Neurology:昏迷,自发性低颅压的严重并发症

2018-06-10 杨中华 脑血管病及重症文献导读

直立性头痛是自发性低颅压(spontaneous intracranial hypotension,SIH)的特征性表现,但是SIH还有其他很多临床表现。意识障碍是大家熟知的SIH并发症,但是诊断往往延迟。不能及时识别SIH会引起死亡、昏迷和卒中。目前尚缺乏SIH合并昏迷患者的临床数据,大多为单个病例报道或小型病例分析,并且不清楚这些患者的长期预后和治疗的有效性。尽管文献很明确的指出昏迷可以发


直立性头痛是自发性低颅压(spontaneous intracranial hypotension,SIH)的特征性表现,但是SIH还有其他很多临床表现。意识障碍是大家熟知的SIH并发症,但是诊断往往延迟。不能及时识别SIH会引起死亡、昏迷和卒中。目前尚缺乏SIH合并昏迷患者的临床数据,大多为单个病例报道或小型病例分析,并且不清楚这些患者的长期预后和治疗的有效性。尽管文献很明确的指出昏迷可以发生在SIH的患者中,但是很少有报道探讨其发生率、与SIH的其他临床表现的关系、治疗的方案、预后以及SIH发展为昏迷的病理生理机制。

2018年5月来自美国的Wouter I. Schievink等在Neurology上公布了他们的研究结果,探讨SIH合并昏迷患者的临床和放射学特征。

研究者采用前瞻性登记研究的数据,共583例SIH患者,其中发生昏迷者15例,未发生昏迷者568例。15例昏迷的患者中,男性12例,女性3例,发生昏迷时的平均年龄为56.2(34-72)岁。1/3的患者,昏迷发生在因硬膜下血肿手术后或无关的颅内情况。影像表现为15例皆表现为脑下沉,包括双侧颞叶疝,8例脑干水肿(53%)。总体来看,经过治疗后昏迷逆转的病例数分别为:15例硬膜外血补片治疗,7例逆转;4例经皮凝胶注射,2例逆转;6例外科手术,皆逆转。仅1例残留昏迷相关神经功能缺损(GOS 4分,中等残疾)。与无昏迷的SIH者相比,昏迷的患者往往年龄更大,大多为男性,更多经历过外科手术。

最终作者认为在SIH患者中昏迷比较罕见,都与脑下沉有关。常规的经皮手术不能逆转昏迷,为了逆转昏迷采用外科手术闭塞CSF漏口是必要的。

原始出处:

Wouter I. Schievink, et al.Coma: A serious complication of spontaneous intracranial hypotension.Neurology. 2018 May 8;90(19):e1638-e1645. doi: 10.1212/WNL.0000000000005477. Epub 2018 Apr 13.

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    2019-04-01 丁鹏鹏
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    2018-11-09 yinhl1978
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    2018-06-12 wgx307
  5. [GetPortalCommentsPageByObjectIdResponse(id=2026136, encodeId=08a0202613694, content=<a href='/topic/show?id=7cc6860e93b' target=_blank style='color:#2F92EE;'>#自发性低颅压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86079, encryptionId=7cc6860e93b, topicName=自发性低颅压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Mon Oct 15 19:13:00 CST 2018, time=2018-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757996, encodeId=c0b51e5799647, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Mon Apr 01 19:13:00 CST 2019, time=2019-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000450, encodeId=44b72000450d6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Nov 09 15:13:00 CST 2018, time=2018-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429490, encodeId=c83514294900b, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Tue Jun 12 08:13:00 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530570, encodeId=697415305e06a, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Tue Jun 12 08:13:00 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323208, encodeId=e36632320860, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Mon Jun 11 06:40:45 CST 2018, time=2018-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323107, encodeId=84cb32310ee0, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Sun Jun 10 20:20:11 CST 2018, time=2018-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323084, encodeId=88ad32308447, content=知之为知之.值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Jun 10 18:00:15 CST 2018, time=2018-06-10, status=1, ipAttribution=)]
    2018-06-12 sodoo
  6. [GetPortalCommentsPageByObjectIdResponse(id=2026136, encodeId=08a0202613694, content=<a href='/topic/show?id=7cc6860e93b' target=_blank style='color:#2F92EE;'>#自发性低颅压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86079, encryptionId=7cc6860e93b, topicName=自发性低颅压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Mon Oct 15 19:13:00 CST 2018, time=2018-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757996, encodeId=c0b51e5799647, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Mon Apr 01 19:13:00 CST 2019, time=2019-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000450, encodeId=44b72000450d6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Nov 09 15:13:00 CST 2018, time=2018-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429490, encodeId=c83514294900b, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Tue Jun 12 08:13:00 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530570, encodeId=697415305e06a, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Tue Jun 12 08:13:00 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323208, encodeId=e36632320860, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Mon Jun 11 06:40:45 CST 2018, time=2018-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323107, encodeId=84cb32310ee0, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Sun Jun 10 20:20:11 CST 2018, time=2018-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323084, encodeId=88ad32308447, content=知之为知之.值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Jun 10 18:00:15 CST 2018, time=2018-06-10, status=1, ipAttribution=)]
    2018-06-11 张新亮1853311252142e2fm

    好文献学习了

    0

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    2018-06-10 天地飞扬

    了解一下.谢谢分享!

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2026136, encodeId=08a0202613694, content=<a href='/topic/show?id=7cc6860e93b' target=_blank style='color:#2F92EE;'>#自发性低颅压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86079, encryptionId=7cc6860e93b, topicName=自发性低颅压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f14236, createdName=经常头晕, createdTime=Mon Oct 15 19:13:00 CST 2018, time=2018-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757996, encodeId=c0b51e5799647, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Mon Apr 01 19:13:00 CST 2019, time=2019-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000450, encodeId=44b72000450d6, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Nov 09 15:13:00 CST 2018, time=2018-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429490, encodeId=c83514294900b, content=<a href='/topic/show?id=26d559642f9' target=_blank style='color:#2F92EE;'>#昏迷#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59642, encryptionId=26d559642f9, topicName=昏迷)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81fb4200032, createdName=wgx307, createdTime=Tue Jun 12 08:13:00 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530570, encodeId=697415305e06a, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Tue Jun 12 08:13:00 CST 2018, time=2018-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323208, encodeId=e36632320860, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Mon Jun 11 06:40:45 CST 2018, time=2018-06-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323107, encodeId=84cb32310ee0, content=了解一下.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/12/23/2f51002e1349ccda5be11c1eea1e1e60.jpg, createdBy=a22097948, createdName=天地飞扬, createdTime=Sun Jun 10 20:20:11 CST 2018, time=2018-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=323084, encodeId=88ad32308447, content=知之为知之.值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Sun Jun 10 18:00:15 CST 2018, time=2018-06-10, status=1, ipAttribution=)]
    2018-06-10 易水河

    知之为知之.值得学习

    0

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