Sex‐ and Age‐Related Differences in the Clinical and Neuroimaging Characteristics of Patients With Spontaneous Intracranial Hypotension: A Records Review

Tanaka, Yoshiaki; Tosaka, Masahiko; Fujimaki, Hiroya; Honda, Fumiaki; Yoshimoto, Yuhei

doi:10.1111/head.12887

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…In the SIH group, EBP was performed more frequently in women, consistent with the results published in another study [ 29 ]. Under the influence of estrogen, swelling of the cerebral blood vessels in CSF hypovolemia is likely to be more pronounced in young women, leading to more severe headaches [ 30 ].…”

Section: Discussionsupporting

confidence: 89%

Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

Lee

Kim

et al. 2021

BMC Neurol

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Background Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment. Methods We retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus). Results A total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02). Conclusions Patients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.

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Section: Discussionsupporting

confidence: 89%

Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

Lee

Kim

et al. 2021

BMC Neurol

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“…The nding was in keeping with a study from Japan (n = 40), in which it took longer for men to make the rst consultation. 33 Besides, in the present study, men were less likely to have nausea, vomiting, photophobia, and tinnitus despite similar severities of headache, structural changes in the brain, and spinal CSF leakages. In fact, the overall percentages of patients reporting individual associated symptoms in our study were similar to those reported in the literature, 1,20 although whether there could be sex differences has rarely been looked upon speci cally.…”

Section: Discussionsupporting

confidence: 46%

“…The nding was independent of age and delays in presentation, and was consistent with some prior reports. 5,33,44 In fact, SDH in general is also more common in men than in women. 45,46 A recent study from China reported the male gender appeared to be a risk factor for SDH in univariable but not multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in the Clinical Manifestations and Treatment Outcomes of Spontaneous Intracranial Hypotension: A Large Cohort Study

Lin,

Hseu,

Fuh

et al. 2023

Preprint

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Background Spontaneous intracranial hypotension is associated with considerable functional disability and potentially fatal complications, and it is uncertain whether men and women should be managed differently. We aimed to determine sex differences in clinical profiles and treatment outcomes in spontaneous intracranial hypotension. Methods This was a retrospective analysis of a prospective cohort of consecutive spontaneous intracranial hypotension patients enrolled from a tertiary medical center between December 1997 and January 2021 and followed up for at least three months. Medical records and imaging findings were reviewed. The outcome of treatment responses to epidural blood patches and risks of subdural hematoma and surgical drainage were measured. Results In total, 442 patients with spontaneous intracranial hypotension (165M/277F, mean age 40.3 ± 10.0 years) were included in the analysis. Men had longer delays between disease onset and initial hospital presentation (20.8 ± 21.5 vs. 38.2 ± 67.4 days, P = .002), and were less likely to have nausea, vomiting, photophobia, and tinnitus compared with women (all P < .05) despite comparable radiologic findings. Among the 374 patients treated with epidural blood patches, men were more likely to fail the first epidural blood patch (58.0% vs. 39.0%, odds ratio [OR] = 2.2 [95% confidence interval = 1.4–3.3], P < .001). However, the cumulative response rates to up to two epidural blood patches were similar in men and women (86.2% vs. 87.7%, P = .680). Men were at a higher risk of having subdural hematoma (29.7% vs. 10.8%, OR = 3.5 [95% CI = 2.1–5.8], P < .001). Among patients with subdural hematoma, men had greater thickness (12.8 ± 4.3 vs. 8.1 ± 5.9 mm, P < .001) and were more likely to receive surgical drainage (55.1% vs. 10.0%, OR = 11.0 [95% CI = 3.0-41.3], P < .001) than women. Two of the three patients with mortality or significant disability were men, and the only death in women was attributed to the underlying malignancy. Conclusions Spontaneous intracranial hypotension in men is characterized by a delayed presentation, poorer response to the first epidural blood patch, and a higher risk of subdural hematoma. Caution should be exercised in the management of men with spontaneous intracranial hypotension, and more aggressive measures, such as early and/or multiple epidural blood patches, may be helpful.

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“…SIH typically manifests as cerebrospinal fluid (CSF) hypotension and the diagnostic feature includes a postural headache [24]. The etiology of the CSF leakage is not understood completely.…”

Section: Discussionmentioning

confidence: 99%

An unusual postural headache: a case report

Pollard¹,

Pollard²

2020

Chiropr Man Therap

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Background This paper presents a case of an evolving unusual thunderclap headache that presented to a chiropractor. Case presentation The intense “migraine-like” headache was aggravated by standing up and relieved substantially when lying down. This low pressure, orthostatic headache was diagnosed as a spontaneous intracranial hypotension (SIH) secondary to a spontaneous tear of the dura. It was referred to the local hospital for management with autogolous blood injection to form an epidural blood patch of the defect. It resolved substantially within 3 days. Conclusions The significance of key features in the history and examination and how if not recognised and subsequently treated with manual therapy, the dural tear could be attributed to the treatment of the chiropractor, a treatment that would typically involve cervical manipulation. Discussion is provided of the implications of a missed diagnosis and possible subsequent chiropractic management with the evolving SIH being attributed to the chiropractic intervention rather than its true “spontaneous” nature.

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Sex‐ and Age‐Related Differences in the Clinical and Neuroimaging Characteristics of Patients With Spontaneous Intracranial Hypotension: A Records Review

Abstract: spontaneous intracranial hypotension, sex, age, magnetic resonance imaging, thunderclap headache.

Cited by 8 publications

References 30 publications

Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

Sex Differences in the Clinical Manifestations and Treatment Outcomes of Spontaneous Intracranial Hypotension: A Large Cohort Study

An unusual postural headache: a case report

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