合并自发性低颅压综合征的硬膜下血肿5例报告并文献复习

目的探讨合并自发性低颅压综合征(SIH)的硬膜下血肿的病因、临床表现、影像学特征及治疗策略。方法回顾性分析2018年1月—2021年12月福建医科大学附属第一医院收治的5例合并自发性低颅压综合征的硬膜下血肿患者的临床资料，总结其临床表现、影像学特征及治疗策略，并对相关文献进行复习。结果4例患者存在典型的体位性头痛，2例患者头颅计算机断层扫描（CT）显示假性蛛网膜下腔出血，4例患者头颅核磁共振成像（MRI）增强扫描显示弥漫性硬脑膜强化，4例患者采取卧床休息、静脉及口服补液等保守治疗后头痛消失，1例患者行左侧钻孔外引流手术，术中颅内压（ICP）1 mmHg，血肿压力低，术后引流不佳，但术后严格按照低颅压综合征的保守治疗方案，最终患者预后良好。结论合并自发性低颅压综合征的硬膜下血肿典型的临床表现为体位性头痛，硬膜下血肿多为双侧，影像学特征主要为头颅MRI增强扫描显示弥漫性硬脑膜强化。治疗策略应根据患者的情况个体化选择保守治疗、硬膜外血补片及钻孔外引流治疗。

Objective To investigate the pathogenesis, clinical manifestations,imaging features and treatment strategies of subdural hematoma in patients with spontaneous intracranial hypotension(SIH). Methods The clinical data of 5 patients with intracranial hypotension syndrome complicated by subdural hematoma admitted to the First Affiliated Hospital of Fujian Medical University from January 2018 to December 2021 were analyzed retrospectively. The clinical manifestations, imaging features and treatment strategies were summarized, and the related literature were reviewed. Results 4 patients had typical orthostatic headache. 2 patients showed pseudosubarachnoid hemorrhage on head computer tomography(CT). 4 patients showed diffuse dural enhancement on brain magnetic resonance imaging(MRI) scan. Headache disappeared after conservative treatment such as bed rest, intravenous and oral rehydration in 4 patients. 1 patient underwent left burr hole drainage operation and the intraoperative intracranial pressure(ICP) was 1 mmHg. The hematoma pressure was low, and postoperative drainage was poor. However, strict adherence to a conservative treatment plan for low ICP syndrome after surgery resulted in a good prognosis for the patient. Conclusions The typical clinical manifestations of intracranial hypotension syndrome complicated with subdural hematoma are orthostatic headache. Subdural hematomas are mostly bilateral, and the imaging features are mainly diffuse dural enhancement on enhanced brain MRI scan. The treatment strategy is based on individualized selection of conservative treatment, epidural blood patch and extra-dural drainage according to the patient’s condition.