Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension

Beck, Jürgen; Ulrich, Christian T.; Fung, Christian; Fichtner, Jens; Seidel, Kathleen; Fiechter, Michael; Hsieh, Kety; Murek, Michael; Bervini, David; Meier, Niklaus; Mono, Marie‐Luise; Mordasini, Pasquale; Hewer, Ekkehard; Z'Graggen, Werner Josef; Gralla, Jan; Raabe, Andreas

doi:10.1212/wnl.0000000000003122

Cited by 116 publications

(142 citation statements)

References 31 publications

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“…We observed CSF leaks associated with degenerative changes in only two patients. Various previous studies in the literature reported disc hernia associated dural tears are more commonly in lower cervical and thoracic areas [18][19][20]. In our series, CSF leaks in two patients with disc hernia were in the cervical region.…”

Section: Discussionsupporting

confidence: 55%

Spinal Cerebrospinal Fluid Leakage in Spontaneous Intracranial Hypotension: An Intrathecal Gadolinium Enhanced MR-Myelography Study

Cebeci

Bilgin

Candan

et al. 2020

Journal of the Belgian Society of Radiology

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In the present study, the authors presented the intrathecal gadolinium enhanced MR-myelography findings of patients with spontaneous intracranial hypotension. Materials and Methods: Intrathecal gadolinium enhanced MR-myelography (Gd-MR-myelography) examinations between October 2012 and September 2018 in patients having clinical and radiological findings of spontaneous intracranial hypotension were evaluated retrospectively. Sites and types of contrast leakages in 20 patients who met inclusion criteria were reviewed. All patients had undergone T1-fat suppressed sagittal images of cervical, thoracic and lumbar region after the off label intrathecal injection of 1 ml gadolinium-based contrast agent. Results: Patients (18 female, 2 male) are aged between 23 and 62 years-old (mean age: 41.1). Cerebrospinal fluid (CSF) leakages were cervical in 6 patients, thoracic in 5 patients, lumbar in 5 patients. One patient had leakage in multiple levels on both cervical and thoracic region and another patient on both cervicalthoracic and lumbar regions. No patients had adverse effects related to intrathecal injection of gadolinium. Conclusions: Gd-MR-myelography is effective imaging modality to reveal spinal CSF leakages in patients with spontaneous intracranial hypotension.

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Section: Discussionsupporting

confidence: 55%

Spinal Cerebrospinal Fluid Leakage in Spontaneous Intracranial Hypotension: An Intrathecal Gadolinium Enhanced MR-Myelography Study

Cebeci

Bilgin

Candan

et al. 2020

Journal of the Belgian Society of Radiology

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“…Cervical and thoracic perineurial cysts are common incidental findings in normal patients, and, in isolation, the presence of such cysts does not necessarily indicate or increase the likelihood of a diagnosis of SIH if no active leakage is identified on imaging. 17,35 One series of over 500 patients identified ventral dural tears as the case of SIH in approximately one-quarter of patients. 4).…”

Section: Summary Of Important Considerations In the Approach To Sihmentioning

confidence: 99%

“…Ventral dural tears are a major source of spontaneous CSF leaks, and are often associated with calcified thoracic disk herniations or osteophytes. 17,35 One series of over 500 patients identified ventral dural tears as the case of SIH in approximately one-quarter of patients. 36 Another recently identified cause of SIH is the CSF-venous fistula.…”

Section: Summary Of Important Considerations In the Approach To Sihmentioning

confidence: 99%

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

2018

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“…Bunun sonucunda, özellikle hastalar dik pozisyonda iken, beyin, posterior fossadan aşağı doğru sarkar ve beyin sapı ile serebellar tonsillerin aşağı doğru yer değiştir-mesine neden olur. BOS kaçağının bildirilen nedenleri arasında, konnektif doku hastalıkları, spinal sinirlerin kök çıkışında görülen yırtıkları, Tarlov kisti, spinal kemik anomalileri ve akkiz dejeneratif disk hastalıkları bulunmaktadır (6,7) .…”

Section: Discussionunclassified

Repeated Blood Patch Treatment In A Patıent With Spontaneous Intracranial Hypotension

Güven¹,

Şimşek²,

Sezer³

et al. 2019

JARSS

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ÖZSpontan intrakraniyal hipotansiyon (SİH) herhangi bir travmatik girişim olmaksızın ortaya çıkan beyin omurilik sıvısı (BOS) basıncındaki (< 6 cmH 2 O) düşüş ve postural baş ağrısı ile karakterize klinik bir tablodur. SİH'ın ortaya çıkış nedeni tam olarak bilinmemekle birlikte, büyük oranda spinal meninkslerdeki konnektif dokunun yapısal bozukluğu sorumlu tutulmaktadır. Orta-ileri yaşlı kadınlarda daha sıklıkla görülmektedir. Boyun ağrısı, bulantı-kusma, diplopi, kraniyal nöropatiler, vertigo, tinnitus, fotofobi, nistagmus ve işitme bozuklukları gibi nörolojik semptomlar baş ağrısına eşlik edebilmektedir. Kraniyal MR görüntüleme (MRG)'de pakimeningeal kontrast tutulumu ve beyin dokusunun aşağı doğru yer değiştirmesi tanıda önemlidir. Tedavi, sırasıyla konservatif yöntemler (yatak istirahatı, sıvı replasmanı, kafein), epidural kan yaması ve cerrahi yöntemlerden oluşmaktadır. Bu makalede, konservatif yöntemler ile tedavi edilemeyen SİH olgusundaki epidural kan yaması uygulamasını literatürler eşliğinde sunulmuştur. Anahtar kelimeler: Epidural kan yaması, ortostatik baş ağrısı, spontan intrakraniyal hipotansiyonABSTRACT Spontaneous intracranial hypotension (SIH) is characterized by low cerebrospinal fluid pressure (<6 cmH 2 O) and postural headache without any traumatic interference. Although the cause of SIH is still not known, the structural defect of the connective tissue in spinal meninges is the mostly held responsible factor. It is more common in middle, and advanced aged women. Neurological symptoms such as neck pain, nausea, vomiting, diplopia, cranial neuropathies, vertigo, tinnitus, fotophobia, nystagmus and hearing disorders may accompany the headache. Cranial MRI findings such as pachymeningeal contrast involvement and downwards displacement of the brain tissue are important in the diagnosis. Treatment consists of conservative methods (bed rest, fluid resuscitation, caffeine), epidural blood patch and surgical methods in that order. In this case report, we have presened the application of epidural blood patch in a patient which could not be treated with conservative methods in the light of the literature.

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Diskogenic microspurs as a major cause of intractable spontaneous intracranial hypotension

Cited by 116 publications

References 31 publications

Spinal Cerebrospinal Fluid Leakage in Spontaneous Intracranial Hypotension: An Intrathecal Gadolinium Enhanced MR-Myelography Study

Spinal Cerebrospinal Fluid Leakage in Spontaneous Intracranial Hypotension: An Intrathecal Gadolinium Enhanced MR-Myelography Study

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

Repeated Blood Patch Treatment In A Patıent With Spontaneous Intracranial Hypotension

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