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

Abstract

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.

Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

“…In a series of 106 patients, Kranz et al found only 34% of patients with confirmed SIH had an opening pressure <6 cm H 2 O; most patients had pressures of 6-20 cm H 2 O, and a few patients with active CSF leaks were found to have pressures >20 cm H 2 O. 8 Yao et al found that 45% of patients had opening pressure of >6 cm H 2 O in a series of 206 patients, 9 and Luetmer et al found that only 21% of patients had a pressure of 5 cm H 2 O in a series of 76 patients, whereas 43% had pressures between 10 and 18 cm H 2 O. 10 These data indicate that while opening pressure is often low in SIH patients, normal pressure is also frequently found, and a normal pressure should not be used to exclude the diagnosis.…”

Cerebrospinal fluid biomarkers of superficial siderosis in patients with spontaneous intracranial hypotension

“…It is important to note that lumbar puncture is not mandatory for the diagnosis of SIH. The opening pressure is within normal range in 44%–62% of cases and its measurement is therefore of limited value [21–24]. Nevertheless, many patients undergo lumbar puncture either to exclude differential diagnosis or for diagnostic myelography.…”

Doctrina Monro-Kellie: fisiología y fisiopatología aplicada para el manejo neurocritico

“…Algunas condiciones pueden generar que la PIC disminuya, tales como la punción lumbar o epidural, trauma o cirugía de cabeza y cuello, trauma Revisión de Tema espinal o cirugía, y la derivación ventricular. Otras condiciones que pueden disminuir la PIC radican en la disminución de la generación de LCR, causadas por deshidratación, cetoacidosis, uremia, grave infecciones sistémicas, y meningoencefalitis 14 . Generalmente, el aumento patológico de estas estructuras conllevan a un aumento en la PIC, cuando esta es sostenida con una medición mayor a 15 mmHg durante 5 a 10 minutos es nombrada como "hipertensión intracraneal" 4,8,9 .…”