Spontaneous intracranial hypotension: searching for the CSF leak

Dobrocky, Tomas; Nicholson, Patrick; Häni, Levin; Mordasini, Pasquale; Krings, Timo; Brinjikji, Waleed; Cutsforth‐Gregory, Jeremy K.; Schär, Ralph T.; Schankin, Christoph; Gralla, Jan; Pereira, Vítor Mendes; Raabe, Andreas; Farb, Richard I.; Beck, Jürgen; Piechowiak, Eike Immo

doi:10.1016/s1474-4422(21)00423-3

Cited by 82 publications

(90 citation statements)

References 80 publications

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“…These dural defects can also produce SIH, which if present, might show on the brain MRI as pachymeningeal enhancement, venous engorgement or “brain sag” [ 30 ]. If indeed there is SS or SIH, or rarely both, then the patient should have heavily T2 weighted cranio-spinal imaging MRI looking for SS as well as for an epidural CSF collection [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Progressive loss of hearing and balance in superficial siderosis due to occult spinal dural defects

Hálmagyi

Parker

Chen

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Superficial siderosis, a progressive, debilitating, neurological disease, often presents with bilateral impairment of auditory and vestibular function. We highlight that superficial siderosis is often due to a repairable spinal dural defect of the type that can also cause spontaneous intracranial hypotension. Methods Retrospective chart review of five patients presenting with moderate to severe, progressive bilateral sensorineural hearing loss as well as vestibular loss. All patients had developed superficial siderosis from spinal dural defects: three after trauma, one after spinal surgery and one from a thoracic discogenic microspur. Results The diagnosis was made late in all five patients; despite surgical repair in four, hearing and vestibular loss failed to improve. Conclusions In patients presenting with progressive bilateral sensorineural hearing loss, superficial siderosis should be considered as a possible cause. If these patients also have bilateral vestibular loss, cerebellar impairment and anosmia, then the diagnosis is likely and the inevitable disease progress might be halted by finding and repairing the spinal dural defect.

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Section: Discussionmentioning

confidence: 99%

Progressive loss of hearing and balance in superficial siderosis due to occult spinal dural defects

Hálmagyi

Parker

Chen

et al. 2022

Eur Arch Otorhinolaryngol

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“…Durch den Volumenverlust in den intrakraniellen Flüssigkeitskompartimenten entstehen Zugkräfte an der schmerzsensitiven Dura, die in der aufrechten Körperposition noch zunehmen. Dies ist die Ursache der Kopfschmerzen [1].…”

Section: Entstehung Der Symptomeunclassified

“…Symptome wie Doppelbilder, Geruchs-und Geschmacksstörungen, Schwindel und Taubheit sind durch ein der Schwerkraft folgendes Absinken des Hirnstamms und durch die hierdurch bedingten Zugphänomene an den Hirnnerven herzuleiten [1,10,11]. Zudem kann der verminderte intrakranielle Druck eine Verschiebung der Drucksysteme im vestibulokochleären Peri-und Endolymphraum zur Folge haben, sodass ein endolymphatischer Hydrops im Sinne eines Morbus Menière entstehen kann [1]. In schweren Fällen bewirken der verminderte intrakranielle Druck und das Absinken des Hirnstamms, dass die Brückenvenen einreißen und subdurale Hämatome entstehen.…”

Section: Entstehung Der Symptomeunclassified

Spontane intrakranielle Hypotension

Albes¹

2023

Radiologie up2date

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“…Intracranial hypotension most com-monly occurs from a persistent CSF leak after spinal tap but may also be spontaneous [2] [3]. The estimated incidence of spontaneous intracranial hypotension is five cases per 100,000 person-years and female is more often affected [4] [5]. The exact etiology of spontaneous spinal CSF leaks is not certain, but probably caused by the weakness of the meninges surrounding the spinal cord [3] [6] [7].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Intracranial Hypotension Complicated with Subdural Hematoma—A Case Report and a Case Series Review

Yip¹

2022

OJMN

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Intracranial hypotension has variable clinical manifestations; subdural hematoma is one of the complications of intracranial hypotension with the reported incidence ranging from 16% to 57%. The author would like to share a case of subdural hematoma caused by recurrent intracranial hypotension with different cerebrospinal fluid (CSF) leakage site and to review a case series of intracranial hypotension treated in the author's hospital (Kaohsiung Veterans General Hospital). A 44-year-old male having the past history of intracranial hypotension was treated in our Neurology division one month previous to this admission, who was sent to our emergency room (ER) due to severe orthostatic headache with nausea and vomiting. Computed tomography (CT) scan of brain at ER showed bilateral subdural hematoma, more on the left side with mass effect. Both surgical removal of the subdural hematoma and epidural blood patch were performed and he had a good outcome. Orthostatic headache is a specific symptom sign of intracranial hypotension. Epidural blood patch is effective to manage intracranial hypotension either the leakage site of CSF is detected or not. In case of non-traumatic subdural hematoma, intracranial hypotension should be kept in mind.

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Spontaneous intracranial hypotension: searching for the CSF leak

Cited by 82 publications

References 80 publications

Progressive loss of hearing and balance in superficial siderosis due to occult spinal dural defects

Progressive loss of hearing and balance in superficial siderosis due to occult spinal dural defects

Spontane intrakranielle Hypotension

Recurrent Intracranial Hypotension Complicated with Subdural Hematoma—A Case Report and a Case Series Review

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