Presentation
Occasionally, presentation is more sinister, with reported cases of decreased level of consciousness and coma 3. [radiopaedia.org]
Posterior globe flattening was the only finding which, if present, was suggestive of the diagnosis of IIH. [bioline.org.br]
The present report is of a patient with spontaneous IHS and a dural leak located at the level of T12–L1. [em-consulte.com]
The authors present this illustrative case of postural headache revealing SIH misdiagnosed and complicated by subdural hematoma following lumbar puncture. [dovepress.com]
In particular, findings on MR imaging studies have allowed physicians to understand and appreciate its true incidence and varied modes of presentation. [jpma.org.pk]
Entire Body System
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Hunting
Akbar JJ, Luetmer PH, Schwartz KM, Hunt CH, Diehn FE, Eckel LJ. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. [rarediseases.org]
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Marfanoid Habitus
habitus).[ 10 ] In spite of the different mechanisms each supports, all of these studies link structurally weak connective tissue to DE and dural structural abnormalities in general and, consequently, elevated risk of SIH. [surgicalneurologyint.com]
habitus X-linked intellectual disability, Abidi type X-linked intellectual disability, Armfield type X-linked intellectual disability, Brooks type X-linked intellectual disability, Cabezas type X-linked intellectual disability, Cantagrel type X-linked [se-atlas.de]
Musculoskeletal
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Back Pain
Spinal Cord Stimulation 1379 Motor Cortex and Deep Brain Stimulation 1392 Epidural Steroid Injections 1423 Intrathecal Drug Delivery in the Management of Pain 1437 Intradiscal Therapies for Low Back Pain 1458 SECTION F SURGICAL APPROACHES 1486 The Surgical [books.google.com]
ANTI TNF – α Drugs and DMARDs for Low Back Pain 65. Facet Syndrome 66. Sacroiliac Joint Syndrome 67. Piriformis Syndrome 68. Pulsed Radiofrequency, Water-Cooled Radiofrequency, and Cryoneurolysis 69. Discography 70. [elsevier.com]
The 67 patients suffered from low back pain with sciatica in 27 cases, inflammatory arthritis in 14 cases, brachial neuralgia in 6 cases, osteoarthritis in 8 cases, and miscellaneous conditions in 12 cases. [slideplayer.com]
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Low Back Pain
Spinal Cord Stimulation 1379 Motor Cortex and Deep Brain Stimulation 1392 Epidural Steroid Injections 1423 Intrathecal Drug Delivery in the Management of Pain 1437 Intradiscal Therapies for Low Back Pain 1458 SECTION F SURGICAL APPROACHES 1486 The Surgical [books.google.com]
ANTI TNF – α Drugs and DMARDs for Low Back Pain 65. Facet Syndrome 66. Sacroiliac Joint Syndrome 67. Piriformis Syndrome 68. Pulsed Radiofrequency, Water-Cooled Radiofrequency, and Cryoneurolysis 69. Discography 70. [elsevier.com]
The 67 patients suffered from low back pain with sciatica in 27 cases, inflammatory arthritis in 14 cases, brachial neuralgia in 6 cases, osteoarthritis in 8 cases, and miscellaneous conditions in 12 cases. [slideplayer.com]
Neurologic
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Trigeminal Neuralgia
Neuralgia 1507 Hypnosis 1238 Relaxation and Imagery Techniques 1255 Ablative Neurosurgical Procedures for Chronic Pain 1515 Perspectives 1523 Spine Clinics 1532 Pain Management at the End of Life 1547 Training Pain Specialists 1558 1558 Emergencies in [books.google.com]
Neurosurg Focus. (2007). 23 E8 [Article] [PubMed] Cheshire, WPJr, Wharen, REJr Trigeminal neuralgia in a patient with spontaneous intracranial hypotension.. [anesthesiology.pubs.asahq.org]
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Cognitive Impairment
Cognitive impairments/mental “clouding” may also occur. However, tolerance to these side effects typically occurs within a few days to weeks of therapy initiation. [slideplayer.com]
Against this view was the observation that no altered levels of alertness, cognitive impairments, or focal neurologic findings were associated with the elevated ICP. [emedicine.medscape.com]
Workup
The CT scan is the frontline imaging workup for headache, excepted the presence of the subdural hematoma, this exam can be easily interpreted as being unremarkable. [omicsonline.org]
See Workup for more detail. Management The goal is to preserve optic nerve function while managing increased ICP. [emedicine.medscape.com]
Lumbar Puncture
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Lumbar Puncture Normal
This condition is associated with low CSF opening pressure on lumbar puncture (normal CSF pressure is at least 60 mmH 2 O or 590 Pa). [2] MR imaging is relatively sensitive and specific in the detection of benign or spontaneous intracranial hypotension [wikidoc.org]
Treatment
Treatment is aimed at preventing permanent visual loss and includes treatment with medicines. Brain surgery (neurosurgery) may also be used. For many people, a combination of medical and surgical treatment can help to control their symptoms well. [patient.info]
In most cases, epidural blood patch is the main treatment; however, bilevel or multilevel epidural injections are gaining some momentum as treatment for selected cases. [journals.lww.com]
Treating Essential Tremor Patients with significant functional impairment usually opt for some form of treatment. Less impaired patients may choose to forgo treatment all together. [columbianeurosurgery.org]
All 18 patients suffered moderate to severe functional disability as a result of their headaches and expressed dissatisfaction with their treatment regimen, which included several commonly used prescription and non-prescription treatments such as naproxen [practicalneurology.com]
Treatments for chronic IH Treatment for IH depends on the underlying cause, if this is known. [nhs.uk]
Prognosis
Post-dural puncture headache: Part II-prevention, management, and prognosis. Headache 2010;50:1482-98. 8. Shah KH, McGillicuddy D, Spear J, Edlow JA. Predicting difficult and traumatic lumbar punctures. Am J Emerg Med 2007;25:608-11. [ruralneuropractice.com]
The prognosis is excellent if precociously and properly diagnosed. Disclosure The authors report no conflicts of interest in this work. References 1. Paldino M, Mogilner AY, Tenner MS. Intracranial hypotension syndrome: a comprehensive review. [dovepress.com]
Treatment and prognosis A non-targeted epidural blood patch is often used in cases of spontaneous intracranial hypotension, on the assumption that the leak is from the spine, with variable success 9. [radiopaedia.org]
What is the outlook (prognosis)? It is essential to detect idiopathic intracranial hypertension (IIH) early and to start treatment early to prevent permanent loss of vision occurring. [patient.info]
Etiology
The loss of CSF can occur at different location of the neural axis depending on the underlying etiology. [neupsykey.com]
Neurology, 6th ed, pp637-8) Year introduced: 1998 PubMed search builder options Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications diagnosis diagnostic imaging drug therapy epidemiology etiology [ncbi.nlm.nih.gov]
Post-dural puncture headache: Part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 2010;50:1144-52. 5. Grant R, Condon B, Hart I, Teasdale GM. [ruralneuropractice.com]
Such headaches can also occur spontaneously without an obvious etiology [3]. Symptoms of this disease include headache, nausea, vomiting, blurred vision, tinnitus, vertigo, and photophobia [4,5]. [academic.oup.com]
Zoom Discussion Diagnosing the etiology of IHS is of major importance [ 2, 3 ]. The most common CSF leak location is at thoracic level. In the present case, the leak was at the T12–L1 level. The first step of IHS treatment is conservative. [em-consulte.com]
Epidemiology
Principles of Neurology, 6th ed, pp637-8) Year introduced: 1998 PubMed search builder options Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications diagnosis diagnostic imaging drug therapy epidemiology [ncbi.nlm.nih.gov]
Post-dural puncture headache: Part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 2010;50:1144-52. 5. Grant R, Condon B, Hart I, Teasdale GM. [ruralneuropractice.com]
Epidemiology of secondary intracranial hypotension is variable and matches that of the underlying cause. The condition often presents as a positional headache which is relieved by lying in a recumbent position, usually within 15-30 minutes 12. [radiopaedia.org]
Descriptive epidemiology in Rochester, Minn, 1976 to 1990. Arch Neurol. 1993 Jan. 50(1):78-80. [Medline]. Radhakrishnan K, Thacker AK, Bohlaga NH, Maloo JC, Gerryo SE. [emedicine.medscape.com]
References Bezov, D, Lipton, RB, Ashina, S Post-dural puncture headache: Part I diagnosis, epidemiology, etiology, and pathophysiology.. [anesthesiology.pubs.asahq.org]
Pathophysiology
Pathophysiological basis of the clinical and imaging features has also been reviewed. [bioline.org.br]
Magnetic resonance imaging of intracranial hypotension syndrome with pathophysiological correlation. Headache 2000; 40: 292-9. [jpma.org.pk]
Post-dural puncture headache: Part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 2010;50:1144-52. 5. Grant R, Condon B, Hart I, Teasdale GM. [ruralneuropractice.com]
TRPV1 in Migraine Pathophysiology. TINS. 2010. Vol 16: 153-159. [practicalneurology.com]
Pathophysiology The pathophysiology of IIH is unclear. A dominant early theory held that cerebral edema played a role in the pathogenesis of elevated ICP in these patients. [emedicine.medscape.com]
Prevention
Phal Journal of Clinical Neuroscience. 2015; 22(12): 1973 4 Evaluation of hydrocephalus and other cerebrospinal fluid disorders with MRI: An update Merve Gulbiz Kartal,Oktay Algin Insights into Imaging. 2014; 5 Pulsed Estrogen Therapy Prevents Post-OVX [neurologyindia.com]
Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications diagnosis diagnostic imaging drug therapy epidemiology etiology genetics metabolism mortality nursing pathology physiology physiopathology prevention [ncbi.nlm.nih.gov]
Preventable deaths among major trauma patients in Mersey Region, North Wales and the Isle of Man. Injury, 1996,27:189-192. Página 83 - CN et al. [books.google.es]