脊椎漏水 站著頭就痛Stood on the first leaking spinal pain

脊椎漏水 站著頭就痛 自發性低腦壓頭痛 躺下就不痛 台北榮總以硬膜外血液貼片治療 第二天就可改善 　「自發性低腦壓頭痛」只要躺下就不痛。【取材自東方影像】 　醫師在脊椎硬膜裂孔處，打入20c.c.血液，凝固後形成血液貼片，有助防止腦脊髓液滲漏。【台北榮民總醫院提供】 【施靜茹】女住院醫師報到第一天，站著站著，突頭痛欲裂，晚上躺床卻不藥而癒，她以為腦裡頭長東西，痛哭擔心無法當醫師，經同院醫師指點，她可能是「自發性低腦壓頭痛」。 台北榮民總醫院一般神經內科主任王署君說，此病又稱腦脊髓液低下症，原因是脊椎薄如紙張的硬膜，先天較脆弱，產生裂縫或裂孔，導致腦脊髓液滲漏，常發生在頸椎、胸椎交界處或胸椎處，好發在30歲至40歲中壯年人身上。 當腦脊髓液滲漏，站立時，就會出現腦組織下垂、腦壓降低而頭痛；但只要一躺下，腦脊髓液可因姿勢改變灌至腦部，又不會頭痛。 「也有求診病人說，上大號用力、釣魚或打網球以後就頭痛，」王署君說，三分之一病患發作前用力，包括咳嗽、打噴嚏、提重物或運動，而在站立15分鐘內頭痛。 有一半病患除了頭痛，會伴隨後頸僵硬或疼痛、惡心、嘔吐、耳朵像塞住有回音、耳鳴、平衡失調、畏光，日常生活大受影響。 台北榮總還有一名病人是女主管，每天都得平躺在休旅車後座，由司機開車送她，維持躺臥姿勢才進得了辦公室，辦公時也只能偏著頭，維持不直立的姿勢。 王署君說，這類病患就醫，常會被診斷說是腦出血，也有人以為腦長瘤，多數病患如能維持平躺姿勢1到3個月，脊椎硬膜裂縫有可能自我修復好，不過一般人多無法全天平躺，也有五分之一病患可能併發腦部硬膜下出血，少數會有靜脈栓塞及昏迷。 台北榮總神經醫學中心主任吳進安說，過去檢查低腦壓頭痛，大多做電腦斷層脊髓攝影，但需做腰椎穿刺及打顯影劑，才能確定腦脊髓液滲漏部位，且有顯影劑過敏風險。 台北榮總兩年前，改用磁振脊髓攝影確認腦脊髓液滲漏部位，再由麻醉醫師做「硬膜外血液貼片」。北榮麻醉部主治醫師許淑霞說，方法是抽病患自己的血液約20c.c.，打到滲漏處，躺一小時讓血液變硬，在體內形成有如貼片，把滲漏處補起來。 王署君說，台北榮總目前用此法治療低腦壓頭痛已有26名病例，病患大多第二天就改善頭痛，且只需做一次。這項技術去年已發表在國際期刊「頭痛」（Cephalalgia）。 2008-08-28 Stood on the first leaking spinal pain Spontaneous cerebral low pressure headache pain can not lie down to the Taipei Veterans General Hospital the next day epidural blood patch treatment can be improved "Spontaneous brain low pressure headache" as long as the pain would not lie down. [Images taken from the East: Dr. subdural hole in the spine, into the 20 c.c. of blood, blood coagulation after a patch, will help to prevent cerebral spinal fluid leakage. [Taipei Veterans General Hospital to provide: Shi Jing-Ru] [female resident to report the first day, stood standing, sudden headache Yulie, lying bed at night and not the more medicine, she thought of things inside the brain, tears and can not be worried when the doctors, the hospital physicians with guidance, she may be "Spontaneous brain low pressure headache." Taipei Veterans General Hospital Department of Neurology, the general director of the Department of Wang Jun said that the disease also known as the cerebral spinal fluid in the lower, because the spine of the thin paper subdural, congenital more vulnerable, cracks or holes, resulting in cerebral spinal fluid leaks, and often occur In the cervical, thoracic or at the junction of the thoracic spine, a good 30-year-old to 40-year-old Zhuang Nianren in possession. When the cerebral spinal fluid leakage, standing, there will be brain tissue down, intracranial pressure and reduce the headache, but as long as I lie down, cerebral spinal fluid can change the posture irrigation to the brain, not a headache. "There are patients that the large force, fishing or playing tennis after headache," said Wang Jun Department, one-third of patients before the attack force, including coughing, sneezing, or heavy objects to campaign, and in the standing 15 Headache within minutes. In addition to half of patients with headache, will be accompanied by the back of your neck stiffness or pain, nausea, vomiting, gagged with a reply like ears, tinnitus, balance disorders, photophobia, greatly affected their daily lives. Taipei Veterans General Hospital and one female patient is in charge of day, had to lie flat in the back seat of sport utility vehicles, drivers Kaiju Song from her position of lying to Jin won office, office, only partial Zhetou, do not maintain Upright posture. Department-Jun Wang said that such patients for medical treatment, was diagnosed often said to be brain hemorrhage, has long been thought that the brain tumor, most patients can maintain a supine position as 1-3, subdural spinal fractures may self-healing good, but Most people can not be more than a day bed, but also one-fifth of patients with brain may subdural bleeding, there will be a small number of venous thrombosis and coma. Taipei Veterans General Hospital medical director of the Center for Neural Wu Jin said, in the past inspection of low pressure headache, do most of the spinal cord CT photography, subject to the lumbar puncture and a reagent, to determine the cerebral spinal fluid leakage site, and a reagent allergy risk. Taipei Veterans General Hospital two years ago, switched to photography spinal cord MRI confirmed cerebral spinal fluid leakage site, by the anesthesiologist to be "epidural blood patch." North-Narcotic Department chief physician XU Shu-Xia said, is pumping blood around their patients 20 c.c., hit leakage, lying one hour to harden the blood, the body is like a patch, the leakage Fill up. Wang Jun said the Department of the Taipei Veterans General Hospital current method for the treatment of low pressure headache have been 26 cases, most patients improve on the second day of headache, and just do a. Last year, the technology has been published in international journals "headache" (Cephalalgia). 2008-08-28 For more information, see World Journal News ePaper

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