Spontaneous intracranial hypotension and its complications

Abstract

Spontaneous intracranial hypotension (SIH) is a syndrome that was unknown until the advent of magnetic resonance imaging (MRI). It is a cause of orthostatic headache, which remains underdiagnosed and, rarely, can result in several complications including dural venous sinus thrombosis, subdural hematoma and subarachnoid hemorrhage. Some of these complications are potentially life-threatening and should be recognized promptly, mainly by imaging studies. We reviewed the MRI of nine patients with SIH and describe the complications observed in three of these patients. Two of them had subdural hematoma and one had a dural venous sinus thrombosis detected by computed tomography and MRI. We concluded that MRI findings are of great importance in the diagnosis of SIH and its complications, which often influence the clinical-surgical treatment of the patient.

Spontaneous Intracranial Hypotension: Case Study and Review of the Literature

“…The presence of subdural hygromas or hematomas on imaging is estimated to be approximately 50% [19]. Subdural hygromas are generally recognized as thin, bilateral, and symmetrical, with minimal mass effect, if any, and are thought to be a compensatory response to CSF hypovolemia [20].…”

Cerebral venous thrombosis: imaging patterns

“…Dural venous sinus and cortical vein thrombosis have been described as uncommon complications of intracranial hypotension syndrome ( Figure 12 ) and are believed to be secondary to slow blood flow in a dilated dural sinus. The risk of the syndrome is increased in patients with thrombotic preconditions( 13 , 14 ).…”

Importance of actively suspecting intracranial hypotension with diagnostic imaging prior to lumbar puncture

“…Twenty percent of patients with SIH develop chronic subdural hematoma (CSDH) complications 1 . Chronic subdural hematoma is caused by subdural rupture of the bridging veins that are stretched as the cerebral parenchyma is pulled down due to low CSF pressure.…”

“…Low CSF pressure (commonly responsive to conservative treatments) may require surgery or lead to a fatal course if subdural hematoma is involved 1 . Therefore, noninvasive diagnostic imaging is crucial in diagnosing low CSF pressure in patients with headaches.…”

“…Spontaneous intracranial hypotension, which causes CSF decrease due to CSF leak from the cerebrospinal cavity to the epidural space, is a rare disease (5 in 100 000) and generally occurs around age 40. Its symptoms, including headache, neck pain, dizziness, visual impairment, hearing changes, and nausea, may be triggered by cranial nerve traction associated with low CSF pressure 1 …”