Background and Purpose: Spontaneous intracranial hypotension (SIH) is an uncommon, but not rare, cause of headache. We analyzed a series of patients with SIH and attempted to establish a clinical procedure. Methods: We retrospectively reviewed 11 patients with SIH who were admitted between January 2004 and May 2007. Data recorded from patients included basic data, clinical symptoms, neurological imaging studies and treatment. Results: Orthostatic headache was the most common symptom, but there were still 2 patients without orthostatic headache. Diffuse pachymeningeal enhancement was the most common finding in brain MRI study and engorgement of the spinal epidural venous plexus was the most common finding in spinal MRI study. Eight of our patients received epidural blood patches in the lumbar area and 6 of these were symptom-free within 2 weeks. Two patients received spinal MRI immediately after administering the epidural blood patch, and this revealed that most of the blood had spread to the upper cervical area from the lumbar injection. Conclusion: A blind epidural blood patch from the lumbar area is an acceptable procedure even if the area of leakage is unknown. A reasonable clinical procedure for the patients of SIH may minimize the rate of repeat puncture.

We present usage of technetium-99m methoxyisobutyl isonitrile (99mTc-sestamibi) single photon emission computed tomography (SPECT) as a novel noninvasive method to evaluate muscular mitochondrial function in patients with progressive supranuclear palsy (PSP). 99mTc-sestamibi SPECT revealed a statistically significant decrease in radionucleotide uptake in the quadriceps in PSP patients as compared with other neurodegenerative parkinsonism (P < 0.05) or control group (P < 0.05). This study demonstrates a remarkable deficit of skeletal muscle bioenergetics in patients with PSP. Our findings suggest a distinctive role of mitochondrial dysfunction in the pathogenesis of PSP. Furthermore, 99mTc-sestamibi SPECT provides a relatively simple, inexpensive, and noninvasive modality in further assessment of mitochondrial function and bioenergetic features in various muscular disorders.

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The underlying pathophysiology of thyrotoxic periodic paralysis (TPP) is still obscure. From histologic surveys, vacuole formation and abundant mitochondrial abnormalities ranged from swelling, matrical pallor, pleomorphism, and reduced cristae were often disclosed in the muscle fibers during paralytic periods. In a 47-year-old man experiencing 2 episodes of transient paralysis, hyperthyroidism with TPP was diagnosed. During the acute paralytic phase, a significant reduction of radionucleotide uptake in the quadriceps on Tc-99m sestamibi scintigraphy was found, aside from the previous morphologic findings, that it further suggests impaired mitochondrial integrity and cellular viability in TPP.