OVERVIEW
Overview
Low Cranial Pressure Syndrome (LCPS) is a condition characterized by low intracranial cerebrospinal fluid (CSF) pressure due to a variety of causes, with postural headache as the main manifestation. The patient’s headache is aggravated by sitting or standing, and is reduced and disappears when lying down, and may be accompanied by headache, nausea, vomiting, vertigo, ringing in the ears, visual disturbances, nuchal rigidity, psychiatric symptoms, and so on.
Whether medical insurance
Yes
Department
Neurology, Neurosurgery
Clinical symptoms
Postural headache, aggravated by sitting, standing or activity, reduced and disappeared when lying down, may be accompanied by nausea and vomiting.
Hazards
This disease may cause visual impairment, mental symptoms.
Examination
Cerebrospinal fluid examination, magnetic resonance imaging, vertebral angiography, etc.
Diagnosis
Diagnosis can be made on the basis of postural headache with nausea, vomiting, vertigo and other manifestations, combined with cerebrospinal fluid examination and magnetic resonance imaging.
Treatment principle
Most patients with low cranial pressure can be normalized by conservative treatment such as lying down and volume supplementation, or temporary hormonal therapy can be given.
Curability
Hypocranial pressure syndrome is usually a benign process that resolves in most cases with conservative treatment.
Dietary recommendations
A light, easy-to-digest diet; drink plenty of fluids or appropriate fluid replacement to promote cerebrospinal fluid secretion can help relieve headache symptoms.
Etiology
Etiology
There are two types of low cranial pressure syndrome: one is secondary low cranial pressure syndrome, mostly seen after lumbar puncture, myelography or anesthesia, brain surgery, spinal cord surgery, cerebral and spinal cord trauma, diabetic coma, hyperventilation, uremia, etc.; the other is spontaneous low cranial pressure syndrome, and no clear cause can be found in these patients.
Symptoms and Diagnosis
Typical symptoms
The most prominent clinical manifestation of low cranial pressure syndrome is postural headache, which is aggravated by sitting, standing or activity, and reduced or disappeared when lying down. The onset is acute, subacute, and occasionally chronic, and the headache is relieved by laughing, coughing, jugular venous compression, and Valsalva maneuvers, in addition to position. The headache is usually located in the temporo-occipital region, sometimes affecting the whole head or radiating to the shoulders and neck, and is mostly a dull pain. In addition to headache, there are nausea, vomiting, anorexia, neck pain, vertigo, horizontal nystagmus, hearing changes, breast milk, facial numbness, facial weakness, and upper extremity radicular pain.
Diagnostic basis
Typical manifestation is postural headache, which may be accompanied by nausea, vomiting, vertigo, tinnitus, visual disturbances, neck pain, etc. Lumbar puncture cerebrospinal fluid pressure less than 60mmH2O can clearly diagnose low cranial pressure. Cranial magnetic resonance imaging shows extensive enhancement of the dura mater, widening of the subarachnoid space, dilation of venous sinuses, subdural effusion, congestion and swelling of the pituitary gland, and subluxation of the brain.
Treatment
Treatment guidelines
The first step is to treat the cause of the disease. For spontaneous low cranial pressure syndrome without a clear cause, most of the patients can be normalized by conservative treatments such as lying down and volume supplementation. Epidural autologous blood filling should be considered if conservative treatment is not effective.
Pharmacologic therapy
Volume replacement includes intravenous or oral rehydration, increased salt intake, and the use of glucocorticoids or salocorticoids.
Other treatments
Epidural autologous blood film therapy should be considered if conservative treatment fails.
Prognosis
Low cranial pressure syndrome is usually a benign process that resolves in most cases with conservative treatment.
Nursing care
Daily care
Rest in a flat position, without pillows, and use the head-down-foot-up position if necessary. Closely observe the patient’s vital signs.
Diet
Take a light, easy-to-digest diet.