Epidural blood patch therapy for chronic whiplash-associated disorder
Epidural blood patch therapy for chronic whiplash-associated disorder
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DOI：
10.1213/01.ane.0000271922.04981.33
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发表时间：
2007-09-01
影响因子：
5.7
通讯作者：
Morita, Kiyoshi
中科院分区：
文献类型：
--
作者：
Ishikawa, Shinichi;Yokoyama, Masataka;Morita, Kiyoshi
背景：尽管没有客观的神经功能缺陷，慢性鞭打相关障碍(WAD)患者仍会出现头痛、头晕和恶心等症状。脑脊液(CSF)渗漏的患者也经常出现这些症状。最近有报道称，放射性核素脑池造影术在脑脊液漏致低颅压的诊断中是有用的。我们通过RI脑池造影术探讨慢性WAD与脑脊液漏的关系，并评价硬膜外补血(EBP)治疗慢性WAD是否有效。方法：对66例症状持续3mo以上的慢性WAD患者进行研究。所有患者均行RI脑池造影术以确定是否存在脑脊液漏。在发现脑脊液漏的患者中，给予EBP治疗。分别于EBP前、EBP后1wk、EBP后6mo进行症状评定。结果：在66例患者中，37例出现脑脊液漏，其中36例接受了EBP 2.2+/-0.7次。平均症状持续时间33mo。EBP后1周症状发生率较EBP前明显降低，头痛：100%比17%，记忆力减退94%比28%，头晕83%比47%，视力障碍81%比25%，恶心78%比42%(P<；0.01)。在6个月的随访检查中也观察到了这些效果(P<；0.01)。结论：我们认为在某些慢性WAD患者中应考虑脑脊液漏，EBP是治疗慢性WAD的一种有效方法。
BACKGROUND: Despite the absence of objective neurological deficits, patients with chronic whiplash-associated disorder (WAD) complain of symptoms such as headache, dizziness, and nausea. These symptoms are also often experienced by patients with cerebrospinal fluid (CSF) leak. It was recently reported that radioisotope (RI) cisternography is useful in the diagnosis of intracranial hypotension due to CSF leak. We investigated the relation between chronic WAD and CSF leak by RI cisternography and evaluated whether epidural blood patch (EBP) administration is effective in the treatment of chronic WAD.METHODS: We studied 66 patients with chronic WAD with symptoms lasting longer than 3 mo. All patients underwent RI cisternography to determine the presence of CSF leak. In patients in whom CSF leak was identified, EBP was administered. Symptoms were assessed before,1 wk after, and 6 mo after EBP. Work status was also assessed and follow-up RI cisternography was performed.RESULTS: Of the 66 patients, 37 showed CSF leak, and 36 of these patients received EBP 2.2 +/- 0.7 times. The mean duration of symptoms was 33 mo. One week after EBP, the percentage of patients with symptoms was decreased significantly compared with that before EBP; headache: 100% vs 17%, respectively, memory loss: 94% vs 28%, dizziness: 83% vs 47%, visual impairment: 81% vs 25%, nausea: 78% vs 42% (P < 0.01). These effects were also observed at the 6 month follow-up examination (P < 0.01). Work status was also significantly improved at follow-up.CONCLUSIONS: We conclude that CSF leak should be considered in some cases of chronic WAD and that EBP is an effective therapy for chronic WAD.