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Intracranial Hypotension


Presentation

  • (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]
  • In this report, we describe an unusual presentation of SIH in a patient who presented with progressive cognitive deficits, increased somnolence, dysarthria, chorea, and urinary incontinence.[frontiersin.org]
Intravenous Administration
  • administration of gadolinium showing subdural fluid-collection enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain. 5, 6 Although typical, these radiological features may be missed, leading[dovepress.com]
  • Yucel A, Ozyalcin S, Talu GK, Yucel EC, Erdine S (1999) Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 24:51–4 131.[thejournalofheadacheandpain.biomedcentral.com]
Sputum
  • […] suspected CSF leak if the discharge contains glucose without any visible blood, blood glucose level is under 6-mmol/L, and in the absence of symptoms suggestive of an upper respiratory tract infection including sneezing, nasal blockage, cough, sore throat, sputum[practicalneurology.com]
Nasal Discharge
  • This test measures glucose concentration as an indicator of CSF in nasal discharge, but it has a low positive predictive value.[practicalneurology.com]
Sore Throat
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
  • Key Words: neuroendoscopy, hydrocephalus, iatrogenic complication, intracranial hypotension, haematoma[medical-dictionary.thefreedictionary.com]
  • Patient 2 presented with a paradoxical positional pattern of orthostatic hypotension.[cambridge.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]
Tachycardia
  • Orthostatic headaches without CSF leak in postural tachycardia syndrome. Neurology. 2003 Oct 14;61(7):980–982.[rarediseases.org]
  • In patients with typical orthostatic headache and no apparent cause, and after exclusion of postural orthostatic tachycardia syndrome (POTS), it is reasonable in clinical practice to provide autologous lumbar epidural blood patch (EBP).[ichd-3.org]
  • 기립빈맥증후군(postural orthostatic tachycardia syndrome)에서도 기립 시 어지럼과 더불어 두통이 흔히 나타나기 때문에 기립두통을 호소하는 환자의 감별진단에 포함시켜야 한다( Table 2 ) [ 18 ]. 편두통의 경우에도 움직이면 두통이 악화하므로 환자가 누워 있는 것을 선호할 수 있다( Table 2 ) [ 19 ].[jkna.org]
  • Orthostatic headaches without CSF leak in postural tachycardia syndrome. Neurology 2003 ; 61(7): 980 – 982. Google Scholar 35. Howraa, A, Patrick, AB, Le-Xin, W. Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review.[journals.sagepub.com]
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]
Neglect
  • […] venous structures, pituitary hyperemia, and sagging of the brain. 5, 6 Although typical, these radiological features may be missed, leading to misdiagnosis of this condition. 7, 8 That was the case in this patient, for whom subdural fluid collection was neglected[dovepress.com]
  • The diagnosis remains difficult due to the various clinical manifestations, some of which are nonspecific and easily to be neglected.[thejournalofheadacheandpain.biomedcentral.com]
Memory Impairment
  • impairment Many medical conditions can cause headaches accompanied by other neurological symptoms.[barrowneuro.org]
Headache Relieved by Lying Down
  • Orthostatic headache relieved on lying down is the most common presentation. This contrasts with the headache of meningitis which is exacerbated by lying down.[ncbi.nlm.nih.gov]
Recurrent Headache
  • Headache, Ophthalmoplegia, and Quadriparesis induced by Intracranial Hypertension 2005 ;23(5) Neurological Manifestations of Acute Intermittent Porphyria 2002 ;20(5) Clinical and Neuroradiologic Evaluations of Intracranial Lipoma 2001 ;19(2)[jkna.org]
Difficulty Concentrating
  • concentrating Double vision Dizziness Imbalance Memory impairment Many medical conditions can cause headaches accompanied by other neurological symptoms.[barrowneuro.org]

Workup

  • 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]

Treatment

  • 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]
  • 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]
  • 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]
  • Conclusions Rebound high-pressure headache occurs in about one-fourth of patients following treatment of SIH and is more common in those with restriction of cerebral venous outflow.[cp.neurology.org]
  • Effective treatment is available, and the risks of treatment for the variety of conditions that may mimic spontaneous intracranial hypotension are significant.[jamanetwork.com]

Prognosis

  • 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 defects[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]

Etiology

  • 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]
  • Cases with encephalitis have special MRI findings varying due to the etiology, being the temporal lobe involvement of HSV 1 encephalitis the most common.[intechopen.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]
  • 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]

Epidemiology

  • 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]
  • 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]
  • 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 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • Investigation of the risk factors for SDH may help to better understand its pathophysiology. Despite numerous publications [ 6, 13 – 16 ], studies on the risk factors for SDH in SIH patients are largely lacking.[journals.plos.org]

Prevention

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

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