摘要
目的分析伴前庭蜗神经症状的自发性颅内低压(SIH)患者临床及影像学特征,探讨前庭蜗神经症状的发生机制。方法回顾性分析郑州大学第一附属医院神经内科自2014年1月至2019年9月收治的72例SIH患者资料。所有患者均行头颅MRI检查,并依据是否出现头晕、眩晕、耳鸣、耳胀或听力下降症状分为伴前庭蜗神经症状组(n=27)和不伴前庭蜗神经症状组(n=45),比较2组患者临床及头颅MRI特征。头颅MRI定量测量的指标包括鞍上池距离、垂体高度、视交叉至垂体窝距离、桥前池距离、乳头体至桥脑距离、中脑桥脑角度及横窦角度;定性征象包括硬脑膜强化、硬膜下积液或出血、鞍上池狭窄、桥前池狭窄、乳头体至桥脑距离缩短、中脑桥脑角度缩小及横窦扩张。结果27例伴前庭蜗神经症状组患者脑脊液压力为(37.50±27.54)mmH2O,22例(91.7%)临床表现为直立性头痛。45例不伴前庭蜗神经症状组患者脑脊液压力(39.00±26.91)mmH2O,39例(95.1%)临床表现为直立性头痛。定量指标方面,伴前庭蜗神经症状组患者垂体高度较不伴前庭蜗神经症状组患者明显下降,差异有统计学意义(P<0.05)。定性征象中,伴前庭蜗神经症状组患者鞍上池狭窄的阳性率较不伴前庭蜗神经症状组患者明显降低,差异有统计学意义(P<0.05)。余定量指标及定性征象阳性率在2组患者间差异均无统计学意义(P>0.05)。结论垂体高度下降、鞍上池狭窄减少可能与SIH患者前庭蜗神经症状的发生机制密切相关。
Objective To analyze the clinical and imaging features of patients with spontaneous intracranial hypotension(SIH)combined with vestibulocochlear nerve symptoms,and explore the mechanism of vestibulocochlear nerve damage.Methods From January 2014 to September 2019,72 patients with SIH were chosen in our hospital;their clinical data were retrospectively analyzed;all patients underwent brain MR imaging.Based on vestibulocochlear nerve symptoms including dizziness,vertigo,tinnitus,aural fullness,and hearing loss,these patients were divided into two groups:27 patients with vestibulocochlear nerve symptoms and 45 patients without vestibulocochlear nerve symptoms.The clinical and brain MR imaging features were compared between the two groups.The quantitative indexes of brain MR imaging were measured including the height of the pituitary gland,distances of the suprasellar cistern and prepontine cistern,distance from optic chiasm to pituitary fossa,mamillopontine distance,pontomesencephalic angle,and angle of transverse sinus.The qualitative signs of brain MR imaging were evaluated including pachymeningeal enhancement,subdural effusion or hematoma,effaced suprasellar cistern and prepontine cistern,decreased mamillopontine distance and pontomesencephalic angle,and transverse sinus distention.Results In 27 SIH patients with vestibulocochlear nerve symptoms,the mean CSF pressure was(37.50±27.54)mmH2O,and 22 patients(91.7%)presented with orthostatic headache.In 45 SIH patients without vestibulocochlear nerve symptoms,the mean CSF pressure was(39.00±26.91)mmH2O,and 39 patients(95.1%)presented with orthostatic headache.As compared with SIH patients without vestibulocochlear nerve symptoms,the patients with vestibulocochlear nerve symptoms showed significantly lower height of the pituitary gland(P<0.05).The positive rate of effaced suprasellar cistern in SIH patients with vestibulocochlear nerve symptoms was significantly decreased as compared with those without vestibulocochlear nerve symptoms(P<0.05);there were no significant differences in other quantitative indexes and positive rates of qualitative signs between the two groups(P>0.05).Conclusion The decrease of pituitary height and effaced suprasellar cistern may be closely related to the pathogenesis of vestibulocochlear nerve symptoms in SIH patients.
作者
祝清勇
宋承汝
滕军放
Zhu Qingyong;Song Chengru;Teng Junfang(Department of Neurology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Magnetic Resonance Imaging,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2020年第10期1014-1019,共6页
Chinese Journal of Neuromedicine
关键词
颅内低压
前庭蜗神经
头颅MRI
鞍上池狭窄
Intracranial hypotension
Vestibulocochlear nerve
Brain MR imaging
Effaced suprasellar cistern
