(February 16, 2017) Spontaneous Intracranial Hypotension Presenting as a "Pseudo-Chiari 1". [cureus.com]

A review of five patients presenting recently to our institution with classical imaging findings together with a review of the literature is presented. [ncbi.nlm.nih.gov]

Case Presentations 12 Noon Q&A 12:15 P.M. [radiology.duke.edu]

If both are present, then other pathogens need not be investigated. [neurologyadvisor.com]

Occasionally, presentation is more sinister, with reported cases of decreased level of consciousness and coma 3. [radiopaedia.org]

• 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]

  Akbar JJ, Luetmer PH, Schwartz KM, Hunt CH, Diehn FE, Eckel LJ (2012) The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. [thejournalofheadacheandpain.biomedcentral.com]

• Acute Intermittent Porphyria

  Intermittent Porphyria 2002 ;20(5) Clinical and Neuroradiologic Evaluations of Intracranial Lipoma 2001 ;19(2) [jkna.org]

• Chills

  She experienced nausea with attempted sitting, but she denied photophobia, neck stiffness, fever, or chills. [anesthesiology.pubs.asahq.org]

• Marfanoid Habitus

  […] skeletal features in 21% of all patients with SIH.[ 29 ] Finally, a case-control analysis showed that the only HCTD feature significantly elevated among patients with diagnosed SIH was dolichostenomelia (Marfanoid habitus).[ 10 ] In spite of the different [surgicalneurologyint.com]

• Arachnodactyly

  Physical exam findings consistent with Marfan syndrome included dolichostenomelia and arachnodactyly, and her cardiovascular examination confirmed a mechanical aortic valve. The remainder of her exam was noncontributory. [surgicalneurologyint.com]

• Constipation

  […] with gadolinium enhanced MRI due to lack of blood–brain barrier and an increase in the volume of venous blood in this compartment. 8 The patients have variously been treated with analgesia, bed rest, caffeine, steroids and senna and lactulose (to avoid constipation [ncbi.nlm.nih.gov]

• Hypotension

  Thoracic Epidural Blood Patches in the Treatment of Spontaneous Intracranial Hypotension: A Retrospective Case Series. Pain Physician. 2015 Aug;18(4):343–348. Mokri B. Spontaneous Intracranial Hypotension. [rarediseases.org]

  Early epidural blood patch in spontaneous intracranial hypotension. Neurology 2004 ; 63 : 1950 –51 ↵ Schievink WI, Meyer FB, Atkinson JL, et al. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. [ajnr.org]

  Enlargement of epidural veins has been described previously in association with both spontaneous intracranial hypotension [ 20 – 23 ] and hypotension after lumbar puncture [ 24 ]. [ajronline.org]

  Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006;295:2286–96. doi: 10.1001/jama.295.19.2286 Yuh EL, Dillon WP. Intracranial hypotension and intracranial hypertension. [ajnrdigest.org]

  Spontaneous intracranial hypotension. Continuum (Minneap Minn) 2015 ;21(4 Headache):1086–1108. Medline, Google Scholar 2. Schievink WI, Gordon OK, Tourje J. [pubs.rsna.org]

• Torticollis

  이상운동 자발두개내압저하에 기인한 두통에서 무도병, 파킨슨증, 기운목(torticollis), 떨림 등이 발생할 수 있다[ 31, 32 ]. 떨림은 체위떨림(postural tremor), 안정시떨림(resting tremor) 등 다양하게 나타난다[ 31, 32 ]. 6. 신경뿌리병증 자발두개내압저하에 기인한 두통에서 팔의 통증, 감각이상이나 무감각을 호소하기도 한다[ 1 ]. [jkna.org]

• Spine Pain

  Other manifestations of intracranial hypotension are nausea, spine pain, neck stiffness, photophobia, hearing abnormalities, tinnitus, dizziness, gait unsteadiness, cognitive and mental status changes, movement disorders and upper extremity radicular [jkna.org]

• Recurrent Headache

  Link Full text via DOI Download Citation E-Mail Print Share: METRICS 0 CrossRef 1,095 View 128 Down Secondary Intracranial Hypertension Due to Unusual Causes 2013 ;31(1) Cerebral Venous Thrombosis Complicated by Intracranial Hypotension 2012 ;30(4) Recurrent [jkna.org]

• Resting Tremor

  떨림은 체위떨림(postural tremor), 안정시떨림(resting tremor) 등 다양하게 나타난다[ 31, 32 ]. 6. 신경뿌리병증 자발두개내압저하에 기인한 두통에서 팔의 통증, 감각이상이나 무감각을 호소하기도 한다[ 1 ]. 자발두개내압저하에 기인한 두통 환자를 분석한 국내 연구에서 상지의 신경뿌리병증(radiculopathy)은 전체 환자의 6.7%에서 나타났다( Table 3 ) [ 9 ]. [jkna.org]

• Communicating Hydrocephalus

  Hearing loss following ventriculoperitoneal shunt in communicating hydrocephalus patients: a pilot study. Laryngoscope 2014;124:1923-1927. 28. Stoeckli SJ, Bohmer A. Persistent bilateral hearing loss after shunt placement for hydrocephalus. [jkna.org]

• Focal Neurological Deficit

  No signs of meningeal irritation nor focal neurological deficits were found. [nnjournal.net]

• Cranial Neuropathy

  However, numerous other symptoms also were seen, including tinnitus, back and neck pain, nausea and vomiting, cranial neuropathy, and myelopathy. Nine of the patients responded to bed rest and blood patching. [ajronline.org]

Myth 4: Dural Enhancement Suggests a Multipathogen Workup Dural enhancement is highly specific to SIH; however, those unfamiliar with SIH imaging may consider ordering other tests to rule out infectious, granulomatous, and neoplastic disorders. [neurologyadvisor.com]

Triaging based on MRI findings instead could make sense "because brain MRI is the first imaging of choice in the workup of patients with clinical suspicion for SIH, to rule out an underlying intracranial pathology." [medscape.com]

This diagnostic confusion may consequently lead to invasive and inappropriate workup, and the brain imaging findings are not always present [ 9, 10 ]. [ajronline.org]

With this rigorous surgical workup, only a few cases (approximately 4%) showed abnormalities along the exiting nerve root, most often nude nerve roots or thin dural covering. [journals.sagepub.com]

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]

Myth 10: One Treatment for SIH Is All It Takes The authors reported a high perception among clinicians that a single epidural blood patch treatment is all that is needed to completely resolve SIH. [neurologyadvisor.com]

In this study, the diagnosis and treatment results of a case of intracranial hypotension headache due to spinal cerebrospinal fluid leakage were reported. Up to now, there is not absolutely effective treatment for intracranial hypotension headache. [springerplus.springeropen.com]

Garcia-Carreira et al. [ 14 ] supported aggressive treatment of the underlying cerebrospinal fluid leak. [nnjournal.net]

Diagnosis and Treatment of Postpatch Headaches – Michael Malinzak, MD, PhD 9:45 A.M. Research Trials – Timothy Amrhein, MD 10:15 A.M. Q&A Break 10:30 A.M. Surgical Treatment of Disc Induced CSF Leaks – Christopher Brown, MD 11:00 A.M. [radiology.duke.edu]

Treatment No clear algorithm exists for the treatment of SIH. Many retrospective studies exist, but high quality evidence is lacking. Treatment recommendations are largely empiric. Conservative measures should always be used as an initial treatment. [appliedradiology.com]

We are hoping that the SIH registry will improve our understanding of the epidemiology, diagnosis, clinical characteristics, useful imaging modalities, treatments & management, prognosis and natural history of SIH. [ucalgary.ca]

Coma due to SIH is generally reversible and the prognosis is good. But timely recognition is essential, and the index of suspicion needs to be high. Dr. Schievink told Neurology Today View Full Article [wfneurology.org]

DIAGNOSIS AND PROGNOSIS The diagnosis is suspected from the patient’s history and is then confirmed if the meninges are enhanced in an MRI of the brain. [headaches.org]

◘ The prognosis is variable, many patients may have only mild symptoms, some patients may deteriorate with cranial nerve palsies, sinus thrombosis, large vessel strokes, or even encephalopathy and coma. 12. (1) Conservative measures for small dural [slideshare.net]

Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. [karger.com]

Akbar et al reported no intrathecal complications of GdM in 24 cases. 25 Recent reports are defining CSF to venous fistulas as another etiology of SIH. 3 These fistulas are suggested on cisternography by early renal activity. [appliedradiology.com]

Spontaneous intracranial hypotension remains an underdiagnosed etiology of new-onset headache. [practicalneurology.com]

Jeffrey Ross The Agony of Aliquorrhea Intracranial hypotension can occur in a variety of clinical settings and can be grouped by primary or secondary etiologies. [ajnrdigest.org]

Although at one point the etiology of spontaneous CSF leaks was thought to be secondary to loss of CSF volume ( Mokri 1999 ), leading to terms such as “CSF hypovolemia” or “CSF volume depletion” appearing in the literature and being used interchangeably [medlink.com]

In order to improve clinical diagnosis and provide effective treatment, the precise etiology of spontaneous intracranial hypotension should be investigated in each patient. [springerplus.springeropen.com]

We are hoping that the SIH registry will improve our understanding of the epidemiology, diagnosis, clinical characteristics, useful imaging modalities, treatments & management, prognosis and natural history of SIH. [ucalgary.ca]

Critical Care and Emergency Medicine, Complementary and Alternative Medicine, Congenital Disorders, Cytology, Dentistry, Dermatology, Developmental Biology, Dietetics, Diseases of Bones and Joints, Embryology, Endocrinology, Environmental Toxicology, Epidemiology [dergipark.org.tr]

Epidemiology of cervical artery dissection. In: Baumgartner RW, Bogousslavsky J, Caso V, et al eds. Handbook of cerebral artery dissection. Basel, Germany: Karger, 200512–15. 7. Mokri B. Spontaneous low cerebrospinal pressure/volume headaches. [ncbi.nlm.nih.gov]

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]

Schievink WI, Roiter V (2005) Epidemiology of cervical artery dissection. Front Neurol Neurosci 20:12–5 8. Schievink WI (2006) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295:2286–96 9. [thejournalofheadacheandpain.biomedcentral.com]

While it is clear from the literature that coma can occur in SIH, little is known about the frequency of the occurrence, correlation with other features of SIH, treatment options, outcomes, and the pathophysiological mechanism that may underlie the development [wfneurology.org]

Conclusions The understanding of SIH has evolved over the recent decades, leading to improvements in knowledge about the pathophysiology of the condition, diagnostic strategies, and expanded treatments. [headachejournal.onlinelibrary.wiley.com]

Pathophysiology in these cases is unclear. It may be related to a dilated epidural venous plexus and/or persistent/redeveloped arachnoid granulations. Treatment No clear algorithm exists for the treatment of SIH. [appliedradiology.com]

Nanotechnology, Neonatology, Nursing Care, Nutrition and Metabolism, Nephrology, Neurology, Neurophysiology and Brain Research, Orthopedics, Obstetrics and Gynecology, Occupational Medicine, Oncology, Ophthalmology, Oral medicine, Otorhinolaryngology, Pathophysiology [dergipark.org.tr]

In this issue of the AJNR News Digest, we focus on the work of authors who refined the pathophysiology, imaging patterns, use of advanced imaging techniques, and treatment of intracranial hypotension and CSF leaks. [ajnrdigest.org]

CONCLUSION: Being aware of orthostatic character of a headache and imaging findings of SIH could prevent diagnostic delay and serious consequences. [tjn.org.tr]

Prevention of iatrogenic risk factors Risk factors for intracranial hypotension are variable and some are avoidable. [thejournalofheadacheandpain.biomedcentral.com]

Internal Medicine, Infectious Diseases, Infertility, Laboratory Medicine, Medical Microbiology, Medical Statistics, Medico-Social Problems of the Youth and the Erderly, Mental Disorders, Mental Health, Metabolic Disorders, Methods of Epidemiology and Other Preventive [dergipark.org.tr]

The presence of subdural hematoma may prevent orthostatic headaches from developing by correcting the abnormally low intracranial pressure or volume. [karger.com]

Therefore, improved therapeutic interventions are required in order to resolve such symptoms and prevent further complications. [springerplus.springeropen.com]