脊髄脳脊髄液の自発的な漏出と頭蓋内低血圧
1Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA. schievinkw@cshs.org
JAMA
|May 18, 2006
まとめ
脊髄髄液 (CSF) の漏出によって引き起こされる自発的な頭蓋内低血圧は,しばしば整形性頭痛として現れ,診断が不十分である. 早期診断と管理は,若年から中年の成人に影響を与えるこの状態の鍵です.
科学分野:
- 神経学 神経学とは
- 神経外科は神経外科です.
- 放射線学 放射線学
背景:
- 自発的な頭蓋内低血圧は,脊髄脳脊髄液 (CSF) の漏れから生じ,通常は正体頭痛を引き起こす.
- これは若年や中年において新しい頭痛の頻発の原因であるが,初期に誤って診断されることが多い.
研究 の 目的:
- spontaneous spinal CSF leakageと頭蓋内低血圧の流行病学,病理生理学,診断,管理に関する現在の証拠を統合する.
主な方法:
- MEDLINE (1966~2005) とOLDMEDLINE (1950~1965) の広範な文献検索が行われました.
- キーワードには"頭蓋内低血圧"",CSF漏れ"",低圧頭痛"",CSF低血圧症"などが含まれていた.
- レファレンスリストと進行中の研究も検討された.
主要な成果:
- 脊髄中枢液の漏れによる自発的頭蓋内低血圧は,年間10万人に5人の推定発生率があり,40歳頃にピークに達します.
- 女性はより頻繁に影響を受けます; 結合組織障害と組み合わせた機械的要因は,CSFの漏れに寄与します.
- 古典的な症状には,静止性頭痛が含まれるが,様々な症状が発生する. 診断イメージングには,MRI (SEEPSの発見を示す) と,漏れを特定するための骨髄検査が含まれています.
- 治療法は,保守的な措置から外科的修復まで様々ですが,結果はさらなる研究を必要とします.
結論:
- 自発的頭蓋内低血圧は,その有病率にもかかわらず,低診断されています.
- 診断は,臨床的な疑い,頭蓋骨MRI,および骨髄検査に基づいています.
- 様々な治療法が存在しますが,ランダム化試験からの確固たる証拠は不足しています.
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