自发的脊髓脑脊髓液泄漏和内低血压
1Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA. schievinkw@cshs.org
JAMA
|May 18, 2006
概括
自发性内低血压是由脊髓脑脊液 (CSF) 泄漏引起的,通常呈现为静止性头痛,并且被低诊断. 早期诊断和管理是这种影响年轻到中年成年人的关键.
科学领域:
- 神经学 神经学
- 神经外科 神经外科
- 放射学 放射学是一门学科.
背景情况:
- 自发的内低血压是由脊髓脑脊液 (CSF) 泄漏引起的,通常会导致静止性头痛.
- 它是年轻和中年人的新发头痛的常见原因,但最初往往被误诊.
研究的目的:
- 巩固当前关于脊柱脊髓液自发泄漏和内低血压的流行病学,病理生理学,诊断和管理的证据.
主要方法:
- 对MEDLINE (1966-2005) 和OLDMEDLINE (1950-1965) 进行了全面的文献搜索.
- 关键词包括"内低血压"",CSF泄漏"",低压头痛"和"CSF低血压".
- 还审查了参考清单和正在进行的研究.
主要成果:
- 自发的内低血压是由脊髓中枢液泄漏引起的,估计每年每10万人有5例发生,在40岁左右达到顶峰.
- 妇女更常受到影响;机械因素与结合性组织疾病相结合,有助于CSF泄漏.
- 经典的症状包括静止性头痛,但会出现各种表现. 诊断成像包括MRI (显示SEEPS发现) 和骨髓图以定位泄漏.
- 治疗范围从保守措施到手术修复,尽管结果需要进一步研究.
结论:
- 自发性内低血压的诊断不足,尽管其流行率很高.
- 诊断依赖于临床怀疑,头骨MRI和骨髓图.
- 虽然存在各种治疗方法,但随机试验中缺乏强有力的证据.
相关概念视频
Cerebrospinal Fluid
7.9K
Cerebrospinal fluid (CSF) is a colorless liquid that flows around the brain and the spinal cord, playing a vital role in the protection, support, and overall function of the central nervous system (CNS). CSF production, circulation, and absorption are tightly regulated processes essential for the brain and spinal cord to function properly.
CSF Production
CSF is produced mainly in the choroid plexus, a network of capillaries and ependymal cells located within the ventricular system of the brain....
CSF Production
CSF is produced mainly in the choroid plexus, a network of capillaries and ependymal cells located within the ventricular system of the brain....
7.9K
Hemorrhagic Stroke ll: Pathophysiology
30
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
30
Increased Intracranial Pressure l: Introduction
27
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component...
27
Increased Intracranial Pressure ll: Pathophysiology
20
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins...
20
Cerebral Edema l: Introduction
30
Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
30
Cerebral Edema ll: Pathophysiology
19
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
19


