| Intracranial hypotension syndrome (IHS) refers to a set of clinicalsyndromes caused by an opening pressure of <70mm H2O upon performing alumbar puncture. It consists of spontaneous intracranial hypotension (SIH) andsecondary intracranial hypotension. The diagnosis rate of IHS which wasregarded as a kind of rare disease was low in the past. With technologicaladvances, the research of IHS is deeper and wider recently. But the truth of IHSis still obscure. Our study based on patients with IHS focus on analysis ofetiology and clinical data. We suggest innovatively that mental factors may berelated with IHS through our research.Objective: To investigate and analyze the IHS for providing a reference ofaccurate diagnosis and effective treatment.Methods: The clinical data of121cases of IHS were retrospectivelyanalyzed, and compared with the domestic and foreign relevant material.Results:1. All patients were from20to81years old with the mean age of37.85, and the ration of males and females was1:1.42.71(58.67%) patients werefrom cities, whereas50patients were from rural areas.2. Before the onset,74patients were under the influence of mental factors,37patients had a history ofinfection,21patients had dehydration history,12patients had iatrogenicoperation history,10patients suffered intradialytic hypotension,5patients weretraumatic,3patients were tired with intense activity or hard physical labour.Mental factors, infection, dehydration, iatrogenic operation, intradialytichypotension are statistically significant.3.107（88.43%）patients are acute onset,11（9.09%）patients are subacute onset,3（2.48%）patients are chronic onset. Theoriginal symptoms were postural usually, which were severe in the uprightposition, and disappeared in a recumbent posture,119patients with headache, 51patients with dizziness,49patients with nausea and vomiting, a few patientswith hearing disorder, vision disorder, neck pain, etc. Physical examinationshowed stiff neck in57, Babinski sign in14, Kerning sign in10, abduct nerveparalysis in9, nystagmus in8, paralysis in2.4. CSF opening pressure was＜70mmH2O in most patients. The color of CSF was colorless transparent, lightyellow transparent or blood color. CSF test showed white count, protein canmoderately elevated. Results of head CT were normal mostly, and16wereabnormal. Evidences of low CSF pressure were found on MRI in45patients.There were abnormal signs on head MRI enhancement scanning, MRV andcervical spine MRI in some patients. Cerebral autoregulation (CA) estimated bydynamic monitoring of cerebral blood flow velocity (CBFV) with transcranialDoppler sonography (TCD) showed that CBFV failed to return to normal within2minutes from decubitus to standing position in4patients.5. A fewcomplications cropped up in28patients, such as subdural effusion, subduralhematoma, subarachnoid hemorrhage (SAH), cerebral venous sinus thrombosis(CVST).6. Through rehydration and symptomatic support treatment, all of thepatients had some degree of improvements.Conclusions:1. Most IHS patients are middle-aged, acute onset, femalesare more common than males.2. Mental factors are related with etiology of IHS.3. The typical clinical expression of most of patients with IHS is posturalsymptom. Postural headche is the most common symptom. Neck stiffness anddizziness are not rare. Atypical symptoms can be seen as well. High alert shouldbe remained in the clinical work to avoid misdiagnosis.4. The key of diagnosisshould be focused on the following several aspects:①Orthostatic symptom,especially postural headache, is an essential condition.②Opening pressure of＜70mmH2O upon performing a lumbar puncture in lateral decubitus position.③Imaging evidence of low CSF pressure, such as dura reinforcement, should be seen on head MRI.④Rehydration is effective.5. Prevention ofcomplications of IHS is important, otherwise severe complications will developwith the disease progressing. Treating based on etiology and symptoms iseffective. |
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