Spontaneous intracranial hypotension

Abstract

We report two patients with spontaneous intracranial hypotension. In addition to the cardinal features of a postural headache and a low CSF pressure, the patients also had subdural fluid collections demonstrated by head MRI. In both patients, radionuclide cisternography revealed a CSF leak along the spinal axis and rapid accumulation of radioisotope in the bladder. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Associated symptoms, including tinnitus and vertigo, and subdural fluid collections are presumably from hydrostatic changes among intracranial fluid compartments that occur at low CSF pressures. Methods of treatment are identical to those for post-dural puncture headaches. Epidural blood patches and epidural saline infusions have rapidly ameliorated the symptoms of spontaneous intracranial hypotension.

Spontaneous intracranial hypotension with pituitary adenoma

“…It is aggravated in the upright position and decreased in the recumbent position. Valsalva manoeuvre and head shaking may also aggravate the headache [2]. Nausea/vomiting, tinnitus, vertigo, photophobia, visual field defects, neck traction and cranial nerve palsies are among the other clinical features [2,3].…”

“…Valsalva manoeuvre and head shaking may also aggravate the headache [2]. Nausea/vomiting, tinnitus, vertigo, photophobia, visual field defects, neck traction and cranial nerve palsies are among the other clinical features [2,3]. CSF pressure evaluation is a reliable method for the diagnosis of SIH and the pressure is usually less than 5-6 cm H 2O [4,5].…”

“…These findings may be subtle when the patient is examined in the supine position, and they may therefore easily be missed [8]. As a late manifestation, descent of cerebellar tonsils may be noted [2]. On spinal MRI, meningeal diverticula or dural tears may be observed [2].…”

“…As a late manifestation, descent of cerebellar tonsils may be noted [2]. On spinal MRI, meningeal diverticula or dural tears may be observed [2]. Diffuse dural enhancement of the spinal canal was also described [3].…”

Hipotensão intracraniana espontânea: relato de caso

“…Inicialmente descrita como aliquorréia aguda por Schaltenbrand, algumas observações foram relatadas na atual década [1][2][3] . Espessamento e hipercaptação de contraste meníngeo podem ser observados na ressonância nuclear magnética (RNM) do crânio de pacientes com tal síndrome, bem como presença de higroma subdural, hematoma subdural e herniação tonsilar ou incisural [4][5][6][7][8][9][10][11] .…”