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Neurology:针灸后可见皮肤部位脑脊液漏出

2019-03-30 zyx整理 神经科病例撷英拾粹

针灸在亚洲国家广泛使用。27岁男性,因新近出现的直立性头痛就诊。数周前,患者腰背部(L3-S1)行多次重复针灸,以缓解过去几年椎板切除和椎间融合(L4-S1)术后仍然存在的疼痛。

针灸在亚洲国家广泛使用。27岁男性,因新近出现的直立性头痛就诊。数周前,患者腰背部(L3-S1)行多次重复针灸,以缓解过去几年椎板切除和椎间融合(L4-S1)术后仍然存在的疼痛。左下背部皮肤可见脑脊液滴落(图1)。脑MRI正常。磁共振脊髓造影明确存在脑脊液漏伴瘘管形成(图2)。患者行硬脊膜成形(L4-5)及瘘管一期缝合术,头痛改善。

(图1:脑脊液,如水滴,可见从左侧腰部皮肤滴落,早晨和左侧卧位时最明显)

(图2:A:可见脑脊液漏[左侧L3-4-5;箭]和异常积液[沿着左侧椎旁肌;箭头];A-B:磁共振脊髓成像;C:T2WI;椎板切除部位可见神经孔和异常积液之间的瘘管形成[箭])

原始出处:Noh SM1, Lee KM1, Kim BJ, et al. Teaching NeuroImages: Cerebrospinal fluid leakage observed from skin after acupuncture. Neurology. 2019 Mar 5;92(10):e1141-e1142.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=813588, encodeId=41158135884d, content=<a href='/topic/show?id=66ed9628563' target=_blank style='color:#2F92EE;'>#针灸#</a>典型的乱针行为!针灸过深并没有实际作用。按目前的研究,<a href='/topic/show?id=e391e8449c0' target=_blank style='color:#2F92EE;'>#经络#</a>很可能是肌肉下<a href='/topic/show?id=e9591038369f' target=_blank style='color:#2F92EE;'>#筋膜间隙#</a>,意味着针过深,并不能取到实际作用。应该凭手感找到肌肉间的缝隙,进行相关刺激,从而影响到筋膜下相关循环,以及炎症因子,从而达到治疗作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=341, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=96285, encryptionId=66ed9628563, topicName=针灸), TopicDto(id=78449, encryptionId=e391e8449c0, topicName=经络), TopicDto(id=103836, encryptionId=e9591038369f, topicName=筋膜间隙)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 26 22:26:45 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000748, encodeId=b6ff2000e48e0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Jun 14 07:05:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=369592, encodeId=1e7a3695929d, content=mark, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=526e2567988, createdName=小微940490, createdTime=Sat Jul 13 12:22:16 CST 2019, time=2019-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740363, encodeId=86ed1e4036380, content=<a href='/topic/show?id=2cab850369a' target=_blank style='color:#2F92EE;'>#脑脊液漏出#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85036, encryptionId=2cab850369a, topicName=脑脊液漏出)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=04e634737554, createdName=passed water, createdTime=Thu Nov 07 20:05:00 CST 2019, time=2019-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597090, encodeId=98dc159e09019, content=<a href='/topic/show?id=0968850356f' target=_blank style='color:#2F92EE;'>#脑脊液漏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85035, encryptionId=0968850356f, topicName=脑脊液漏)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a6b618479697, createdName=gds2015, createdTime=Mon Apr 01 12:05:00 CST 2019, time=2019-04-01, status=1, ipAttribution=)]
    2020-08-26 zhaojie88

    #针灸#典型的乱针行为!针灸过深并没有实际作用。按目前的研究,#经络#很可能是肌肉下#筋膜间隙#,意味着针过深,并不能取到实际作用。应该凭手感找到肌肉间的缝隙,进行相关刺激,从而影响到筋膜下相关循环,以及炎症因子,从而达到治疗作用

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    展开1条回复
  2. [GetPortalCommentsPageByObjectIdResponse(id=813588, encodeId=41158135884d, content=<a href='/topic/show?id=66ed9628563' target=_blank style='color:#2F92EE;'>#针灸#</a>典型的乱针行为!针灸过深并没有实际作用。按目前的研究,<a href='/topic/show?id=e391e8449c0' target=_blank style='color:#2F92EE;'>#经络#</a>很可能是肌肉下<a href='/topic/show?id=e9591038369f' target=_blank style='color:#2F92EE;'>#筋膜间隙#</a>,意味着针过深,并不能取到实际作用。应该凭手感找到肌肉间的缝隙,进行相关刺激,从而影响到筋膜下相关循环,以及炎症因子,从而达到治疗作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=341, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=96285, encryptionId=66ed9628563, topicName=针灸), TopicDto(id=78449, encryptionId=e391e8449c0, topicName=经络), TopicDto(id=103836, encryptionId=e9591038369f, topicName=筋膜间隙)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 26 22:26:45 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000748, encodeId=b6ff2000e48e0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Jun 14 07:05:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=369592, encodeId=1e7a3695929d, content=mark, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=526e2567988, createdName=小微940490, createdTime=Sat Jul 13 12:22:16 CST 2019, time=2019-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740363, encodeId=86ed1e4036380, content=<a href='/topic/show?id=2cab850369a' target=_blank style='color:#2F92EE;'>#脑脊液漏出#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85036, encryptionId=2cab850369a, topicName=脑脊液漏出)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=04e634737554, createdName=passed water, createdTime=Thu Nov 07 20:05:00 CST 2019, time=2019-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597090, encodeId=98dc159e09019, content=<a href='/topic/show?id=0968850356f' target=_blank style='color:#2F92EE;'>#脑脊液漏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85035, encryptionId=0968850356f, topicName=脑脊液漏)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a6b618479697, createdName=gds2015, createdTime=Mon Apr 01 12:05:00 CST 2019, time=2019-04-01, status=1, ipAttribution=)]
    2019-06-14 yinhl1978
  3. [GetPortalCommentsPageByObjectIdResponse(id=813588, encodeId=41158135884d, content=<a href='/topic/show?id=66ed9628563' target=_blank style='color:#2F92EE;'>#针灸#</a>典型的乱针行为!针灸过深并没有实际作用。按目前的研究,<a href='/topic/show?id=e391e8449c0' target=_blank style='color:#2F92EE;'>#经络#</a>很可能是肌肉下<a href='/topic/show?id=e9591038369f' target=_blank style='color:#2F92EE;'>#筋膜间隙#</a>,意味着针过深,并不能取到实际作用。应该凭手感找到肌肉间的缝隙,进行相关刺激,从而影响到筋膜下相关循环,以及炎症因子,从而达到治疗作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=341, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=96285, encryptionId=66ed9628563, topicName=针灸), TopicDto(id=78449, encryptionId=e391e8449c0, topicName=经络), TopicDto(id=103836, encryptionId=e9591038369f, topicName=筋膜间隙)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 26 22:26:45 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000748, encodeId=b6ff2000e48e0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Jun 14 07:05:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=369592, encodeId=1e7a3695929d, content=mark, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=526e2567988, createdName=小微940490, createdTime=Sat Jul 13 12:22:16 CST 2019, time=2019-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740363, encodeId=86ed1e4036380, content=<a href='/topic/show?id=2cab850369a' target=_blank style='color:#2F92EE;'>#脑脊液漏出#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85036, encryptionId=2cab850369a, topicName=脑脊液漏出)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=04e634737554, createdName=passed water, createdTime=Thu Nov 07 20:05:00 CST 2019, time=2019-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597090, encodeId=98dc159e09019, content=<a href='/topic/show?id=0968850356f' target=_blank style='color:#2F92EE;'>#脑脊液漏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85035, encryptionId=0968850356f, topicName=脑脊液漏)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a6b618479697, createdName=gds2015, createdTime=Mon Apr 01 12:05:00 CST 2019, time=2019-04-01, status=1, ipAttribution=)]
    2019-07-13 小微940490

    mark

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=813588, encodeId=41158135884d, content=<a href='/topic/show?id=66ed9628563' target=_blank style='color:#2F92EE;'>#针灸#</a>典型的乱针行为!针灸过深并没有实际作用。按目前的研究,<a href='/topic/show?id=e391e8449c0' target=_blank style='color:#2F92EE;'>#经络#</a>很可能是肌肉下<a href='/topic/show?id=e9591038369f' target=_blank style='color:#2F92EE;'>#筋膜间隙#</a>,意味着针过深,并不能取到实际作用。应该凭手感找到肌肉间的缝隙,进行相关刺激,从而影响到筋膜下相关循环,以及炎症因子,从而达到治疗作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=341, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=96285, encryptionId=66ed9628563, topicName=针灸), TopicDto(id=78449, encryptionId=e391e8449c0, topicName=经络), TopicDto(id=103836, encryptionId=e9591038369f, topicName=筋膜间隙)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 26 22:26:45 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000748, encodeId=b6ff2000e48e0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Jun 14 07:05:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=369592, encodeId=1e7a3695929d, content=mark, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=526e2567988, createdName=小微940490, createdTime=Sat Jul 13 12:22:16 CST 2019, time=2019-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740363, encodeId=86ed1e4036380, content=<a href='/topic/show?id=2cab850369a' target=_blank style='color:#2F92EE;'>#脑脊液漏出#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85036, encryptionId=2cab850369a, topicName=脑脊液漏出)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=04e634737554, createdName=passed water, createdTime=Thu Nov 07 20:05:00 CST 2019, time=2019-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597090, encodeId=98dc159e09019, content=<a href='/topic/show?id=0968850356f' target=_blank style='color:#2F92EE;'>#脑脊液漏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85035, encryptionId=0968850356f, topicName=脑脊液漏)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a6b618479697, createdName=gds2015, createdTime=Mon Apr 01 12:05:00 CST 2019, time=2019-04-01, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=813588, encodeId=41158135884d, content=<a href='/topic/show?id=66ed9628563' target=_blank style='color:#2F92EE;'>#针灸#</a>典型的乱针行为!针灸过深并没有实际作用。按目前的研究,<a href='/topic/show?id=e391e8449c0' target=_blank style='color:#2F92EE;'>#经络#</a>很可能是肌肉下<a href='/topic/show?id=e9591038369f' target=_blank style='color:#2F92EE;'>#筋膜间隙#</a>,意味着针过深,并不能取到实际作用。应该凭手感找到肌肉间的缝隙,进行相关刺激,从而影响到筋膜下相关循环,以及炎症因子,从而达到治疗作用, beContent=null, objectType=article, channel=null, level=null, likeNumber=341, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=96285, encryptionId=66ed9628563, topicName=针灸), TopicDto(id=78449, encryptionId=e391e8449c0, topicName=经络), TopicDto(id=103836, encryptionId=e9591038369f, topicName=筋膜间隙)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 26 22:26:45 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000748, encodeId=b6ff2000e48e0, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Fri Jun 14 07:05:00 CST 2019, time=2019-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=369592, encodeId=1e7a3695929d, content=mark, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=526e2567988, createdName=小微940490, createdTime=Sat Jul 13 12:22:16 CST 2019, time=2019-07-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1740363, encodeId=86ed1e4036380, content=<a href='/topic/show?id=2cab850369a' target=_blank style='color:#2F92EE;'>#脑脊液漏出#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85036, encryptionId=2cab850369a, topicName=脑脊液漏出)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=04e634737554, createdName=passed water, createdTime=Thu Nov 07 20:05:00 CST 2019, time=2019-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597090, encodeId=98dc159e09019, content=<a href='/topic/show?id=0968850356f' target=_blank style='color:#2F92EE;'>#脑脊液漏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85035, encryptionId=0968850356f, topicName=脑脊液漏)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a6b618479697, createdName=gds2015, createdTime=Mon Apr 01 12:05:00 CST 2019, time=2019-04-01, status=1, ipAttribution=)]

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Medicine (Baltimore):针灸在过敏性鼻炎患者中的治疗效果研究

最近,有研究人员在舌下特异性过敏原免疫治疗(SASIT)的过敏性鼻炎(AR)患者中,回顾性的分析了针灸疗法作为一种附加的疗法(AAOT)对过敏性鼻炎患者的治疗效果。研究总共包括了120名符合研究标准的AR成年人患者。其中60名患者接受了AAOT和SASIT治疗,并作为治疗组,其他60名受试者只接受了SASIT治疗,并作为对照组。主要结果为AR症状,次级结果为通过鼻炎生活质量调查问卷(RQLQ)评估

JAMA:看国外专家如何玩转针灸,缓解癌症副作用

近日,国际顶尖杂志JAMA主刊,刊发了关于针灸可以显著缓解激素敏感性乳腺癌由于使用芳香酶抑制剂而产生的关节疼痛的副作用。第一作者是Hershman博士。其中应用的试验和统计方法,对于研究针灸对于各种疾病的作用具有指导意义。

针灸在美快速发展,新法案首将针灸疗法纳入其中

起源于中国的针灸近来在美国快速发展。美国一项代号为H.R.6的新法案(SUPPORT for Patients and Communities Act,支持患者和社区法案)首次将针灸疗法纳入其中,要求在一年内对针灸的镇痛效果进行评估;一项新研究也显示,美国的针灸师数量比20年前增长了257%。

针灸刮痧有用吗?医生们吵翻了

近日,一条“贴膏药贴出一条人命”的消息,再次引发“中医到底科学不科学”的争论。尽管前有因发现青蒿素所获得的诺贝尔奖撑腰,中医药在部分国人心中仍缺少底气。西医是科学,这是人所共知,也是西医的自信所在。那么,中医是科学有效的吗?有效就是科学?在影视明星里,有不少人都自称是“中医迷”,演员佟大为就是其中之一。相信中医,陈坤也不例外。他曾在微博上写道,“我相信中医疗法,没有之一。”很多人在经过针灸、

中国针灸有望纳入美国医保?四百多种病针灸都能治

近日,美国总统特朗普签署一项名为H.R.6的法案,旨在寻找治疗疼痛的替代性药物和疗法,遏制阿片类止痛药物在美国的泛滥。在该法案中,针灸、医疗按摩等项目,被列入有待评估的替代性疗法。这意味着,未来一年内,针灸有望获美国卫生部评估和认可。阿片类药物滥用成瘾 针灸大有可为目前,美国阿片类止痛药物滥用与成瘾危机日益严重,阿片类止痛药包括杜冷丁、吗啡等,镇痛作用强大,但有极强成瘾性。官方数据显示,每天平均有

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