低颅压综合征合并颅内出血的诊断和治疗

目的探讨低颅压综合征合并颅内出血的病因、临床表现、影像学特点及救治方法。方法回顾性分析2015年1月—2022年12月苏州大学附属张家港医院神经外科收治的14例低颅压综合征合并颅内出血患者的临床资料，并进行定期随访，了解其预后及转归。结果14例低颅压综合征患者中，13例存在直立性头痛。4例自发性低颅压综合征合并双侧慢性硬脑膜下血肿患者，行头颅核磁共振成像（MRI）增强显示硬脑膜下出血或积液、硬脑膜强化、静脉结构充盈、垂体充血和脑组织下垂等影像学特征，钻颅引流手术治疗3例、保守治疗1例；10例创伤性低颅压综合征伴颅内出血患者保守治疗7例，钻颅引流手术治疗2例，开颅血肿清除手术治疗1例；治疗后相关症状明显好转或消失。结论对于低颅压综合征合并颅内出血的患者，临床上应根据患者的个体情况选择保守治疗或手术治疗；早期明确病因有助于临床治疗方案的优化，改善患者神经功能及预后。

Objective To explore the etiology, clinical manifestation, imaging characteristics and treatment of intracranial hemorrhage in patients combined with low intracranial pressure syndrome. Methods The clinical data of 14 patients with low intracranial pressure syndrome and intracranial hemorrhage who were admitted to Department of Neurosurgery, Zhangjiagang Hospital Affiliated to Suzhou University from January 2015 to December 2022 were analyzed retrospectively. Regular follow-up was conducted to understand the prognosis and outcome. Results Among 14 patients with low intracranial pressure syndrome, 13 patients had orthostatic headache. 4 patients with spontaneous intracranial hypotension syndrome combined with bilateral chronic subdural hematoma underwent enhanced cranial magnetic resonance imaging(MRI) to demonstrate imaging features such as subdural fluid collection, enhancement of pachymeninges, engorgement of venous structures,pituitary enlargement and sagging of the brain. Treatment methods included surgical operation(3 cases) and conservative treatment(1 case). 10 cases of traumatic intracranial hypotension syndrome with intracranial hemorrhage were treated conservatively in 7 cases, craniotomy and drainage surgery in 2, and craniotomy and hematoma removal surgery in 1. After treatment, the relevant symptoms of all patients were significantly improved or disappeared. Conclusions For patients with low intracranial pressure syndrome and intracranial hemorrhage, conservative treatment or surgical treatment should be selected according to the individual situation of the patient. Early identification of the etiology contributes to the optimization of clinical treatment options, improving patients’ neurological function and prognosis.