural space CSF on MRI and received lumbar puncture to excluded meningitis. The patient re-ceived conservative treatments but in vain. Some CSF was found in lumbar epidural space (L3-4) during aempiric lumbar epidural blood patch (LEBP) treatment 5 days later. The patient was pain relief immediately. We discuss the pathophysiology, pro-posed etiologies and treatments, and safety of LEBP anesthesia in spontaneous in-tracranial hypotension, and a rare case is found CSF far away to the target CSF leakage site.