特发性颅高压合并复发性脑脊液鼻漏1例病例报告并文献复习

A Case Report and Literature Review of Idiopathic Intracranial Hypertension Complicated by Recurrent Cerebrospinal Fluid Rhinorrhea

摘要:

目的:通过对1例复发性颅高压合并脑脊液鼻漏患者的影像学特征的回顾性分析，总结颅内高压的CT及MRI影像学特点，以期为临床同类型的患者提供诊疗依据。 方法:选取2020年就诊于郑州大学第一附属医院1例复发性颅高压合并脑脊液鼻漏患者作为研究对象，收集相关资料并随访预后情况。 结果:50岁男性，因“右侧鼻腔间断流清水样分泌物4月”为主诉入院，高血压10年，体重92kg,BMI为31.1，完善鼻窦CT、MRI及鼻分泌物成分分析后，全麻下行右侧蝶窦外侧隐窝脑脊液鼻漏修补术；术后5年，患者再次以“左侧鼻腔流清水样液体2月”入院，完善相关检查后，全麻下行左侧蝶窦外侧隐窝脑脊液鼻漏修补术；现随访1年，患者鼻部症状未复发,体重减至85kg。 结论:空泡蝶鞍、视神经周围蛛网膜下腔增宽、侧隐窝气化及蛛网膜颗粒小凹是颅内高压的典型影像学特征；颅内高压并发脑脊液鼻漏的治疗是一个长期并且复杂的过程,一旦发现患者存在颅内压升高的影像学表现,我们应该及时进行腰椎穿刺术以明确诊断,及时、合理并有效的控制颅内压。

Abstract:

Objective: Through a retrospective analysis of the imaging characteristics of a patient with recurrent intracranial hypertension combined with cerebrospinal fluid rhinorrhea, this study aims to summarize the CT and MRI imaging features of intracranial hypertension, thereby providing diagnostic and therapeutic references for similar clinical cases. Methods: A case of recurrent intracranial hypertension with cerebrospinal fluid rhinorrhea treated at the First Affiliated Hospital of Zhengzhou University in 2020 was selected as the study subject. Relevant clinical data were collected, and follow-up on prognosis was conducted. Results: A 50-year-old male patient was admitted with the chief complaint of "intermittent clear watery discharge from the right nasal cavity for 4 months," a history of hypertension for 10 years, a body weight of 92 kg, and a BMI of 31.1. Following comprehensive sinus CT, MRI, and analysis of nasal secretions, he underwent total anesthesia for repair of a cerebrospinal fluid rhinorrhea in the lateral recess of the right sphenoid sinus. Six months postoperatively, the patient was readmitted due to "clear watery discharge from the left nasal cavity for 2 months"; after completing relevant examinations, he underwent total anesthesia for repair of a cerebrospinal fluid rhinorrhea in the lateral recess of the left sphenoid sinus. At one year postoperatively, follow-up showed no recurrence of nasal symptoms and a weight reduction to 85 kg. Conclusion: Vascular space enlargement in the sella turcica, widening of the subarachnoid space around the optic nerve, gasification of the lateral recess, and arachnoid granular cisterns are typical imaging features of intracranial hypertension; the management of intracranial hypertension complicated by cerebrospinal fluid rhinorrhea is a prolonged and complex process. Upon identification of imaging evidence of elevated intracranial pressure, lumbar puncture should be performed promptly to establish a definitive diagnosis and ensure timely, appropriate, and effective control of intracranial pressure.