Frequency of spontaneous intracranial hypotension in the emergency department

Schievink, Wouter I.; Maya, M. Marcel; Moser, Franklin G.; Tourje, James; Torbati, Sam

doi:10.1007/s10194-007-0421-8

Cited by 111 publications

(85 citation statements)

References 10 publications

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“…The annual incidence has been estimated as 5 per 100,000. 16 Orthostatic headache is the most common, but not mandatory, manifestation of IHS, accompanied by a wide variety of other symptoms such as neck pain or stiffness, nausea, hearing loss, visual blur- ring, facial numbness, Parkinsonism, ataxia, or dementia. 2,9,17 It seems plausible that a low CSF volume due to a persistent CSF leak is the cause of this syndrome.…”

Section: Discussionmentioning

confidence: 99%

CT Myelography for the Planning and Guidance of Targeted Epidural Blood Patches in Patients with Persistent Spinal CSF Leakage

Wendl¹,

Schambach²,

Zimmer³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:Intracranial hypotension is a rare cause of persistent headache mostly originating from a dural CSF leak. If a conservative treatment fails, a minimally invasive EBP can lead to a successful sealing of such a leak. Independent of the leakage site, an EBP is usually applied at the lumbar level with varying success. We used CT myelography to detect the site of the dural leakage, then immediately applied a targeted EBP at the corresponding level to patch the leak. Seven patients from our clinic were treated with a single targeted EBP in the lumbar or cervical spine. Within 24 hours, 6 patients experienced a considerable relief of symptoms; 1 patient went into remission after a repeat procedure. Our preliminary data suggest that a CT-guided, CT myelography-assisted targeted EBP is a safe and effective treatment for persistent spinal CSF leaks.ABBREVIATIONS: EBP ϭ epidural blood patch; IHS ϭ intracranial hypotension syndrome; LP ϭ lumbar puncture; SDH ϭ subdural hematoma I HS usually manifests with symptoms including orthostatic headache, nausea, neck pain, vomiting, and dizziness. In most cases, a persistent CSF leak is the cause of IHS. Such a persistent dural leak may sometimes arise spontaneously due to a rupture of subarachnoid perineural cysts. 1 However, it occurs most commonly as an undesirable effect of a lumbar puncture or is related to trauma or spinal surgery. 2 Patients frequently recover spontaneously; therefore, the first approach should be conservative treatment including bed rest, analgesic medication, and oral hydration to restore the depleted CSF volume. If the conservative treatment fails, an EBP should be considered as a minimally invasive therapy option before taking surgical intervention into account. In general, the EBP itself can be performed either blindly at the lumbar level, or it may be targeted at the suspected leakage site. Most studies, however, arrive at the conclusion that a blind lumbar EBP is preferred due to an assumed lower risk, though a targeted EBP appears to be more effective. 3-10 Thus, only a few reports of targeted EBPs exist in the literature. [11][12][13][14][15] In contrast to a blind EBP, a targeted EBP relies on an accurate localization of the leakage site. To this end, several imaging techniques are available, including CT myelography, radioisotope cisternography, and MR imaging of the spine. However, even if the site of the leak is known precisely, the execution of the CT-guided targeted patch is difficult due to the limited anatomic resolution of the planning CT scan for intra-and extradural compartments.In view of these problems, we performed CT myelography in a group of 7 patients with IHS and proved epidural CSF leak. We then used the resultant contrast-enhanced images to plan, and also guide, the targeted EBPs. Materials and MethodsAfter giving informed consent, all patients underwent a CT myelography with subsequently guided autologous epidural blood patches at the site of the leak. The myelography consisted of an injection of 15 mL of contrast agent (...

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Section: Discussionmentioning

confidence: 99%

CT Myelography for the Planning and Guidance of Targeted Epidural Blood Patches in Patients with Persistent Spinal CSF Leakage

Wendl¹,

Schambach²,

Zimmer³

et al. 2011

AJNR Am J Neuroradiol

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“…A 4-year observation study of a large urban ED identified 11 confirmed cases of SIH, none of which were diagnosed in the ED. 3 The general accepted mechanism of SIH is CSF leakage rather than low CSF production. Leakages of CSF occur through defects in the dura mater.…”

Section: Discussionmentioning

confidence: 99%

“…Small studies report that SIH is often misdiagnosed in the ED mainly due to lack of awareness of the condition. 3 …”

mentioning

confidence: 99%

Spontaneous low cerebrospinal fluid pressure headache: an emergency medicine perspective

Ahn

Akincioğlu²,

Gulka³

et al. 2013

CJEM

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Spontaneous low cerebrospinal fluid pressure headaches are a rare but treatable cause of debilitating headaches. The condition is characterized by a postural headache in the absence of any recent spinal procedures and is exacerbated when upright and relieved when supine. Diagnosis and treatment are often delayed, however, due to a lack of recognition and awareness, as illustrated by this case report of a patient who had multiple emergency department visits before further investigations were sought. RÉ SUMÉUne diminution spontané e de la pression du liquide cé phalorachidien est une cause rare mais soignable de cé phalé es dé bilitantes. L'affection se caracté rise par des cé phalé es orthostatiques, en l'absence de toute intervention rachidienne ré cente, qui s'intensifient en position debout et s'atté nuent en position couché e. La pose du diagnostic et la mise en route du traitement sont souvent retardé es en raison d'un manque de reconnaissance de l'affection et de prise de conscience de son existence, comme en té moigne le pré sent exposé de cas d'une patiente qui a consulté à plusieurs reprises au service des urgences avant que ne soit entreprise une exploration approfondie.

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“…CT scan should contribute to diagnostic resolution. Rest and hydration are the treatment of choice in most of these cases; in only a few is neurosurgery required [31].…”

Section: Intracranial Hypotensionmentioning

confidence: 99%

Acute migraine in the Emergency Department: extending European principles of management

2008

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The World Health Organization (WHO) placed migraine 19th among all causes of disability (12th in women) measured in years of healthy life lost to disability (YLD). The importance of headache disorders, particularly of the primary forms, is established by their distribution worldwide, their duration (the majority being life-long conditions) and their imposition of both disability and life-style restrictions among large numbers of people. For these reasons, headache disorders should represent a public-health priority. In the Emergency Department (ED), as elsewhere, migraine is often under-diagnosed-and under-treated when it is diagnosed. The result is likely to be failure of treatment. Particular attention to diagnosis is needed in ED patients with acute headache, since there is a higher probability of secondary headache due to underlying pathologies. According to European principles of management, acute migraine treatment generally is stepwise. Of the two main steps, the first relies on symptomatic medication, preferably NSAIDs with or without antiemetics. The second step uses specific therapies, usually triptans. Modifications to routine practice are appropriate in the ED. Parenteral administration of symptomatic therapies is a preferred first choice, whilst immediate resort to triptans may be appropriate, and achieve better outcomes, in patients with severe headache and diagnostic confirmation of migraine.

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Frequency of spontaneous intracranial hypotension in the emergency department

Cited by 111 publications

References 10 publications

CT Myelography for the Planning and Guidance of Targeted Epidural Blood Patches in Patients with Persistent Spinal CSF Leakage

CT Myelography for the Planning and Guidance of Targeted Epidural Blood Patches in Patients with Persistent Spinal CSF Leakage

Spontaneous low cerebrospinal fluid pressure headache: an emergency medicine perspective

Acute migraine in the Emergency Department: extending European principles of management

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