Spontaneous intracranial hypotension: key features for a frequently misdiagnosed disorder

Perez‐Vega, Carlos; Robles-Lomelín, Pilar; Robles-Lomelin, Isabel; García-Navarro, Victor

doi:10.1007/s10072-020-04368-8

Cited by 19 publications

(23 citation statements)

References 53 publications

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“…The variability of clinical and imaging findings makes SIH an elusive diagnosis, and this often delays treatment 5. An improved systematic approach to SIH requires continued research into the relationship of specific MRI and other imaging findings with the diagnosis of SIH 6. Furthermore, studying the imaging and clinical findings over time of a unique cohort of patients who did not receive interventional leak-related treatment, such as blood patches, may provide insight into counseling patients on the predicted natural history of the illness with only conservative treatment.…”

Section: Introductionmentioning

confidence: 99%

Natural history of spontaneous intracranial hypotension: a clinical and imaging study

Williams

Brinjikji

Cutsforth‐Gregory

2022

J NeuroIntervent Surg

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BackgroundAlthough spontaneous intracranial hypotension (SIH) is well studied, there are few studies of the clinical and imaging history of SIH without interventional treatments. For example, what is the natural history of those who are untreated or treated only with conservative measures?ObjectiveTo conduct a retrospective study examining changes in imaging findings for patients with SIH without interventional treatments and to study associations between imaging findings and clinical symptoms.MethodsIncluded patients had a clinical diagnosis of SIH, were seen at Mayo Clinic between 1999 and 2021, had a brain MRI scan indicating SIH (Bern score), and had a brain MRI scan 6 or more months later without intervening leak-related interventional treatment. Bern scores were assigned for the first and last MRI scans prior to treatment. Patients were also grouped into three qualitative categories: overall improvement of symptoms, stable symptoms, or worsened symptoms based on patient report during the clinical visit at the time of the follow-up brain MRI scan.ResultsAmong 46 patients with untreated SIH, the Bern score improved over time in 11 (24%), was stable in 30 (65%), and worsened in 5 (11%). Two patients (4.3%) showed complete resolution of all abnormalities by the Bern scoring criteria. Symptoms improved in 7 (15%), were stable in 29 (63%), and worsened in 10 (22%).ConclusionsIn patients with brain MRI evidence of SIH, almost 25% demonstrated radiographic improvement, and 15% reported clinical improvement, during at least 6 months of observation or conservative treatment. Most had stable, persistent MRI abnormalities and symptoms when SIH was untreated.

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Section: Introductionmentioning

confidence: 99%

Natural history of spontaneous intracranial hypotension: a clinical and imaging study

Williams

Brinjikji

Cutsforth‐Gregory

2022

J NeuroIntervent Surg

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“…Clinically, the condition is primarily described as a postural headache,[ 25 ] which worsens in an upright position after a few seconds, minutes, or even hours of the patient being upright. The pain may be improved on resumption of a supine position, although an orthostatic component may not be found in all patients.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 , 28 , 30 , 34 ] In certain cases, the headache is associated with other clinical complaints such as nausea, vomiting, meningism, and cochlear-vestibular signs. [ 25 ] Common cochlear-vestibular signs include vertigo, tinnitus, dizziness, sound distortion, hearing change, and hypoacusia. [ 9 , 10 ] Rarer manifestations may include facial pain or numbness, weakness or facial spasm, dysgeusia, and transient diplopia associated with cranial nerve palsy.…”

Section: Introductionmentioning

confidence: 99%

Lumbar epidural blood patch: An effective treatment for intracranial hypotension

Leung¹,

Chan²,

Chan³

2022

Surgical Neurology International

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Background: The literature has demonstrated the efficacy of lumbar epidural blood patch (LEBP) in the management of spontaneous intracranial hypotension (SIH). However, the underlying pathophysiology of such management remains unclear. In this study, we aim to evaluate the utility of LEBP injections in the management of SIH and develop a potential management algorithm used in the triage and management of SIH patients. Methods: We retrospectively examined the clinical case notes of 14 patients with SIH (age: 25–69 years) who were managed with LEBP injections during the year of 2016–2021. We evaluated the presenting symptoms of each selected patient and radiological findings as well as treatment outcomes. Our aim is to evaluate the effectiveness of LEBP in the treatment of SIH patients through follow-up clinical and imaging assessment. Results: About 93% of patients describe the presence of headache at presentation, while 43% describe it as being of an orthostatic nature. All patients demonstrated typical findings on magnetic resonance imaging brain. Treatment success assessed through symptomatic improvement and radiological resolution was found in 85% of our patients at a 2-month interval. Conclusion: LEBP injection is an effective method of management in patients with a diagnosis of SIH. It should be considered in all SIH patients irrespective of whether a “dural leak” can be localized through radiological investigations.

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“…[ 9 ] This process results in a downward traction of the brain, that may cause headaches, subdural fluid collections, and possible brain herniation, among other complications. [ 2 , 10 ] Approximately 16–57% of patients with SIH are expected to suffer from subdural hematomas (SDH), and it is particularly predominant in males. Case series have reported mixed clinical outcomes that span from a benign and self-limiting course to death from SDH.…”

Section: Introductionmentioning

confidence: 99%

Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension – A non-reported complication

Perez‐Vega

Robles-Lomelín

Robles-Lomelin

et al. 2020

Surgical Neurology International

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Background: Spontaneous intracranial hypotension (SIH) is an uncommon, benign, and generally self-limiting condition caused by low cerebrospinal fluid (CSF) volume and pressure usually caused by a CSF leak. Patients with SIH have an increased incidence of subdural hematomas (SDH), which may be bilateral and recurrent. Case Description: We report a unique case of a man presenting with SIH and bilateral SDH that were drained with bilateral craniotomies. During drain removal, the patient had an acute neurological deterioration and a CT scan showed SDH recurrence. The patient had two new recurrent SDH afterwards. After the third surgical intervention, the drain was removed in the OR with concomitant subdural saline infusion, there was no recurrence of SDH after that and the patient has had no further complications after a 2-year follow-up. Conclusion: Patients with intracranial hypotension are predisposed to form SDH. In this case, drain removal caused further decrease in intracranial pressure and triggered a new SDH formation, subdural saline irrigation masked atmospheric pressure and prevented this complication from happening again.

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Spontaneous intracranial hypotension: key features for a frequently misdiagnosed disorder

Cited by 19 publications

References 53 publications

Natural history of spontaneous intracranial hypotension: a clinical and imaging study

Natural history of spontaneous intracranial hypotension: a clinical and imaging study

Lumbar epidural blood patch: An effective treatment for intracranial hypotension

Acute subdural hematoma recurrence during drain removal associated with spontaneous intracranial hypotension – A non-reported complication

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