OBJECTIVE To investigate clinical and imaging features of 40 patients with spontaneous intracranial hypotension (SIH). METHODS 40 cases of spontaneous intracranial hypotension (SIH) diagnosed in our hospital from June 2013 to September 2017 were collected and retrospectively analyzed. RESULTS In our study, the male to female ratio was 2:3. The average age of onset was 43.0 ± 15.0 years. There were 12 (30.0%) patients with clear incentives, mostly catching cold. The average length of hospital stay was 11.2 ± 6.3 days. All the patients showed orthostatic headaches, 62.5% patients with nausea or vomiting, 40.0% patients with neck stiffness, 17.5% patients with dizziness and vertigo, 10.0% patients with numbness and weakness of limbs, 5% patients with neck discomfort, and 2.5% patients with visual symptoms (visual impairment, photophobia, diplopia). 24 patients underwent CT scans which showed no abnormalities in 20 cases (83.3%), subdural fluid accumulation in 3 cases (12.5%), and subdural haematoma in 1 case (2.5%). Cranial contrast-enhanced MR scans showed diffuse pachymeningeal enhancement (95.83%, 23/24), signs of pituitary hyperaemia in 5 cases (20.8%), subdural fluid accumulation and subdural hematoma in 4 cases (16.7%), sagging of the brain in 3 cases (12.5%), and engorgement of venous structures in 1 case (4.1%). Six patients underwent plain and contrast-enhanced spinal MR scans which showed varying degrees of dural thickening and enhanced performance in all the patients. 92.5% (37/40) of patients had cerebrospinal fluid pressure <60 mmH2O on lumbar puncture. 97.5% of patients underwent conservative treatment with drugs and had a good outcome. CONCLUSION Orthostatic headache and cranial MRI diffuse pachymeningeal enhancement are characteristic features of SIH. Cranial contrast-enhanced MR scan is recognized as the first and non-invasive investigation in the diagnosis of SIH. Most patients had cerebrospinal fluid pressure <60 mmH2O. The vast majority of patients improved with fluid replacement.

中文翻译：

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40例自发性颅内低血压综合征的临床分析。

目的探讨40例自发性颅内低血压（SIH）患者的临床和影像学特点。方法收集2013年6月至2017年9月在我院诊断为自发性颅内低血压（SIH）的40例病例并进行回顾性分析。结果在我们的研究中，男女之比为2：3。平均发病年龄为43.0±15.0岁。有12名（30.0％）明确诱因的患者，大部分是感冒。平均住院时间为11.2±6.3天。所有患者均表现为直立性头痛，62.5％的恶心或呕吐患者，40.0％的颈部僵硬患者，17.5％的头晕眩晕患者，10.0％的肢体麻木和无力患者，5％的颈部不适患者和2.5％有视觉症状（视觉障碍，畏光，复视）的患者。24例患者进行了CT扫描，其中20例（83.3％）未见异常，硬膜下积液3例（12.5％），硬膜下血肿1例（2.5％）。颅脑造影增强扫描显示弥漫性前脑膜增强（95.83％，23/24），垂体充血迹象5例（20.8％），硬脑膜下积液和硬膜下血肿4例（16.7％），脑下垂3例（12.5％），静脉结构充血1例（4.1％）。6例患者接受了平扫和对比增强的脊髓MR扫描，这些扫描显示所有患者的硬脑膜均有不同程度的硬脑膜增厚和增强的表现。腰穿时92.5％（37/40）的患者脑脊液压力<60 mmH2O。97.5％的患者接受了药物的保守治疗，并取得了良好的效果。结论体位性头痛和颅内MRI弥漫性前脑膜增强是SIH的特征。颅骨造影增强MR扫描被认为是SIH诊断中的第一项非侵入性检查。大多数患者的脑脊液压力<60 mmH2O。绝大多数患者的补液改善了。