背景:我们旨在为诊断的最佳实践创建多学科共识临床指南,基于当前证据和多学科专家兴趣小组(SIG)的共识,对脑脊液漏引起的自发性颅内低血压(SIH)进行调查和处理。
方法:建立了由29名成员组成的SIG,有神经病学的成员,神经放射学,麻醉药,神经外科和患者代表。SIG以协商一致方式同意了该准则的范围和目的。然后,SIG使用修改后的Delphi过程为一系列问题主题开发了指南声明。这一过程得到了系统文献综述的支持,对患者和医疗保健专业人员进行调查,并由几位国际专家对SIH进行审查。
结果:任何出现体位性头痛的患者都应考虑SIH及其鉴别诊断。一线成像应该是大脑和整个脊柱的MRI。一线治疗是非靶向硬膜外血贴片(EBP),应该尽早执行。我们根据脊柱MRI结果和对EBP的反应提供进行脊髓造影的标准,我们概述了治疗的原则。保守管理的建议,还提供了头痛的对症治疗和SIH并发症的处理。
结论:本多学科共识临床指南有可能提高医疗保健专业人员对SIH的认识,在护理方面产生更大的一致性,提高诊断准确性,促进有效的调查和治疗,减少SIH导致的残疾。
We aimed to create a multidisciplinary
consensus clinical
guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and
consensus from a multidisciplinary specialist interest group (SIG).
A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the
guideline were agreed by the SIG by
consensus. The SIG then developed
guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH.
SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided.
This multidisciplinary
consensus clinical
guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH.