Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension

Schievink, Wouter I.

doi:10.1001/jama.295.19.2286

Cited by 909 publications

(1,136 citation statements)

References 114 publications

(118 reference statements)

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“…The CSF pressure of SIH patients with a long duration of symptoms was higher than of those with a short duration. We found that in several cases, the initial CSF OP was lower than 60 mmH 2 O, while the follow-up value elevated to within the normal range, which may be explained by compensatory mechanisms (Schievink, 2006;2008;Mokri, 2013;Kranz et al, 2015;Limaye et al, 2016). In the case of CSF leakage, the volume of CSF decreased as a result.…”

Section: Discussionmentioning

confidence: 73%

“…The acronym SEEPS can be used to summarize the typical MRI features: subdural fluid collections, enhancement of pachymeninges, engorgement of venous structures, pituitary enlargement, and sagging of the brain (Schievink, 2006;Spears, 2014;Limaye et al, 2016). The mechanisms of these abnormalities can be well explained by the Monro-Kellie hypothesis (Mokri, 2001;2004;2013;Limaye et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Though commonly believed to be the key feature of this disease, low cerebrospinal fluid (CSF) pressure (≤60 mmH 2 O; 1 mmH 2 O=9.806 65 Pa) is not always present. According to some previous reports (Mokri et al, 1998;Schievink, 2006;Mokri, 2013), quite a few SIH patients show normal CSF pressure.…”

Section: Introductionmentioning

confidence: 88%

“…Brain sagging, defined as downward sloping of the third ventricular floor or descent of the mammillary bodies to the level of the dorsum sellae, was evaluated on midsagittal T1-weighted images (Kranz et al, 2016). Venous (Schievink, 2006;Limaye et al, 2016). All images were reviewed by two board-certified neuroradiologists who each had more than 10 years of experience.…”

Section: Radiographic Findingsmentioning

confidence: 99%

“…Spontaneous intracranial hypotension (SIH), once regarded as a rare disorder, is becoming far more commonly recognized (Schievink, 2006;2008;Mokri, 2013). It is characterized by an orthostatic headache, which worsens with standing and improves after lying down.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

Yao

2017

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Spontaneous intracranial hypotension (SIH) is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid (CSF) pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure (CSF OP) and explore the factors affecting CSF OP in SIH patients. Methods: We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables (including demographic data, body mass index (BMI), duration of symptoms, and brain imaging findings). Univariate and multivariate analyses were performed to identify the potential factors affecting CSF OP. Results: In a total of 114 (55.3%) cases the CSF OP was ≤60 mmH 2 O (1 mmH 2 O=9.806 65 Pa), in 90 (43.7%) cases it was between 60 and 200 mmH 2 O, and in 2 (1.0%) cases it was >200 mmH 2 O. Univariate analysis showed that the duration of symptoms (P<0.001), BMI (P<0.001), and age (P=0.024) were positively correlated with CSF OP. However, multivariate analysis suggested that only the duration of symptoms (P<0.001) and BMI (P<0.001) were strongly correlated with CSF OP. A relatively high R 2 of 0.681 was obtained for the multivariate model. Conclusions: Our study indicated that in patients without a low CSF OP, a diagnosis of SIH should not be excluded. BMI and the duration of symptoms can influence CSF OP in SIH patients, and other potential factors need further investigation.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

Section: Radiographic Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

Yao

2017

J. Zhejiang Univ. Sci. B

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Spontaneous Cerebrospinal Fluid Leak With Venous Engorgement Mimicking a Contrast-Enhancing Cervical Mass

et al. 2016

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Assessing Spinal Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension With a Scoring System Based on Brain Magnetic Resonance Imaging Findings

et al. 2019

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IMPORTANCE Various signs may be observed on brain magnetic resonance imaging (MRI) in patients with spontaneous intracranial hypotension (SIH). However, the lack of a classification system integrating these findings limits decision making in clinical practice. OBJECTIVE To develop a probability score based on the most relevant brain MRI findings to assess the likelihood of an underlying spinal cerebrospinal fluid (CSF) leak in patients with SIH. DESIGN, SETTING, AND PARTICIPANTS This case-control study in consecutive patients investigated for SIH was conducted at a single hospital department from February 2013 to October 2017. Patients with missing brain MRI data were excluded. Three blinded readers retrospectively reviewed the brain MRI scans of patients with SIH and a spinal CSF leak, patients with orthostatic headache without a CSF leak, and healthy control participants, evaluating 9 quantitative and 7 qualitative signs. A predictive diagnostic score based on multivariable backward logistic regression analysis was then derived. Its performance was validated internally in a prospective cohort of patients who had clinical suspicion for SIH. MAIN OUTCOMES AND MEASURES Likelihood of a spinal CSF leak based on the proposed diagnostic score. RESULTS A total of 152 participants (101 female [66.4%]; mean [SD] age, 46.1 [14.3] years) were studied. These included 56 with SIH and a spinal CSF leak, 16 with orthostatic headache without a CSF leak, 60 control participants, and 20 patients in the validation cohort. Six imaging findings were included in the final scoring system. Three were weighted as major (2 points each): pachymeningeal enhancement, engorgement of venous sinus, and effacement of the suprasellar cistern of 4.0 mm or less. Three were considered minor (1 point each): subdural fluid collection, effacement of the prepontine cistern of 5.0 mm or less, and mamillopontine distance of 6.5 mm or less. Patients were classified into groups at low, intermediate, or high probability of having a spinal CSF leak, with total scores of 2 points or fewer, 3 to 4 points, and 5 points or more, respectively, on a scale of 9 points. The discriminatory ability of the proposed score could be demonstrated in the validation cohort. CONCLUSIONS AND RELEVANCE This 3-tier predictive scoring system is based on the 6 most relevant brain MRI findings and allows assessment of the likelihood (low, intermediate, or high) of a positive spinal imaging result in patients with SIH. It may be useful in identifying patients with SIH who are leak positive and in whom further invasive myelographic examinations are warranted before considering targeted therapy.

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Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension

Cited by 909 publications

References 114 publications

Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

Spontaneous Cerebrospinal Fluid Leak With Venous Engorgement Mimicking a Contrast-Enhancing Cervical Mass

Assessing Spinal Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension With a Scoring System Based on Brain Magnetic Resonance Imaging Findings

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