Spontaneous Intracranial Hypotension in Childhood and Adolescence

Schievink, Wouter I.; Maya, M. Marcel; Louy, Charles; Moser, Franklin G.; Sloninsky, Liliana

doi:10.1016/j.jpeds.2013.01.055

Cited by 55 publications

(39 citation statements)

References 32 publications

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“…Despite representing the gold standard for post-lumbar puncture headaches, EBP has a widely variable success rate and a failure rate up to 44% and often requires multiple treatments when used for spontaneous intracranial hypotension. 4,21 The largest case series involving percutaneous epidural fibrin glue injection involved 23 patients and reported a 65% success rate. 16 In pediatrics, EBP requires weight-based dosing, and typically between 0.3 and 0.4 ml/kg is used and larger doses (up to 0.8 ml/kg) have been reported for repeat procedures.…”

Section: Discussionmentioning

confidence: 99%

Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Chu¹,

Miller²,

Bazylewicz

et al. 2016

PED

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Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.

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Section: Discussionmentioning

confidence: 99%

Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Chu¹,

Miller²,

Bazylewicz

et al. 2016

PED

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“…Female are affected twice to fifth as often as males [8, 11]. The peak incidence is in 30–50 year-old although it also occurs in children and the aged [8, 11–16]. …”

Section: Reviewmentioning

confidence: 99%

The status of diagnosis and treatment to intracranial hypotension, including SIH

Lin

Zhang

et al. 2017

J Headache Pain

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Intracranial hypotension, especially spontaneous intracranial hypotension (SIH), is a well—recognized entity associated with cerebrospinal fluid (CSF) leaks, and has being recognized better in resent years, while still woefully inadequate. An increasing number of factors including iatrogenic factors are realized to involve in development and progression of intracranial hypotension. The diagnosis remains difficult due to the various clinical manifestations, some of which are nonspecific and easily to be neglected. Multiple imaging tests are optional in CSF leakage identification while clinicians are still confronted with difficulties when making selection resulting from superiorities and disadvantages of different imaging tests. Treatments for intracranial hypotension are multifarious but evidence is anecdotal. Values of autologous epidural blood patching (EBP), the mainstay of first-line interventional treatment currently, is getting more and more regards while there are no systematic review of its efficacy and risks. Hereby, the purpose of this review was to reveal the present strategy of intracranial hypotension diagnosis and treatment by reviewing literatures, coupled with our experience in clinical work.

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“…An additional eight patients in this 50-patient series met criteria for benign joint hypermobility syndrome. In another study of 24 pediatric cases of SIH, 13 patients were found to have evidence of a generalized disorder of connective tissue, a notably higher prevalence compared with adults [34]. Intracranial aneurysm was found in 9 % of patients with SIH (n=93) as compared to 1 % of controls (n= 291), also suggesting the presence of underlying connective tissue disorder [35•].…”

Section: Dural Weaknessmentioning

confidence: 99%

Headache Secondary to Intracranial Hypotension

Schievink

Deline²

2014

Curr Pain Headache Rep

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Intracranial hypotension is known to occur as a result of spinal cerebrospinal fluid (CSF) leaking, which may be iatrogenic, traumatic, or spontaneous. Headache is usually, but not always, orthostatic. Spontaneous cases are recognized more readily than in previous decades as a result of a greater awareness of clinical presentations and typical cranial magnetic resonance imaging findings. An underlying disorder of connective tissue that predisposes to weakness of the dura is implicated in spontaneous spinal CSF leaks. CT, MR, and digital subtraction myelography are the imaging modalities of choice to identify spinal CSF leakage. Spinal imaging protocols continue to evolve with improved diagnostic sensitivity. Epidural blood patching is the most common initial intervention for those seeking medical attention, and may be repeated several times. Surgery is reserved for cases that fail to respond or relapse after simpler measures. While the prognosis is generally good with intervention, serious complications do occur. More research is needed to better understand the genetics and pathophysiology of dural weakness as well as physiologic compensatory mechanisms, to continue to refine imaging modalities and treatment approaches, and to evaluate short- and long-term clinical outcomes.

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Spontaneous Intracranial Hypotension in Childhood and Adolescence

Cited by 55 publications

References 32 publications

Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

The status of diagnosis and treatment to intracranial hypotension, including SIH

Headache Secondary to Intracranial Hypotension

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