Báo cáo ca lâm sàng ít gặp: Giảm áp lực nội sọ do rò dịch não tủy tại cổ cao
Nội dung chính của bài viết
Tóm tắt
Chúng tôi xin báo cáo một trường hợp giảm áp lực nội sọ (GALNS) hiếm gặp, bệnh nhân (BN) nữ 30 tuổi vào viện vì đau đầu theo tư thế kéo dài 2 tuần, tiền sử sinh con đường âm đạo có sử dụng giảm đau bằng gây tê ngoài màng cứng vùng thắt lưng trước đó 1 tháng. Trên phim MRI sọ não có hình ảnh điển hình của GALNS gồm dày và ngấm thuốc lan tỏa màng cứng, phồng xoang tĩnh mạch, phì đại tuyến yên và tụt thấp trung não. Xung Heavily T2W (Heavily T2-Weighted Magnetic Resonance Myelography - HT2W MRM) gợi ý vị trí rò dịch não tủy tại vùng cổ sau, ngang mức C1-2. Áp lực nội sọ khi chọc dịch não tủy (DNT) đo được < 5cmH20. bệnh nhân được chẩn đoán xác định là GALNS do rò dịch não tủy vùng cổ cao, được điều trị vá màng cứng bằng máu tự thân. Sau 2 tuần bệnh nhân đã cải thiện cả triệu chứng lâm sàng và các dấu hiệu hình ảnh trên MRI.
Chi tiết bài viết
Từ khóa
Giảm áp lực nội sọ, T2W heavily, rò dịch não tủy, vá màng cứng
Tài liệu tham khảo
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19. Kwon SY, Kim YS, Han SM. Spontaneous C1-2 cerebrospinal fluid leak treated with a targeted cervical epidural blood patch using a cervical epidural Racz catheter. Pain Physician. 2014; 17(3): E381-384.
2. Swyden S, Carter C, Shah S u. Intracranial Hypotension. In: StatPearls. StatPearls Publishing; 2024. Accessed July 6, 2024. http://www.ncbi.nlm.nih.gov/books/NBK560764/.
3. Walker DG. Refractory headache due to spontaneous intracranial hypotension from a CSF leak at C1-2. J Clin Neurosci. 2003; 10(4): 482-485. doi:10.1016/s0967-5868(02)00304-1.
4. Schievink WI, Maya MM, Tourje J. False localizing sign of C1-2 cerebrospinal fluid leak in spontaneous intracranial hypotension. J Neurosurg. 2004; 100(4): 639-644. doi:10.3171/jns.2004.100.4.0639.
5. An S, Jeong HG, Seo D, et al. Heavily T2-Weighted Magnetic Resonance Myelography as a Safe Cerebrospinal Fluid Leakage Detection Modality for Nontraumatic Subdural Hematoma. J Korean Neurosurg Soc. 2022; 65(1): 13-21. doi:10.3340/jkns.2020.0326.
6. Dobrocky T, Winklehner A, Breiding PS, et al. Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences. American Journal of Neuroradiology. 2020; 41(7): 1309-1315. doi:10.3174/ajnr.A6592.
7. Kranz PG, Gray L, Amrhein TJ. Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions. Headache. 2018; 58(7): 948-959. doi:10.1111/head.13328.
8. Callen AL, Timpone VM, Schwertner A, et al. Algorithmic Multimodality Approach to Diagnosis and Treatment of Spinal CSF Leak and Venous Fistula in Patients With Spontaneous Intracranial Hypotension. American Journal of Roentgenology. 2022; 219(2): 292-301. doi:10.2214/AJR.22.27485.
9. Cerebrospinal fluid leak presented with the C1-C2 sign caused by spinal canal stenosis: a case report | BMC Neurology | Full Text. Accessed July 5, 2024. https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-020-01697-1.
10. Yousry I, Förderreuther S, Moriggl B, et al. Cervical MR imaging in postural headache: MR signs and pathophysiological implications. AJNR Am J Neuroradiol. 2001; 22(7): 1239-1250.
11. Mokri B, Hunter SF, Atkinson JL, Piepgras DG. Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology. 1998; 51(3): 786-790. doi:10.1212/wnl.51.3.786.
12. Wang DJ, Pandey SK, Lee DH, Sharma M. The Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI. AJNR Am J Neuroradiol. 2019; 40(8): 1299-1303. doi:10.3174/ajnr.A6120.
13. Dobrocky T, Winklehner A, Breiding PS, et al. Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences. American Journal of Neuroradiology. 2020; 41(7): 1309-1315. doi:10.3174/ajnr.A6592.
14. Marcelis J, Silberstein SD. Spontaneous low cerebrospinal fluid pressure headache. Headache. 1990; 30(4): 192-196. doi:10.1111/j.1526-4610.1990.hed3004192.x.
15. Post-spinal anesthesia headache treated with caffeine. Evaluation with demand method. Part I | Cochrane Library. Accessed July 6, 2024. https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01368120/full.
16. Burnett CJ, White AJ, Vulcan MD. Epidural Blood Patch for Treatment of Postdural Puncture Headache in a Patient with Spinal Fusion and Recent Implantation of Intrathecal Pain Pump. OJAnes. 2013; 03(03): 168-169. doi:10.4236/ojanes.2013.33039.
17. Tubben RE, Jain S, Murphy PB. Epidural Blood Patch. In: StatPearls. StatPearls Publishing; 2024. Accessed October 14, 2024. http://www.ncbi.nlm.nih.gov/books/NBK482336/.
18. Rai A, Rosen C, Carpenter J, Miele V. Epidural Blood Patch at C2: Diagnosis and Treatment of Spontaneous Intracranial Hypotension. AJNR Am J Neuroradiol. 2005; 26(10): 2663-2666.
19. Kwon SY, Kim YS, Han SM. Spontaneous C1-2 cerebrospinal fluid leak treated with a targeted cervical epidural blood patch using a cervical epidural Racz catheter. Pain Physician. 2014; 17(3): E381-384.