The Decrease of Pressure Gradient in Spontaneous Intracranial Hypotension Treated by Epidural Blood Patch: An Illustrated Case

降低顱內壓力差在自發性低顱內壓病患經脊椎硬膜外腔血液注入凝固貼覆法中的表現：示範個案

溫中瑜(Chung-Yu Wen) ； 許斯凱(Szu-Kai Hsu) ； 張志儒(Chih-Ju Chang) ； 李欣恩(Sing-Ong Lee) ； 謝政達(Cheng-Ta Hsieh)

《輔仁醫學期刊》 13卷1期 (2015/03) Pp. 55-59

https://doi.org/10.3966/181020932015031301006

摘要

當病患患有自發性低顱內壓時，脊椎硬膜外腔血液注入凝固貼覆法是一種有效的治療。臨床上，一般認為和腦脊髓液透漏孔被血貼直接修補，立即增加了顱內壓，讓病患在接受這種治療後，立即改善症狀。但這樣的理論，並沒有從直接顱內壓力監測結果得到證實，所以，真正的治療機轉仍未明。在此，我們報導一個因脊椎腦脊髓液透漏造成自發性低顱內壓的個案，因裝有即時顱內壓監測器，藉由連續顱內壓資料，可分析病患經脊椎硬膜外腔血液注入凝固貼覆法後，臨床上神經功能立即改善的原因。最後我們發現，降低顱內壓力差，可能是本項治療成功的原因。

關鍵字

自發性低顱內壓 ； 脊椎硬膜外腔血液注入凝固貼覆法 ； 顱內壓監測 ； 壓力差 ； 腦脊髓液透漏

並列摘要

Epidural blood patch (EBP) is an effective method for patients suffering from spontaneous intracranial hypotension (SIH). Because the clinical symptoms dramatically improved after EBP, the immediate increase in the intracranial pressure from the direct sealing of the spinal cerebrospinal fluid (CSF) leak has been proposed. However, this hypothesis was not proved according to the real-time ICP monitoring. Therefore, the real effect of EBP is still unknown. We report a case of SIH resulting from the spinal CSF leak. EBPs were performed and ICP levels were analyzed based on the real-time ICP monitoring. His previous neurologic deficit improved dramatically after EBPs. The decreased pressure gradient may be the reason for patients with dramatic recovery from SIH after EBP.

並列關鍵字

spontaneous intracranial hypotension ； epidural blood patch ； intracranial pressure monitoring ； pressure gradient ； cerebral spinal fluid leak