A Study Of Imaging Findings And The Risk Factors For Complicated Subdual Hemorrhage Of Spontaneous Intracranial Hypotension

Objective:1.The aim of this study was to retrospectively investigate Spontaneous Intracranial Hypotension(SIH)and its complications based on brain MRI findings.To explore a potential correlation between SIH clinical data,imaging performances,and that in between clinical data and imaging performance.2.The risk factors of SIH complicated with subdural haematoma(SDH)were also comprehensively studied in this thesis.Methods:1.Brain MRI manifestations of SIH and its correlation with the clinical data.The diagnosis of SIH was made according to the criteria of the International Classification of Headache Disorder,2nd edition(ICHD-2),177 patients with SIH diagnosed between March 2010 and April 2017 were reviewed,A total of 32 cases were excluded:1 case with obvious clinical symptoms but the EBP treatment was effective,20 cases without head-enhanced MR examination,4 cases without lumbar puncture or lumbar puncture failure,7 cases could not obtain accurate leak points of CSF using MRM of the spinal cord,CT myelography and MR intrathecal examination(including failure of examination).Correlation analysis was performed on 145 clinical data and brain MR images.Clinical data included gender,age,clinical course,cerebrospinal fluid(CSF)stress,and blood pressure.Image manifestations include brain descent,sinus venosus dilatation,pituitary congestion,subdural collection liquid(blood),subdural hematoma,degree of homogeneous signal on subdural hematoma,and dural enhancement.The measurement method,grading standard and dura mater grading standard of brain descent degree were jointly confirmed by two senior imaging diagnosticians.Clinical and imaging data of 145 patients with life-threatening complications were also recorded.2.Risk factors of SIH complicated with subdural haematoma(SDH).Retrospectively analyzed the clinical and imaging data of 177 patients with SIH,145 patients were selected as study subjects,which was divided into an SDH group and a non-SDH(NSDH)group.Then the univariate analysis and further multiple logistic regression analysis were performed to identify the potential risk factors,including the gende,age,clinical course,blood pressure,cerebrospinal fluid pressure,lesions,for the development of SDHs.Results:1.Brain MRI findings of SIH and its complications.Within 145 patients with SIH,140(96.5%)of which displayed a dura mater enhancement.Most of them showed a linear enhancement,and often occured in infratentorial brain.The 121 patients(83%)with sinus dilatation showed low signal in transverse position and sagittal venous sinus,local expansion,and was round.In 114 patients(78%)with pituitary congestion,the pituitary morphology was satiation and the pituitary imaging was significantly enhanced after enhancement.Twenty-nine patients(20.0%)with subdural hematoma showed subdural crescent and banded signals,showed isointensity signal and high signal.Twelve patients(8%)with subdural collection liquid showed a sub-subdial crescent and banded hypointensity on T1-weighted hyperintensity on T2-weighted images.The 64 patients(44.1%)displayed a lower edge of cerebellar tonsil that did not exceed with occipital foramen occlusion.The brain descent more than 3mm possessed in 23 cases(16%),more than 5mm occured in 9 cases(6.2%).The 2 patients were diagnosised a cerebellar tonsil hernia by the imaging,also displayed a typical clinical feature of cerebellar tonsil hernia.In 1 case of sinus thrombosis,the primary imaging findings were punctate and strip-like hyperintensity filling defects.2.Correlation between clinical data and imaging manifestations.(1)Correlation analysis of clinical data of SIH patients.Pearson correlation analysis showed that there was a significant correlation(p<0.05)between some indicators,including age and sex(r=.194*),age and systolic blood pressure(r=.303**),age and diastolic blood pressure(r=.167*),age and clinical course(r=.195*),age and CSF pressure(r=0.174*).All the above indicators are positively correlated,that is,the older the patient was,the longer clinical course,and also higher for the systolic blood pressure,diastolic blood pressure and CSF pressure.(2)Correlation analysis of imaging performance in SIH patients.Spearman rank correlation analysis showed that there was a significant correlation(p<0.05)between multiple imaging indicators.Venous sinus dilatation was positively correlated with pituitary congestion(r-.220**),with dura mater(r=.220**)and with brain descent(r=.170*).There had a greater the possibility for pituitary congestion and dural enhancement complicated venous sinus expansion.Pituitary congestion is positively associated with dura mater(r=.340**),ie,the greater the likelihood of pituitary congestion in the presence of dura mater enhancement cases.(3)Correlation analysis between clinical data and imaging findings in SIH patients.Spearman rank correlation analysis showed a significant correlation among multiple indicators(p<0.05),which was positively correlated as follows:gender and subdural effusion(blood)(r=0.231**),same as SDH(r=.257**)is positively correlated,that is,men were more likely to have a subdural collection liquid(blood)and SDH than women.Age and subdural collection liquid(blood)(r=.231*),and SDH(r=.170*)are positively correlated.The older,the bigger of probability of subdural collection liquid(blood),SDH may occur.The clinical course is positively correlated with subdural collection liquid(blood)(r=.200*)and SDH(r=.241**).The longer the course of disease,the greater the possibility of more subdural collection liquid and SDH.The correlation is negative as follows:age and pituitary congestion(r =-.210*),the greater the age,the less likely the pituitary congestion.The clinical course and the SDH signal uniformity(r=-.365*),that is,the longer the course of disease,the less the probability of getting a uniform SDH signal.3.Risk factors of SIH complicated with subdural haematoma(SDH).(1)The 29 of 145 patients complicated with SDHs(20.0%,29/145).Male gender dominated for the majority of cases(18/29,62.1%);An SDH group had a mean age of 44.72± 11.03 years and the mean clinical course of 50.41±30.42 days;A NSDH group had a mean age of 39.96±9.35 years and the mean clinical course of 31.70±24.39 days.(2)The univariate analysis showed that elder age,male gender and longer clinical course were highly associated with the development of SDHs.However,multivariate analysis only included male gender[Exp(B)=0.303,95%Cl 0.126-0.727,p=0.008,longer clinical course Exp(B)=1.021,95%CI 1.006～1.036,p=0.005].(3)If the clinical course exceeded 18 days,the probability of the development of SDHs was significantly increased,the incidence of SDH increased to 24.3%(p<0.05).Conclusions:1.The primary brain MRI manifestations of SIH includes dural enhancement,subdural collection liquid(blood),brain descent,sinus dilatation,and pituitary congestion.SIH complicated with subdural hematoma were the most common cases,with 9 cases of cerebral palsy and 1 case of sinus thrombosis.2.The older SIH patient,the more likely they would have a longer course of disease and the higher their blood pressure and CSF pressure.The SIH patients with venous sinus dilation,complicated with pituitary hyperemia,dural enhancement and brain subsidence were more likely.Pituitary hyperemia was positively correlated with dural enhancement.Subdural effusion(blood)and SDH are more likely to occur in men,with a long course of disease and age.The older the age,the less likely the pituitary congestion would occur.The longer the clinical course,the lower the probability that the SDH signal would be homogeneous.3.The univariate analysis showed that advanced age,male gender and longer clinical course were associated with the development of SDHs.However,multivariate analysis only included male gender.4.If the clinical course duration exceeded 18 days,and the clinical course duration was more than 18 days,there would be a greater potential for the development of SDHs over other factors.