自發性顱內低壓伴隨多處腦部缺血性中風：病例報告

Spontaneous Intracranial Hypotension with Multiple Ischemic Stroke: A Case Report

林琬鈞(Won-Jean Lin) ； 李偉強(Wai-Keung Lee) ； 韋有維(Yau-Wai Wai) ； 陳立蓉(Li-Rong Chen) ； 廖正智(Cheng-Chih Liao)

《台灣復健醫學雜誌》 34卷4期 (2006/12) Pp. 255-260

https://doi.org/10.6315/2006.34(4)08

摘要

腦脊髓液外漏導致顱內低壓發生原因多為外力創傷或是醫源性因素所致，臨床症狀除了典型的姿勢性頭痛之外，還可以伴隨多種神經學症狀，如顱神經傷害、嘔吐、頭暈、畏光、運動失調、痴呆，甚至嚴重意識昏迷、死亡…等等。不明原因自發性的腦脊髓液外漏之型態較為少見，同時發生腦血管病變者則未被提出報告，本文是一位自發性腦脊髓液外漏的病人發生顱內低壓及多處腦血管缺血性中風病例報告。
本病例為一名43歲男性，自2004年以來常有輕微斷續的頭痛，經休息可以緩解症狀。於2005年9月30日因發生一次的嚴重頭痛送醫，當時理學檢查並沒有其他異常，但頭部電腦斷層顯示兩側硬腦膜下出血，脊髓造影亦發現有頸胸椎腦脊髓液外漏，因病人並沒有其他外力因素造成，被診斷為自發性顱內低壓。此病患意識狀態漸漸下降，因此緊急施予硬腦膜上血液注射及硬膜下血塊清除處置，然而症狀未見改善。術後三天又發現有腦部多處缺血性壞死現象，雖然昏迷指數逐漸改善，但腦中風導致雙眼視盲、眼球轉動及睜眼困難、行動障礙，功能活動能力則幾乎為臥床狀態。雖給予長期照護及漸進式復健計劃，但因病患有隨時再發之危險，復健的實行有其困難度。提出本病例讓臨床醫療人員對腦脊髓液外漏和顱內低壓有更深入的了解，俾能在臨床治療上作為參考。

關鍵字

自發性顱內低壓 ； 缺血性中風 ； 腦脊髓液外漏 ； 復健

並列摘要

The causes of cerebrospinal fluid leakage leading to intracranial hypotension are generally iatrogenic or due to trauma. Postural headache is usually a characteristic symptom of intracranial hypotension, although other presenting neurologic symptoms occur, such as cranial nerve injury, vomiting, dizziness, photophobia, ataxia, dementia, coma, or death. A spontaneous cause for intracranial hypotension is uncommon. Intracranial hypotension with ischemic stroke, as described herein, has not been previously reported.
A 43-year-old man complained of intermittent headaches for approximately one year, but the symptoms remitted with bedrest. He was ultimately sent to the hospital due to a severe headache. Although there were no significant findings on physical examination, a CT of the head revealed bilateral subdural hemorrhage and myelography indicated CSF leakage. Because the patient did not report to have a history of trauma, a diagnosis of spontaneous intracranial hypotension was made. An emergent subdural blood patch was placed and the hematoma was evacuated due to progressive changes in consciousness. Three days after surgery, multiple infarctions were confirmed by cranial CT. Even though the patient recovered consciousness, complications of ischemic stroke included bilateral blindness, limitation of extraocular muscle movement, ptosis, and poor functional status. The rehabilitation program was difficult due to the risk of recurrent attacks during exercise. In addition to share our clinical experience, the current case illustrates the need for additional research in CSF leakage and intracranial hypotension.

並列關鍵字

spontaneous intracranial hypotension ； ischemic stroke ； cerebrospinal fluid leakage ； rehabilitation