Intracranial Hypotension With Parkinsonism, Ataxia, and Bulbar Weakness

Pakiam, Anthony S.-I.; Lee, Christine; Lang, Anthony E.

doi:10.1001/archneur.56.7.869

Cited by 111 publications

(76 citation statements)

References 22 publications

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“…3 Other clinical manifestations include disappearance of or improvement in the headache within 30 minutes after lying supine, and cranial nerve palsies related to traction from caudal displacement of the brainstem. 9 Severe midbrain compression may result in nigral dopaminergic dysfunction and manifest as parkinsonism. 9 Coma occurs from delayed decompression of brainstem descent.…”

Section: Discussionmentioning

confidence: 99%

“…9 Severe midbrain compression may result in nigral dopaminergic dysfunction and manifest as parkinsonism. 9 Coma occurs from delayed decompression of brainstem descent. 4 Subdural haematoma is a late finding and occurs in around 10% of patients with SIH, 3 commonly seen in males and those older than 35 years.…”

Section: Discussionmentioning

confidence: 99%

“…Findings of MRI in the brain classically show diffuse pachymeningeal thickening which has a sensitivity of up to 94% (Fig 2b). 9 The venous distention sign may also be seen and is best appreciated in the mid-portion of the dominant transverse sinus 12 ; on sagittal sections, the sinus, which normally adopts a concave or straight inferior border, bulges with a convex contour. Venous engorgement at the dura mater across the sella turcica could produce reactive hyperaemia and possible increase in size of the pituitary gland.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous intracranial hypotension: improving recognition and treatment strategies in the local setting

Lee¹,

Abrigo²,

Cheung³

et al. 2014

Hong Kong Med J

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We report a case of spontaneous intracranial hypotension with classic symptoms of orthostatic headache and acute presentation of subdural haematoma on computed tomographic scan. Conventional approach with conservative treatment was initially adopted. The patient's condition, however, deteriorated after 2 weeks, requiring surgical evacuation of the intracranial haemorrhage. We reviewed the clinical features of this disease and the correlated magnetic resonance imaging findings with the pathophysiological mechanisms, and described treatment strategies in the local setting. Subtle findings on initial computed tomographic scan are also reported which might improve pathology recognition. Spontaneous intracranial hypotension is not uncommonly encountered in Hong Kong, and physicians must adopt a high level of clinical suspicion to facilitate early diagnosis Spontaneous intracranial hypotension: improving recognition and treatment strategies in the local setting Case reportA 54-year-old man with no history of trauma was admitted to the Prince of Wales Hospital for headache of progressive severity accompanied by dizziness in August 2012. He had consulted the emergency room 4 weeks earlier for neck pain, and had an unremarkable computed tomographic (CT) scan of the brain (CTB). Further enquiry revealed an orthostatic component within the headache (worse in upright position and relieved within minutes of assuming supine posture), while admission CTB revealed interval development of bilateral 5 mmthick frontoparietal subacute subdural haematomas (SDHs) with disproportionate tightness of the basal cisterns. Cerebral magnetic resonance imaging (MRI) additionally demonstrated compression of the midbrain, but no caudal herniation of the cerebellar tonsils beyond the foramen magnum. Contrast study showed diffuse pachymeningeal enhancement, venous sinus distension, and prominent pituitary gland. Spinal MRI was unremarkable and MRI cisternography/myelography was negative for cerebrospinal fluid (CSF) leakage.The patient was advised complete bed rest

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spontaneous intracranial hypotension: improving recognition and treatment strategies in the local setting

Lee¹,

Abrigo²,

Cheung³

et al. 2014

Hong Kong Med J

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“…13 Other unusual presentations include bradycardia, nystagmus, binasal fields defect, 15 stupor secondary to diencephalic compression, 16 cerebellar ataxia, bulbar weakness, and parkinsonism. 17 The latter may be due to a compressive effect on the brainstem.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracranial Hypotension in the Absence of Magnetic Resonance Imaging Abnormalities

Schoffer

Benstead

Grant

2002

Can. j. neurol. sci.

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Originally named "aliquorrhea" by Schaltenbrand 1 in 1938, spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome characterized by a triad of low CSF pressure, postural headache, and magnetic resonance imaging (MRI) abnormalities. 2 The classic MRI finding of diffuse pachymeningeal enhancement, 3 with leptomeningeal sparing, is thought to be a result of engorgement of dural bridging veins secondary to decreased CSF pressure.4 This is such a hallmark feature that its absence has been suggested to exclude the diagnosis. 2 There have been only a few reported cases of SIH with absent MRI findings. 5 We report four cases of SIH that presented to our institution ABSTRACT: Background: Spontaneous intracranial hypotension (SIH) is a neurologic syndrome of unknown etiology, characterized by features of low cerebral spinal fluid (CSF) pressure, postural headache and magnetic resonance imaging (MRI) abnormalities. Methods: Four symptomatic cases of SIH presented to our institution over a six-month period. Magnetic resonance imaging studies were performed in all four cases. Diagnostic lumbar puncture was done in all except one case. Results: All of the patients on whom lumbar punctures were performed demonstrated low CSF pressure and CSF protein elevation with negative cultures and cytology. Three out of the four patients exhibited MRI findings of diffuse spinal and intracranial pachymeningeal gadolinium enhancement and extradural or subdural fluid collections. One patient had no MRI abnormalities despite prominent postural headache and reduced CSF pressure at lumbar puncture. All patients recovered with intravenous fluids and conservative treatment. Conclusions: Magnetic resonance imaging abnormalities are found in most, but not all patients, with SIH. Cerebral spinal fluid abnormalities can be detected even in patients with normal MRI studies. It is important to recognize the variability of imaging results in this usually benign disorder.

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“…Neurological manifestations include visual symptoms such as diplopia, visual blurring, field defects, or photophobia 16 , hearing abnormalities including tinnitus, distortions and sensory neural hearing loss 15,16 , various cranial nerve palsies, and even peripheral manifestations of interscapular pain or radicular symptoms 2,5,12,14 . Unusual clinical manifestations have been described in case reports and include parkinsonism, gait abnormalities, cerebellar ataxia 17 , bipolar disorder 18 , encephalopathy, cognitive changes (including one case of frontotemporal dementia [FTD]) 19 , obtundation and coma 11,[20][21][22][23] . Only one case of death related to SIH has been published to date 24 .…”

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confidence: 99%

Intracranial Hypotension Causing Reversible Frontotemporal Dementia and Coma

Sayao

Heran²,

Chapman³

et al. 2009

Can. j. neurol. sci.

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Intracranial Hypotension With Parkinsonism, Ataxia, and Bulbar Weakness

Abstract: The clinical spectrum of intracranial hypotension can be broadened to include parkinsonism, cerebellar ataxia, and prominent bulbar dysfunction. As with more common manifestations of the disorder, these features may resolve after appropriate treatment.

Cited by 111 publications

References 22 publications

Spontaneous intracranial hypotension: improving recognition and treatment strategies in the local setting

Spontaneous intracranial hypotension: improving recognition and treatment strategies in the local setting

Spontaneous Intracranial Hypotension in the Absence of Magnetic Resonance Imaging Abnormalities

Intracranial Hypotension Causing Reversible Frontotemporal Dementia and Coma

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