Intracranial hypotension syndrome: a comprehensive review

Paldino, Michael J.; Mogilner, Alon Y.; Tenner, Michael

doi:10.3171/foc.2003.15.6.8

Cited by 169 publications

(201 citation statements)

References 42 publications

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“…Patients who are refractory to the initial conservative management are candidates for EBP, either by percutaneous or open surgical approaches. The mechanism of action of EBP is suggested by its initial tamponade effect of a blood clot over a dural tear or defect and subsequent scar formation [11]. The success rate of EBP was 70-90% in most studies.…”

Section: Discussionmentioning

confidence: 98%

“…The success rate of EBP was 70-90% in most studies. Factors that may affect the success rate include the timing of the treatment, the severity of patient's symptoms and the amount of autologous blood injected [11,16]. Surgical treatment is reserved for patients who fail in multiple attempts of EBP [8,11].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of SIH begins with conservative management, including bed rest, restoring the depleted CSF volume by intravenous fluid, intravenous or oral caffeine, theophylline and steroids [8,11]. Patients who are refractory to the initial conservative management are candidates for EBP, either by percutaneous or open surgical approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Factors that may affect the success rate include the timing of the treatment, the severity of patient's symptoms and the amount of autologous blood injected [11,16]. Surgical treatment is reserved for patients who fail in multiple attempts of EBP [8,11]. Also, patients in whom the spinal level of CSF leak is determined but no underlying lesion is visualized by the imaging studies, exploratory surgery, consisting of a laminectomy (with or without foraminotomy) and inspection of the spinal dural sleeves, is performed [7].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases

et al. 2011

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Spontaneous intracranial hypotension (SIH) is a clinical syndrome in which absolute or relative hypovolemia of the cerebrospinal fluid (CSF) results in various neurological symptoms. The etiology of spontaneous CSF leaks often remains unknown. However, it is believed that the most common cause is the fragility of spinal meninges at the level of radicular nerve root sleeve. These tears can be spontaneous (primary) or secondary. Spinal pathologies can cause this tear with resultant CSF leak and SIH, which include spinal trauma, degenerative diseases and spinal surgery. Uncommonly, SIH is developed by osteophyte with disc herniation without any other pathology. In this article, we reported two cases of SIH secondary to spinal dural tear due to intradural thoracic osteophyte with superimposed disc herniation, with the absence of other pathologies, which were treated successfully with epidural blood patch (EBP).

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases

et al. 2011

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“…5,19 The proposed mechanisms for the effectiveness of EBPs in treating intracranial hypotension from CSF leaks are thought to be due to tamponade of the dural hole as well as increased epidural and, consequently, intrathecal pressures by the injected blood, resulting in immediate relief of symptoms. 6,12,17,20 It is thought that the ''plugged'' hole undergoes fibroblastic remodelling within 48 hr, collagen deposition within 2 weeks and, ultimately, scar formation by 3 months. 6 Thus, it can be postulated that multiple EBPs and/or large volumes of blood may be required for multiple small CSF leaks.…”

Section: Discussionmentioning

confidence: 99%

Repeated large-volume epidural blood patches for the treatment of spontaneous intracranial hypotension

Mehta

Tarshis

2009

Can J Anesth/J Can Anesth

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Purpose Refractory headache from spontaneous intracranial hypotension can be debilitating for patients. This report describes the use of repeated high-volume epidural blood patches to treat this condition. Clinical features A 39-yr-old male presented with a history and diagnostic imaging findings consistent with spontaneous intracranial hypotension. The associated intractable and incapacitating headache was unrelieved by meperidine and a 20 mL lumbar autologous blood patch. Two weeks later, a second epidural blood patch of 45 mL autologous blood administered in the lower thoracic epidural space achieved partial relief. With symptoms persisting despite oral analgesics, a third blood patch was undertaken one month after the initial procedure. On this occasion, administration of 32 mL autologous blood into the mid-thoracic epidural space resulted in complete and lasting resolution of the headache. Conclusion The ideal volume of blood injectate to achieve maximal effectiveness for an epidural blood patch is unknown. While many clinicians use a predetermined maximal volume, a volume titrated to patient symptoms is a suggested alternate approach. RésuméObjectif Les ce´phale´es re´fractaires cause´es par l'hypotension intracraˆnienne spontane´e peuvent eˆtre de´bilitantes pour les patients. Ce compte-rendu de´crit l'utilisation de colmatages sanguins pe´riduraux re´pe´te´s à grand volume pour traiter cette condition. É léments cliniques Un homme de 39 ans s'est pre´senteá vec des ante´ce´dents et des re´sultats d'imagerie diagnostique indiquant qu'il souffrait d'hypotension intracraˆnienne spontane´e. Les ce´phale´es re´fractaires et handicapantes associe´es a`cette condition ont e´te´soulage´es graˆce a`de la me´pe´ridine et un colmatage lombaire de sang autologue de 20 mL. Deux semaines plus tard, un deuxie`me colmatage sanguin pe´ridural de 45 mL de sang autologue administred ans l'espace pe´ridural thoracique bas a permis un soulagement partiel. En raison de la persistance des symptômes en de´pit de la prise d'analge´siques oraux, un troisie`me colmatage sanguin a e´te´re´alise´un mois apre`s la premie`re intervention. Lors de ce colmatage, une re´solution comple`te et durable des ce´phale´es a e´te´obtenue graˆce a`l'administration de 32 mL de sang autologue dans l'espace pe´ridural thoracique moyen. Conclusion Nous ne connaissons pas le volume ide´al de sang a`injecter afin d'obtenir la plus grande efficacite´lors d'un colmatage sanguin pe´ridural. Alors que nombre de cliniciens utilisent un volume maximal pre´de´termine´, un volume titre´selon les symptômes du patient pourrait constituer une approche alternative.

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Fatal postoperative intracranial hypotension‐associated venous congestion after elective laminectomy

Schopmeyer

Sindhunata

Drogt-Bilaseschi

et al. 2021

Anaesthesia Reports

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Postoperative intracranial hypotension-associated venous congestion is a rare complication that features radiologic characteristics suggestive of hypoxic ischaemic encephalopathy without systemic hypoxia or hypotension actually occurring. This makes the condition prone to being misidentified as a complication of anaesthesia. In this case, a patient undergoing emergency haematoma evacuation after a previous lumbar laminectomy lost cerebrospinal fluid rapidly and accidentally via a wound drain. She subsequently developed postoperative seizures and eventually died some days later having never regained consciousness. A magnetic resonance imaging scan acquired after the event showed signs initially thought to be indicative of hypoxic ischaemic encephalopathy but was later identified to be postoperative intracranial hypotension-associated venous congestion due to temporary obstruction of the great cerebral vein, resulting in local rather than systemic hypoxia. Anaesthetists should be aware of this rare condition and be familiar with its pathophysiology and presentation.

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Intracranial hypotension syndrome: a comprehensive review

Cited by 169 publications

References 42 publications

Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases

Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases

Repeated large-volume epidural blood patches for the treatment of spontaneous intracranial hypotension

Fatal postoperative intracranial hypotension‐associated venous congestion after elective laminectomy

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