Intracranial hypotension

Abstract

Clinical presentation as well as diagnostic and therapeutic approaches in intracranial hypotension are very heterogenous.

Application of time-spatial labeling inversion pulse magnetic resonance imaging in the diagnosis of spontaneous intracranial hypotension due to high-flow cerebrospinal fluid leakage at C1-2

“…Although SIH due to CSF leakage at C1-2 is less frequent than leakage occurring in the lower cervical or thoracolumbar spine,[14] it poses both diagnostic and therapeutic challenges to spine surgeons. With regard to diagnosis, it has been reported that extradural CSF collection at C1-2 on conventional CT myelography or MRI may often be a false localizing sign;[1019] CSF leakage from the dura of the lower cervical spine may move upward.…”

“…The use of conventional blood patch therapy administered from the lower lumbar spine may not be effective,[14] considering the long distance between the lower lumbar and upper cervical spine. Furthermore, the risk of vascular and neural injury associated with percutaneous puncture at C1-2 may not be negligible, considering its anatomical complexity and proximity to the brainstem.…”

“…[214] Identifying CSF leakage points in the spinal dura is important for treatment, particularly in patients with high-flow CSF leakage. [69] Although computed tomography (CT) myelography has been the imaging modality of choice for this purpose, the importance of magnetic resonance imaging (MRI) is increasing owing to rapid technological advances.…”

Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift

“…Spontaneous intracranial hypotension (SIH) is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF) results in various symptoms [ 1 , 2 , 3 ]. The progression of symptoms is usually gradual and most patients seek medical attention complaining of chronic orthostatic headaches [ 1 , 2 , 3 ]. Although rare, patients may sustain a rapid neurologic deterioration and are brought to an emergency department [ 4 , 5 , 6 ].…”

“…Although rare, patients may sustain a rapid neurologic deterioration and are brought to an emergency department [ 4 , 5 , 6 ]. On imaging studies, the great majority of those presenting with an altered mental status exhibit a bilateral accumulation of subdural fluid or hematoma, which is an important diagnostic clue [ 3 , 4 , 5 ]. However, when SIH-related subdural hematoma is only present unilaterally with a concomitant midline shift, diagnosing SIH may be difficult and inadvertent hematoma evacuation may result in further neurologic deterioration.…”