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神经疾病

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急诊科如何评估脑积水
原作者: Wan-Tsu Wendy Chang; 发布日期:2015-01-05

Title: Evaluation of hydrocephalus in the ED
题目:急诊科如何评估脑积水
Author 作者: Wan-Tsu Wendy Chang
翻译:郑辛甜 校对:肖锋


Hydrocephalus is a disorder of cerebrospinal fluid (CSF) accumulation.  Acute obstructive hydrocephalus such as in subarachnoid hemorrhage and CSF shunt malfunction can cause a rapid rise in intracranial pressure.  Nonobstructive hydrocephalus is associated with subacute symptoms.  
脑积水是脑脊液(CSF)增加引起的疾病。急性梗阻性脑积水,如蛛网膜下腔出血和脑脊液导管障碍可能会导致颅内压迅速升高,而非梗阻性脑积水与亚急性症状有关。
Clinical features of acute obstructive hydrocephalus include headache, blurred vision, papilledema, ocular palsies, nausea and vomiting, and decreased level of consciousness.
急性梗阻性脑积水的临床特征包括头痛,视力模糊,视神经乳头水肿,眼球麻痹,恶心,呕吐,意识水平下降。

Evaluation of hydrocephalus in the ED should include neuroimaging, typically noncontrast head CT given its wide availability.  CT characteristics of hydrocephalus can be seen in Figure 1: ventriculomegaly with dilated 3rd ventricle, dilated 4th ventricle, and presence of temporal horns.
急诊科评估脑积水应包含神经影像,特别是头颅CT平扫,因其广泛存在。脑积水CT的特征:第3、第4脑室扩张,以及颞角的存在。
When evaluating patients with pre-existing hydrocephalus for worsening symptoms, such as in the evaluation of CSF shunt malfunctions, it is helpful to compare the head CT or MRI for interval ventricular enlargement.  Two simple measurements can be taken on a CT or MRI for objective comparisons (Figure 2).
当评估已有脑积水且症状在恶化的患者,如评估脑脊液导管障碍时,通过比较以往头颅CT或MRI有脑室增大是有帮助的。CT或MRI中的两项简单的测量指标能够用于进行客观比较。
Evans' ratio = A/B = Maximum width of frontal horns (A) divided by maximum width of inner skull (B) at the same CT/MRI level
Evans指数=双额角的最大宽度/同一CT或MRI层面的颅骨内壁宽度Width of 3rd ventricle
第3脑室宽度
Use of acetazolamide to decrease CSF production is not effective in long-term treatment of hydrocephalus.  About 75% of patients with hydrocephalus require CSF shunt placement.
使用乙酰唑胺以减少脑脊液产生不能长期有效地治疗脑积水。大约75%的脑积水患者需要安置脑脊液分流管。

References 参考文献:
Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008;8(5):371-376.
Poca MA, Sahuquillo J. Short-term medical management of hydrocephalus. Expert Opin Pharmacother. 2005;6(9):1525-1538.
Anvekar B 2011, Neuroradiology Cases, viewed 8 October 2014.