CSF hypotension: A review of its manifestations, investigation and management

Pattichis, Andrew Andreas; Slee, Mark

doi:10.1016/j.jocn.2016.07.002

Cited by 42 publications

(27 citation statements)

References 64 publications

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“…Side effects include headache and intra- cranial hypotension. 36 A non-invasive approach is most suitable for patients, and intravenous injection is safer than intrathecal injection. Presently, via a circulation approach dependent on the homing peptides SP1 and SP2, plasmid vector was delivered to the spinal cord and taken up by cells, and the transgene was expressed in the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Advanced Technology for Gene Delivery with Homing Peptides to Spinal Cord through Systemic Circulation in Mice

Terashima

Ogawa

Sato

et al. 2019

Molecular Therapy - Methods & Clinical Development

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Homing peptides to the spinal cord were identified and isolated using phage display technology. In vivo biopanning was performed by intravenous systemic injection of a phage library to screen specific peptides targeting the spinal cord of mice. Analyses of the sequences of targeted phages yielded two candidate peptides targeting the spinal cord: SP1 (C-LHQSPHI-C) and SP2 (C-PTNNPRS-C). These peptides were synthesized and intravenously injected into mice to evaluate their tissue specificity and potential as gene delivery carriers. The complexes between SP1 or SP2 peptides and the plasmid vector expressing the reporter gene could induce gene transduction in the spinal cord through systemic injection without gene expression in the brain, liver, and kidney. In addition, intravenous injection of the complex between SP1 and the vectors induced interleukin-4 expression in the spinal cord, resulting in effective suppression of lipopolysaccharide-induced hyperalgesia. Therefore, intravenously administered spinal cord homing peptides complexed with a plasmid vector provided tissuespecific treatment featuring gene delivery to the CNS through systemic circulation. This novel method of gene delivery is feasible and has great potential for clinical application.

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Section: Discussionmentioning

confidence: 99%

Advanced Technology for Gene Delivery with Homing Peptides to Spinal Cord through Systemic Circulation in Mice

Terashima

Ogawa

Sato

et al. 2019

Molecular Therapy - Methods & Clinical Development

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“…It may also occur spontaneously due to a multitude of etiologies, including spinal meningeal diverticula or connective tissue diseases like Marfan's syndrome. 42 Headaches associated with low CSF pressure are classically described as postural orthostatic headache, in which the headache improves dramatically in the supine position and Headache in the Emergency Room may or may not be accompanied by other symptoms such as nausea, vomiting, visual field changes, or tinnitus. 42 At times, the diagnosis can be challenging and involves neuroimaging and LP, although high suspicion with negative initial testing may warrant more advanced and invasive diagnostic imaging techniques.…”

Section: Neoplastic/cerebrospinal Fluid Pressurementioning

confidence: 99%

“…42 Headaches associated with low CSF pressure are classically described as postural orthostatic headache, in which the headache improves dramatically in the supine position and Headache in the Emergency Room may or may not be accompanied by other symptoms such as nausea, vomiting, visual field changes, or tinnitus. 42 At times, the diagnosis can be challenging and involves neuroimaging and LP, although high suspicion with negative initial testing may warrant more advanced and invasive diagnostic imaging techniques. 43 Initial treatment of low CSF pressure headaches in the ER setting are geared toward symptom relief and correcting the insulting etiology.…”

Section: Neoplastic/cerebrospinal Fluid Pressurementioning

confidence: 99%

Headache in the Emergency Room

Kahkeshani¹,

Sheikh²

2017

US Endocrinology

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Headache is seen in the emergency room (ER) on a daily basis and is a vague symptom, which can be a part of many different types of conditions and diseases. Although most people who come to the ER will have a benign headache, it is important to make sure that dangerous causes of headache are ruled out. There are a number of features that may alert someone to a secondary cause of headache. This article highlights two specific secondary headache syndromes, including carotid dissection and reversible cerebral vasoconstriction syndrome. It also broadly points out other possible causes of secondary headache. The last section focuses on a common primary headache that presents to the ER, migraine and its treatment.

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“…This syndrome can result from CSF leakage from dural defects caused by central nervous system trauma, lumbar puncture or epidural anesthesia, or it can develop when there are underlying degenerative changes such as disc herniations or osteophyte formations and spinal meningeal diverticulum (1). Diffuse non-nodular cerebral meningeal contrast enhancement, congestion of venous sinuses, tightening of the posterior fossa, flattening of the corpus callosum, subdural hematoma, and hygroma are the most frequent radiologic features (1). Spinal MRI can show typical imaging findings, underlying anatomic abnormalities, and play a guiding role in the management of treatment (1).…”

Section: Dear Editormentioning

confidence: 99%

“…Diffuse non-nodular cerebral meningeal contrast enhancement, congestion of venous sinuses, tightening of the posterior fossa, flattening of the corpus callosum, subdural hematoma, and hygroma are the most frequent radiologic features (1). Spinal MRI can show typical imaging findings, underlying anatomic abnormalities, and play a guiding role in the management of treatment (1). MR myelography is used routinely to show CSF leakage (2).…”

Section: Dear Editormentioning

confidence: 99%

Neuroradiologic Findings of Intracranial Hypotension: Two Cases

Yıldız¹,

Dönmez²,

Gökçe³

et al. 2017

tnd

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A 26-year-old female was admitted to hospital with orthostatic headache, blurred and double vision, nausea, vomiting, and numbness of the hands. A neurologic examination revealed left abducens nerve palsy and left peripheral facial palsy. Cranial magnetic resonance imaging (MRI) showed diffuse dural thickening and contrast enhancement and bilateral -right predominant-subdural hematoma ( Figure 1). Spinal MRI and MR myelography showed multiple dural clefts, cerebrospinal fluid (CSF) accumulation around the spinal roots, and a right paracentral perineural cyst at the level of L1-2 (Figure 2, 3). The patient did not respond to bed rest, hydration, and analgesic treatment, and was treated with blood patch.A 33-year-old female was admitted to hospital with orthostatic headache, vertigo, and double vision. She had a baby with spontaneous vaginal delivery without regional anesthesia 1 month ago. Neurologic examination showed left abducens palsy. Cerebral and spinal MRI showed diffuse dural thickening and contrast enhancement. No abnormality was shown to cause CSF leakage (Figure 4). The patient responded to bed rest, hydration, and analgesic treatment.Intracranial hypotension is an intracranial pressure disorder characterized by orthostatic headache that worsens with standing Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Özlem Kayım Yıldız MD,

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CSF hypotension: A review of its manifestations, investigation and management

Cited by 42 publications

References 64 publications

Advanced Technology for Gene Delivery with Homing Peptides to Spinal Cord through Systemic Circulation in Mice

Advanced Technology for Gene Delivery with Homing Peptides to Spinal Cord through Systemic Circulation in Mice

Headache in the Emergency Room

Neuroradiologic Findings of Intracranial Hypotension: Two Cases

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