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At least 19 recordsLinked to original sources
PubMed2003

CSF hypovolemia vs intracranial hypotension in "spontaneous intracranial hypotension syndrome".

OBJECTIVES: To investigate the role of CSF hypovolemia in spontaneous intracranial hypotension (SIH) syndrome because so-called SIH syndrome sometimes lacks intracranial hypotension. METHODS: Ten women (aged from 28 to 49 years) with characteristic orthostatic headache without a previous history of dural tear were investigated. In addition to gadolinium (Gd)-enhanced brain MRI, spinal MRI with and without Gd enhancement was performed. RESULTS: Gd-enhanced brain MRI demonstrated diffuse pachymeningeal enhancement in all patients. Sagittal T2-weighted spinal MRI revealed a variable amount of CSF in the extradural space in all patients. Sagittal T2-weighted MRI or axial Gd-enhanced T1-weighted MRI showed dilated epidural veins located in the high cervical portion in each patient. The intensity of dilatation of the epidural veins correlated significantly with the amount of CSF in the epidural space. This suggested that the Monro-Kellie doctrine was applicable in this circumstance. CONCLUSIONS: Since some patients with SIH syndrome have normal CSF pressure and since a downward displacement of the brain due to a reduction of the buoyant action of CSF may induce symptoms, CSF hypovolemia, not intracranial hypotension, may be the cause. Based on the Monro-Kellie doctrine, detecting leaked CSF and venous engorgement (epidural vein dilatation and pachymeningeal enhancement) is an important clue to diagnose so-called SIH syndrome. Dilatation of epidural veins suggests CSF hypovolemia in appropriate conditions.

Adult↗
PubMed1996

Intracranial hypotension.

Intracranial hypotension (IH) is present when cerebrospinal fluid (CSF) pressure is 60mm H2O or lower and there has been no previous dural puncture. IH is more common in women than in men (3:1). Orthostatic headache is the cardinal symptom. Visual, auditory, and other symptoms occur. Postulated mechanisms include sagging of the brain, dilation of intracranial veins, and activation of adenosine receptors. Examination may disclose visual field defects. The condition may be primary (probably related to an occult dural leak) or secondary to many causes that include lumbar puncture, trauma, pneumonectomy, diabetic coma, and uremia. Patients with postural headache should undergo neuroimaging prior to lumbar puncture. Radionuclide cisternography is the most sensitive means of demonstrating a CSF fistula. Severe, intractable headache associated with IH may respond to intravenous of oral caffeine. An epidural blood patch and epidural infusion of normal saline are treatment measures for symptoms of IH that follow lumbar puncture.

Cerebrospinal Fluid Pressure↗
PubMed2007

Spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is caused by leakage of cerebrospinal fluid (CSF), with resultant CSF hypovolemia and intracranial hypotension. Although in some patients SIH may be preceded by minor trauma, it often occurs in the absence of any identifiable initiating event. Orthostatic headache is the primary clinical manifestation, usually accompanied by one or more other symptoms of SIH. Diagnosis can be reached by a combination of imaging studies, which may include MRI with gadolinium, nuclear cisternography, and myelography. Treatment ranges from conservative management, such as bed rest and hydration, to invasive procedures, such as lumbar puncture with autologous blood patch, CT-guided fibrin glue injection at the site of the leak, and open surgical intervention. Outcomes vary from complete resolution of CSF leak with alleviation of symptoms to continued and/or recurrent leaks with chronic unremitting symptomatology.

Humans↗
PubMed2002

Epidural blood patch for treatment of spontaneous intracranial hypotension.

Spontaneous intracranial hypotension is an uncommon disease caused by cerebrospinal fluid leakage. We reported a case of a 42-year-old male with postural headache who was diagnosed as having spontaneous intracranial hypotension. His headache did not completely improve by conservative therapies, so he underwent an autologous epidural blood patch. The site of cerebrospinal fluid restoration was identified at the level from the C2 to Th7 epidural space by 111In-DPTA cisternography and computed tomography coupled with myelography, and cervical EBP was performed. Because cerebrospinal fluid drops from the catheter, it is useful to identify the location of the catheter tip under contrast injection X-ray. Rapid and dramatic relief from the headache was obtained, and no serious complications occurred.

Adult↗
PubMed2001

[Intracranial hypotension syndrome].

Intracranial hypotension syndrome is an essential or, more frequently, secondary entity. This is characterized by orthostatic headaches and diffuse dural gadolinium enhancement on magnetic resonance imaging with or without subdural fluid collections or evidence of descent of the brain. What determines the various clinical and imaging features of intracranial hypotension syndrome is the cerebrospinal fluid volume depletion. In this article, we review the clinical and neuroimaging findings, pathophysiology, and treatment of this syndrome.

Adult↗
PubMed2006

[Spontaneous intracranial hypotension].

Spontaneous intracranial hypotension is an infrequent clinical entity characterized by orthostatic headache, low cerebrospinal fluid pressure, and magnetic resonance imaging findings of diffuse pachymeningeal gadolinium enhancement without previous history of head trauma or lumbar puncture. A 24 year-old healthy woman was referred after having daily headaches for two weeks. She described a headache that occurred soon after assuming an upright position and disappeared after resuming a recumbent position. The cerebrospinal fluid showed pleocytosis primarily lymphocitic, raised protein content and an opening pressure of 20 mm H2O. Magnetic resonance imaging of the head showed diffuse pachymeningeal gadolinium enhancement. Radioisotope cisternography using 99mTc-DTPA confirmed the cerebrospinal fluid leak in the thoracic region. With conservative treatment the patient improved in a few days and the headache disappeared. Radiological findings, together with a compatible clinical condition, help to establish the diagnosis of spontaneous intracranial hypotension and avoid the use of unnecessary clinical investigations.

Adult↗
PubMed2004

[Extraordinary high cerebrospinal fluid protein in two cases of intracranial hypotension syndrome].

Intracranial hypotension is a rare cause of chronic headache. Although there is still debate about the aetiology, it is believed that the syndrome is caused by low cerebrospinal fluid volumes due to dural leakage. Such leakages can occur spontaneously after lumbar puncture or surgical or traumatic opening of the dura. In magnetic resonance contrast imaging, diffuse meningeal enhancement can be seen; usually the pressure at the cerebrospinal opening is lower than normal. Sometimes a pleocytosis and, in most cases, increased protein content can be identified in the CSF. These protein levels most frequently range between 0.5 g/l and 2 g/l. Here we describe two patients with typical clinical signs and neuroradiological alterations of intracranial hypotension syndrome but with extraordinarily high CSF protein levels (8.3 g/l and 9.63 g/l). On the basis of these findings, the putative causes of elevated CSF protein contents are discussed.

Cerebrospinal Fluid Proteins↗
PubMed2003

Orthostatic tinnitus: an otological presentation of spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is a syndrome characterized by orthostatic headache, low cerebrospinal fluid (CSF) pressure without apparent causes for CSF loss, and diffuse pachymeningeal gadolinium enhancement on cranial MRI. Hearing is affected in some patients with SIH. A case of SIH with orthostatic tinnitus is reported. A 51-year-old woman developed a severe headache that was almost completely relieved on recumbency. Cranial MRI with gadolinium infusion showed diffuse enhancement of the dura mater. Radionuclide cisternography demonstrated CSF leaks at the upper and lower thoracic levels. Epidural blood patches at these leak sites alleviated the orthostatic headache, however, orthostatic tinnitus and muffled hearing persisted. Initial audiometry was unremarkable; repeat audiometry performed 6 weeks later demonstrated low-frequency hearing loss in the right ear. Continuous epidural saline infusion for 3 consecutive days was performed; auditory symptoms disappeared 4 weeks thereafter. This case illustrates that orthostatic tinnitus represent intracranial hypotension even in the absence of orthostatic headache. MRI with gadolinium infusion should be carried out in the evaluation of patients with orthostatic tinnitus.

Dura Mater↗
PubMed2003

Misdiagnosis of spontaneous intracranial hypotension.

BACKGROUND: Spontaneous intracranial hypotension is an important cause of "new daily persistent headaches" but is not a well-recognized entity. The misdiagnosis of spontaneous intracranial hypotension can have serious consequences. METHODS: The clinical course in 18 consecutive patients with spontaneous intracranial hypotension who were evaluated for definitive surgical treatment of the underlying spontaneous spinal cerebrospinal fluid leak from January 1, 2001, through June 30, 2002, was investigated by correspondence with the patients and physicians. RESULTS: Seventeen patients (94%) initially received an incorrect diagnosis, and the diagnostic delay ranged from 4 days to 13 years (median, 5 weeks; mean, 13 months). Migraine, meningitis, and psychogenic disorder were the most commonly entertained diagnoses. Diagnostic or therapeutic procedures for disorders that mimicked spontaneous intracranial hypotension included cerebral arteriography in 2 patients, craniotomies for Chiari malformation in 2 patients, craniotomy for evacuation of subdural hematomas in 1 patient, and brain biopsy in 1 patient. CONCLUSIONS: Patients with spontaneous intracranial hypotension are commonly misdiagnosed, causing a significant delay in the initiation of effective treatments and exposing patients to the risks associated with treatment for disorders that mimic intracranial hypotension. Increasing the awareness of this spontaneous type of intracranial hypotension is required to decrease the high rate of misdiagnosis.

Adult↗
PubMed2006

Rebound intracranial hypertension after treatment of spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache and the cause is usually cerebrospinal fluid leaks in spine level. Most patients with SIH have a benign course. Epidural blood patch (EBP) is the treatment of choice when initial conservative managements are ineffective. We reported a patient with SIH diagnosed by using magnetic resonance imaging and radionuclide cisternography. Acute rebound intracranial hypertension developed after EBP and was successfully treated with intravenous osmotic agent.

Adult↗
PubMedDate not supplied

Unusual cause of sudden onset headache: spontaneous intracranial hypotension.

Spontaneous intracranial hypotension is a very distinctive but unusual cause of acute headache. The postural nature of the headache can be easily overlooked in the celerity to exclude subarachnoid haemorrhage. We describe the clinical and radiological features of a case that emphasizes some of the diagnostic difficulties. An approach to management and treatment for this condition is outlined.

Acute Disease↗
PubMed1999

Spontaneous intracranial hypotension.

Spontaneous intracranial hypotension is a rare benign and usually self-limited condition of unknown aetiology. Four cases are presented that illustrate how the MRI features may support a diagnosis suggested on clinical grounds. The MRI findings include diffuse symmetric smooth dural thickening and enhancement, not only at the cranial level, but also involving the cervical spinal dura, subdural effusions and downward displacement of the cerebellar tonsils.

Female↗
PubMed2004

Organic bipolar disorder occurring together with spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is known to cause postural headache, often combined with auditory, and vestibular symptoms, nausea, vomiting, and diplopia. We report a 63-year-old male patient who for the first time developed a depressive episode followed by acute manic symptoms during the course of SIH, both relieved after treatment of the underlying organic disturbance.

Bipolar Disorder↗
PubMedDate not supplied

Epidural blood patch at C2: diagnosis and treatment of spontaneous intracranial hypotension.

Spontaneous intracranial hypotension in a 37-year-old man with intractable headaches was diagnosed on MR imaging. A generous CSF leak was identified at C2 on CT myelography. Successful treatment was performed with CT-guided blood patch at the leakage site after the patient had failed 2 lumbar blood patches. Imaging-guided precise placement of the blood patch is safe and recommended when a lumbar blood patch away from the leakage site could be ineffective.

Adult↗
PubMed2002

Spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome. Postural headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delay in diagnosing this condition may subject patients to unnecessary procedures and prolong morbidity. We describe a patient with SIH and outline the important clinical and radiographic features of this syndrome. Headache due to SIH is similar to headache occurring after lumbar puncture. Patients with postural headaches should have brain MRI before lumbar puncture. Meningeal abnormalities with typical clinical features are helpful in establishing the diagnosis. When correctly diagnosed, SIH management, in most cases, is easy and highly effective.

Adult↗
PubMed2002

Delayed gadolinium enhancement in epidural space of the cervicothoracic spine in a patient with spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) due to a spinal cerebrospinal fluid leak is a rare but increasing cause of postural headache. Its extravasated epidural fluid collection tends to be non-enhanced or mildly enhanced on enhanced magnetic resonance (MR) imaging. The mild enhancement of the epidural fluid in SIH is usually attributed to fenestrated neovascularization provoked by an inflammatory component, such as blood, of the fluid collection. In this report, we present a case of SIH with a prominent delayed enhancement of the spinal epidural fluid collection on MR imaging. Subsequent vertebral angiography revealed that this delayed enhancement was related to contrast extravasation from a torn anterior meningeal branch of the right vertebral artery. Therefore, we suggest that contrast extravasation from a torn meningeal vessel may be a possible cause of the enhancement in the spinal epidural fluid of SIH.

Cervical Vertebrae↗