慢性頭痛患者における半定量的RI脳槽造影所見―低髄液圧症との類似性について

Semi-quantiative RI Cisternographic Patterns in Patients with Chronic Headache : A Resemblance to Those of Intracranial Hypotension Syndrome

体位性に変動する傾向のある慢性頭痛・頸部痛症例に対し，RI脳槽造影を用いて髄液漏出について評価した。髄液腔全体のRI活性を経時的に計測し，減衰率を初期値との比で表した。42例中16例で，RI活性は急速に減少するという髄液漏（低髄液圧症）患者と酷似した結果が得られた。このうち14例に硬膜外自家血注入を行い，10例にて何らかの改善を示し，治療後にRI検査を再検した3例のRI動態は正常化していた。これらの結果は，慢性頭痛患者の中には髄液漏出が潜在している症例があり，その治療によって症状の改善が期待できる症例があることを示唆している。

Semi-quantitative radionuclide cisternography was performed to evaluate CSF leakage for patients with long-lasting headache and/or neck pain or refractory dizziness which appeared to be related to posture as well as patients with spontaneous intracranial hypotension （SIH）. Radioactivity in the whole CSF space was counted and was plotted against time. SIH cases showed rapid decrease of radioactivity in the CSF space. Chronic headache patients were divided into Group I （rapid decrease of activity similarly to those in patients with SIH, to less than 80％ at 5h and 40％ at 24h）, Group II （gradual decrease to less than 40％ at 24h）, and Group III （activity remained more than 80％ at 5h and 40％ at 24h）. Of 16 patients in Group I, epidural blood patch was attempted in 14, and improvement of symptoms was obtained in 10. In 3 patients who underwent post-treatment RI study, tracer kinetics was normalized. These findings may indicate that some of patients with chronic headache actually have CSF leakage that can be treated with epidural blood patch.

（Received : July 8, 2005）