Spontaneous intracranial hypotension: A study of six cases with MR findings and literature review

Sainani, NI; Lawande, Malini; Pungavkar, SA; Desai, Milind Y.; Patkar, Deepak; Mohanty, PH

doi:10.1111/j.1440-1673.2006.01615.x

Cited by 22 publications

(36 citation statements)

References 19 publications

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“…Subdural effusion was found in 3 patients and downward displacement of the brain was observed in 2 patients. Downward displacement of the brain is identified when the position of the opening of the aqueduct of Sylvius lies below the incisural line or when the tonsillar position lies under the foramen magnum line [8, 9] (fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Lan²,

Chang³

et al. 2009

Eur Neurol

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Background and Purpose: Spontaneous intracranial hypotension (SIH) is an uncommon, but not rare, cause of headache. We analyzed a series of patients with SIH and attempted to establish a clinical procedure. Methods: We retrospectively reviewed 11 patients with SIH who were admitted between January 2004 and May 2007. Data recorded from patients included basic data, clinical symptoms, neurological imaging studies and treatment. Results: Orthostatic headache was the most common symptom, but there were still 2 patients without orthostatic headache. Diffuse pachymeningeal enhancement was the most common finding in brain MRI study and engorgement of the spinal epidural venous plexus was the most common finding in spinal MRI study. Eight of our patients received epidural blood patches in the lumbar area and 6 of these were symptom-free within 2 weeks. Two patients received spinal MRI immediately after administering the epidural blood patch, and this revealed that most of the blood had spread to the upper cervical area from the lumbar injection. Conclusion: A blind epidural blood patch from the lumbar area is an acceptable procedure even if the area of leakage is unknown. A reasonable clinical procedure for the patients of SIH may minimize the rate of repeat puncture.

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Section: Resultsmentioning

confidence: 99%

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Lan²,

Chang³

et al. 2009

Eur Neurol

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“…The findings that are indicative of SIH on a spinal MRI are meningeal enhancement, dilatation of the epidural venous plexus and an extra-arachnoid fluid collection [9,12]. For our case, we found a dilated epidural venous plexus.…”

Section: Discussionmentioning

confidence: 49%

“…When the RNC does not lead to finding the leak, CT myelography could be more helpful. Because of its higher sensitivity, performing CT myelography is better for finding CSF leaks than performing RNC and spinal MRI [12]. We were able to find the leak in the cervical and thoracic levels in our patient by performing RNC, so we did not have to perform further tests.…”

Section: Discussionmentioning

confidence: 96%

“…Enhancement of the pachymeninges was previously considered to be the most critical finding for making the diagnosis of SIH, but it has recently been discovered that 20% of SIH patients do not have this [12]. Moreover, many other diseases have been found to cause pachymeningeal enhancement such as infectious diseases (tuberculosis, fungal infection, lyme's disease, syphilis and HTLV), colleagen vascular diseases (rheumatoid arthritis, SLE and complex connective tissue diseases), neoplasia (multifocal fibrosclerosis, carcinoma, lymphoma and meningioma en plaque) and miscellaneous disorders (sarcoidosis, hemodialysis and intrathecal drug administration) [13].…”

Section: Discussionmentioning

confidence: 99%

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Epidural Blood Patches in a Patient With Multi-level Cerebrospinal Fluid Leakage That Was Induced by Spontaneous Intracranial Hypotension

Kim

Hong

2010

Korean J Pain

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Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

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“…The diagnosis is confirmed by encephalic MRI and axial and sagittal T1 sequences, with intravenous administration of gadolinium showing subdural fluid-collection enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain 5,6. Although typical, these radiological features may be missed, leading to misdiagnosis of this condition 7,8…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture

Louhab¹,

Adali²,

Laghmari³

et al. 2014

IJGM

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IntroductionSpontaneous intracranial hypotension is an infrequent cause of secondary headache due to cerebrospinal fluid (CSF) hypovolemia.ObjectiveTo describe a case of headache revealing spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture.ObservationA 34-year-old man presented with acute postural headache. The first cerebral computed tomography scan was normal. Lumbar puncture showed hyperproteinorachy at 2 g/L with six lymphocytic cells. The headache became very intense. At admission, clinical examination was normal. Ophthalmological examination did not show any abnormalities. Encephalic magnetic resonance imaging (MRI) showed bilateral subdural hematoma with tonsillar descent simulating Chiari type I malformation. After surgical drainage and symptomatic treatment, the patient was discharged with no recurrence.ConclusionSpontaneous intracranial hypotension is associated with simple clinical presentation, orthostatic headache, and characteristic MRI findings. Misdiagnosed, it leads to unnecessary procedures.

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Spontaneous intracranial hypotension: A study of six cases with MR findings and literature review

Cited by 22 publications

References 19 publications

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Clinical Features, Neuroimaging and Treatment of Spontaneous Intracranial Hypotension and Magnetic Resonance Imaging Evidence of Blind Epidural Blood Patch

Epidural Blood Patches in a Patient With Multi-level Cerebrospinal Fluid Leakage That Was Induced by Spontaneous Intracranial Hypotension

Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture

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