Syndrome of cerebral spinal fluid hypovolemia

Abstract

Patients with CSF hypovolemia frequently have distinct MRI and radioisotope cisternographic abnormalities and often respond favorably to an epidural blood patch.

Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

“…In contrast to previous findings (Mokri et al, 1998;Chung et al, 2000;Wang et al, 2014), only 55.3% of SIH cases in our study showed a low CSF pressure (≤60 mmH 2 O). Mokri et al (1998) reviewed a series of 40 patients with orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPGE), and found normal CSF pressure in only seven (18%) patients.…”

Intracranial Hypotension Causing Reversible Frontotemporal Dementia and Coma

“…The Table summarizes The treatment of some cases of SIH can prove challenging. A two-month trial of conservative management comprised of bed rest and hydration, analgesics, caffeine and theophylline, in mild cases of postural headaches without disabling neurological symptoms has been recommended by some 5,9,28,29 , with a success rate of less than 30% reported 28 . There has only been one previously published case report of a patient with SIH who presented with chronic daily headache and neuropsychiatric features of FTD 27 .…”

“…Failing conservative medical management, one should consider the use of an epidural blood patch to seal dural CSF leaks 5,9,10,19,28,29,31,32 . The proposed mechanism for the efficacy of blood patching is two fold: an initial displacement of the dura towards the spinal cord moves peri-spinal CSF into cranium, thus immediately increasing intracranial CSF volume, pressure and buoyancy forces; and later, as blood coagulates at the leak site, further CSF loss is prevented.…”

“…Variation exists in the site of blood patch administration, however targeted patches are theoretically and therapeutically more effective. Cousins et al reported a 57% response rate to blind lumbar epidural blood patches in patients with SIH 10 , whereas Chung et al report an 80% success rate of guided epidural blood patch at the site of a single CSF leak 28 . Therefore, a large volume (20 to 60 cc) targeted blood patch of a demonstrated CSF leak is recommended.…”

“…Radionuclide Cisternography 3,7,28,35 Decreased radioactivity reaching brain convexities Rapid elimination of isotope from CSF & early appearance in bladder Soft tissue uptake of isotope Leak visualization Dural / subdural biopsy 37 Non-inflammatory reactive changes Organized hygromas comprised of fibroblasts, thin-walled blood vessels and amorphous matrix. …”