Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions

Kranz, Peter G.; Gray, Linda; Amrhein, Timothy J.

doi:10.1111/head.13328

Cited by 105 publications

(104 citation statements)

References 56 publications

(148 reference statements)

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“…Until recently, the cause of SIH had been unclear, and several etiologies had been postulated. 10 With evidence presented here as well as that provided by other authors, 1,2,5,11,[17][18][19] it now appears that these leaks are predominantly, if not exclusively, due to mechanical tears, CVFs, and leaking nerve root sleeves. For guidance of management and efficiency of discussion, we have categorized the CSF leaks we have encountered into 4 types based on the morphology and distance from the midline.…”

Section: Discussionsupporting

confidence: 73%

“…Such patients may still harbor a CSF leak despite normal findings on CSF manometry. 1,2,23 In this report, 3 symptomatic patients positive for SLEC with no intracranial findings under-went DSM (mandated by their SLEC) and were proved to have a leak. Therefore, we must allow the corollary to be true-that is, there must be a percentage of patients negative for SLEC (types 3 and 4) who are leaking slowly and thus not attaining the threshold to display intracranial MR imaging stigmata but are still nonetheless leaking and having symptoms.…”

Section: Discussionmentioning

confidence: 70%

“…is caused by leakage of CSF from the thecal sac within or along the spinal canal. [1][2][3][4] The leakage of CSF causes variable symptoms, the most characteristic of which is a positional headache and is commonly associated with typical intracranial MR imaging findings or stigmata. [5][6][7][8][9][10] We have also noted, as have other authors, 2,[11][12][13] that while many patients with SIH present with a spinal longitudinal extradural CSF collection (SLEC), some do not.…”

Section: T He Syndrome Of Spontaneous Intracranial Hypotension (Sih)mentioning

confidence: 99%

See 2 more Smart Citations

Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography

Farb¹,

Nicholson²,

Peng³

et al. 2019

AJNR Am J Neuroradiol

121

137

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BACKGROUND AND PURPOSE:Localization of the culprit CSF leak in patients with spontaneous intracranial hypotension can be difficult and is inconsistently achieved. We present a high yield systematic imaging strategy using brain and spine MRI combined with digital subtraction myelography for CSF leak localization. MATERIALS AND METHODS:During a 2-year period, patients with spontaneous intracranial hypotension at our institution underwent MR imaging to determine the presence or absence of a spinal longitudinal extradural collection. Digital subtraction myelography was then performed in patients positive for spinal longitudinal extradural CSF collection primarily in the prone position and in patients negative for spinal longitudinal extradural CSF collection in the lateral decubitus positions. RESULTS: Thirty-one consecutive patients with spontaneous intracranial hypotension were included. The site of CSF leakage was definitively located in 27 (87%). Of these, 21 were positive for spinal longitudinal extradural CSF collection and categorized as having a ventral (type 1, fifteen [48%]) or lateral dural tear (type 2; four [13%]). Ten patients were negative for spinal longitudinal extradural CSF collection and were categorized as having a CSF-venous fistula (type 3, seven [23%]) or distal nerve root sleeve leak (type 4, one [3%]). The locations of leakage of 2 patients positive for spinal longitudinal extradural CSF collection remain undefined due to resolution of spontaneous intracranial hypotension before repeat digital subtraction myelography. In 2 (7%) patients negative for spinal longitudinal extradural CSF collection, the site of leakage could not be localized. Nine of 21 (43%) patients positive for spinal longitudinal extradural CSF collection were treated successfully with an epidural blood patch, and 12 required an operation. Of the 10 patients negative for spinal longitudinal extradural CSF collection (8 localized), none were effectively treated with an epidural blood patch, and all have undergone (n ϭ 7) or are awaiting (n ϭ 1) an operation. CONCLUSIONS: Patients positive for spinal longitudinal extradural CSF collection are best positioned prone for digital subtraction myelography and may warrant additional attempts at a directed epidural blood patch. Patients negative for spinal longitudinal extradural CSF collection are best evaluated in the decubitus positions to reveal a CSF-venous fistula, common in this population. Patients with CSF-venous fistula may forgo further epidural blood patch treatment and go on to surgical repair. ABBREVIATIONS: CVF ϭ CSF-venous fistula; DSM ϭ digital subtraction myelography; EBP ϭ epidural blood patch; SIH ϭ spontaneous intracranial hypotension; SLEC ϭ spinal longitudinal extradural CSF collection; SLEC-N ϭ negative for spinal longitudinal extradural CSF collection; SLEC-P ϭ positive for spinal longitudinal extradural CSF collection Indicates open access to non-subscribers at www.ajnr.org http://dx.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 70%

Section: T He Syndrome Of Spontaneous Intracranial Hypotension (Sih)mentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Intracranial Hypotension: A Systematic Imaging Approach for CSF Leak Localization and Management Based on MRI and Digital Subtraction Myelography

Farb¹,

Nicholson²,

Peng³

et al. 2019

AJNR Am J Neuroradiol

121

137

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“…Migraine Progression: A Systematic Review 1 Peter Kranz, Linda Gray, Timothy Amrhein Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions 2 Members of the AHS will be asked during March 2020 to vote on their favorite paper published online in Headache over the previous 12 months. As an Editorin-Chief of Headache, I have provided a shortlist of 5 papers that I feel represented the very best content we have published.…”

Section: From the Editorial Office Ahs Members' Choice Award For The mentioning

confidence: 99%

AHS Members’ Choice Award for the Best Article in Headache

Ward¹

2020

Headache

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“…We are humbled to have our manuscript “Spontaneous Intracranial Hypotension: 10 Myths and Misperceptions” selected as corecipient of the AHS Members' Choice Award for 2019. We are deeply grateful the AHS membership for their interest in this topic.…”

mentioning

confidence: 99%