Spontaneous Intracranial Hypotension in the Critical Patient

Mamlouk, Mark D.; Shen, Peter Y.; Sedrak, Mark

doi:10.1177/08850666211024886

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…3 Other symptoms include tinnitus, muffled hearing, frontotemporal-like dementia, coma, and rarely, death. 4 To date, there are three main treatments for CVFs: percutaneous fibrin glue occlusion, endovascular embolization, and open surgical ligation. [5][6][7] The CT-guided fibrin glue technique has been recently introduced in a series of 13 patients, where the technique was highlighted and a short term imaging and clinical follow-up was assessed.…”

Section: Introductionmentioning

confidence: 99%

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Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

2022

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Objective: To assess headache response and patient perception of improvement after computed tomography (CT)-guided fibrin glue occlusion of cerebrospinal fluid-venous fistulas (CVFs) in a large sample size and with a long clinical follow-up.Background: CVFs are an increasingly identified type of spinal leak in patients with spontaneous intracranial hypotension (SIH), and CT-guided fibrin glue occlusion has been introduced as a treatment option in a prior small series.Methods: Retrospective case series review of medical records from a single institution was performed for all patients with CVFs that were treated with CT-guided fibrin glue occlusion between August 2018 and April 2022 in an outpatient or inpatient setting. Pre-and posttreatment Headache Impact Tests (HIT-6) were administered to patients, and a change in scores was evaluated. In some patients, pretreatment HIT-6 tests were not obtained prior to the fibrin glue procedure, and the patient was asked to fill out the pretreatment test based on personal recall of their symptoms prior to treatment. Patients completed a Patient Global Impression of Change (PGIC) scale after treatment. Pre-and posttreatment brain imaging was compared using Bern SIH scores.Results: Thirty-five patients (19 females, 16 males; mean age 60 years) with CVFs treated with CT-guided fibrin glue occlusion met the inclusion criteria. Mean pretreatment and posttreatment HIT-6 scores were 64.7 ± 10.2 and 43.4 ± 9.9 (p < 0.001), respectively. The posttreatment HIT-6 questionnaires were completed on average 10.3 months after treatment, and 20 patients filled out the pretreatment HIT-6 form after their treatment. The mean PGIC score was 6.1 ± 1.3. Mean pretreatment and posttreatment Bern SIH scores were 5.9 ± 2.5 and 1.5 ± 1.5 (p < 0.001), respectively. Conclusions:We report a large series of patients who underwent CT-guided fibrin glue occlusion of CVFs. We showed that headache scores decreased after treatment, and the majority of patients had high PGIC scores. Posttreatment brain MRIs also showed improved Bern SIH scores.

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Section: Introductionmentioning

confidence: 99%

“…Headaches can wane with time or may be absent altogether, which can sometimes make diagnosis of SIH challenging 3 . Other symptoms include tinnitus, muffled hearing, frontotemporal‐like dementia, coma, and rarely, death 4 …”

Section: Introductionmentioning

confidence: 99%

Headache response after CT‐guided fibrin glue occlusion of CSF‐venous fistulas

2022

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“…[1][2][3] Type III spinal CSF leaks were first described in 2014 and are an increasingly recognized cause of spontaneous intracranial hypotension. [4][5][6][7][8][9][10][11][12][13][14] Because these type III leaks are considered to be slower in nature, they do not necessarily result in epidural fluid collections and can be more difficult to detect compared with types I and II CSF leaks. 15 Much has been previously described in the literature related to use of dynamic myelography, computed tomography myelography (CTM), and digital subtraction myelography to detect types I to III spinal CSF leaks.…”

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confidence: 99%

“…Types I and II leaks are most common, with type III leaks being less common and underrecognized 1–3 . Type III spinal CSF leaks were first described in 2014 and are an increasingly recognized cause of spontaneous intracranial hypotension 4–14 . Because these type III leaks are considered to be slower in nature, they do not necessarily result in epidural fluid collections and can be more difficult to detect compared with types I and II CSF leaks 15 …”

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Imaging, Clinical, and Demographic Differences in Patients With Type III Spinal Cerebrospinal Fluid Leak (Cerebrospinal Venous Fistulas) Compared With Patients With Types I and II Spinal Cerebrospinal Fluid Leak

Mehan

Buch

2022

J Comput Assist Tomogr

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ObjectiveSpinal cerebrospinal fluid (CSF) leaks are an underdiagnosed cause of neurologic symptoms. The most common types of spinal CSF leaks are from dural tears (type I) and meningeal diverticula (type II). Cerebrospinal fluid–venous fistulas (type III) are less common and underrecognized. The purpose of this study was to evaluate the intracranial and spinal imaging findings in patients with types I/II versus type III leaks.Materials and MethodsThis was a retrospective, institutional review board–approved study performed on adult patients between January 2020 to September 2021 with surgically confirmed type I/II/III spinal CSF leak. Patients had preoperative brain magnetic resonance imaging (MRI) with contrast and medical records detailing symptoms and clinical diagnoses. Patients were excluded for nondiagnostic brain MRIs. Demographic and clinical information were recorded. The presence of extra-axial collections, pachymeningeal thickening, brain sagging, and decreased pontomamillary distance were evaluated on MRI.ResultsSeven patients had type III leaks, and 16 had type I/II leaks. Patients with type III leaks were older (P = 0.0003) and had higher rates of initial misdiagnosis (100% vs 31%) and longer times to correct diagnosis (P = 0.03) compared with type I/II leaks. Intracranial extra-axial collections were never seen with type III leaks but were seen in 50% of type I/II leaks. Pachymeningeal thickening and brainstem sagging occurred in nearly equal frequency between groups. Smaller pontomamillary distances were seen in type III leaks versus type I/II leaks (P = 0.047).ConclusionsWhen evaluating patients with suspected spinal CSF leak, findings of older age, absence of intracranial extra-axial collections, and small pontomamillary distances may raise suspicion for type III versus type I/II leak.

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