DOI QR코드

DOI QR Code

Spontaneous Intracranial Hypotension : Clinical Presentation, Imaging Features and Treatment

  • Park, Eun-Soo (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Ealmaan (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine)
  • 발행 : 2009.01.28

초록

Objective : In the present study, the authors investigated the clinical and imaging features as well as the therapeutic outcomes of SIH (spontaneous intracranial hypotension) patients. Methods : A retrospective review of 12 SIH patients was carried out. The diagnostic work-up included lumbar tapping and measurement of CSF opening pressure, radioisotope cisternography, brain and spinal magnetic resonance imaging (MRI), and computed tomography (CT) myelography. Autologous epidural blood patching was performed in patients who did not respond to conservative therapies, including analgesics, steroids, hydration and rest. Results : Typical postural headache was found in 11 (91%) patients. Nine (75%) patients showed pachymeningeal enhancement on their initial T1-weighted MR images. The CSF opening pressure was less than 60 mm$H_2O$ in 9 of 11 patients. Autologous epidural blood patching was performed in 7 patients, and all of them showed good responses. Conclusion : SIH can present with various clinical presentations and neuroimaging findings. Autologous epidural blood patching is thought to be the treatment of choice for patients with SIH.

키워드

참고문헌

  1. Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B : Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg 88 : 237-242, 1998 https://doi.org/10.3171/jns.1998.88.2.0237
  2. Chung SJ, Kim JS, Lee MC : Syndrome of cerebral spinal fluid hypovolemia. Neurology 55 : 1321-1327, 2000 https://doi.org/10.1212/WNL.55.9.1321
  3. Cohen-Gadol AA, Mokri B, Piepgras DG, Meyer FB, Atkinson JL : Surgical anatomy of dural defects in spontaneous spinal cerebrospinal fluid leaks. Neurosurgery 58 : ONS-238-ONS-245; discussion ONS-245, 2006
  4. Fuh JL, Wang SJ, Lai TH, Hseu SS : The timing of MRI determines the presence or absence of diffuse pachymeningeal enhancement in patients with spontaneous intracranial hypotension. Cephalalgia 28 : 318-322, 2008 https://doi.org/10.1111/j.1468-2982.2007.01498.x
  5. Kawase Y, Ikeda K, Murata K, Iwamoto K, Ito H, Wasaki Y : Nonpostural headache in spontaneous intracranial hypotension. Headache 48 : 641-642, 2008 https://doi.org/10.1111/j.1526-4610.2008.01068.x
  6. Kong DS, Park K, Nam DH, Lee JI, Kim ES, Kim JS, et al : Atypical spontaneous intracranial hypotension (SIH) with nonorthostatic headache. Headache 47 : 199-203, 2007 https://doi.org/10.1111/j.1526-4610.2006.00687.x
  7. Lee DC, Jeun SS, Ryu KS, Lee TK, Lee KS, Son BC : Clinical analysis of spontaneous intracranial hypotension. J Korean Neurosug Soc 31 : 558-563, 2002
  8. Mokri B : Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia-evolusion of a concept. Mayo Clin Proc 74 : 1113-1123, 1999 https://doi.org/10.4065/74.11.1113
  9. Mokri B : Syndrome of cerebral spinal fluid hypovolemia : clinical and imaging features and outcome. Neurology 56 : 1607-1608, 2001
  10. Mokri B, Atkinson JL, Dodick DW, Miller GM, Piepgras DG : Absent pachymeningeal gadolinium enhancement on cranial MRI despite symptomatic CSF leak. Neurology 53 : 402-404, 1999 https://doi.org/10.1212/WNL.53.2.402
  11. Mokri B, Atkinson JL, Piepgras DG : Absent headache despite CSF volume depletion (intracranial hypotension). Neurology 55 : 1722- 1724, 2000 https://doi.org/10.1212/WNL.55.11.1722
  12. Mokri B, Hunter SF, Atkinson JL, Piepgras DG : Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology 51 : 786-790, 1998 https://doi.org/10.1212/WNL.51.3.786
  13. Mokri B, Krueger BR, Miller GM : Meningeal gadolinium enhancement in low pressure headache. Ann Neurol 30 : 294-295, 1991
  14. Pannullo SC, Reich JB, Krol G, Deck MD, Posner JB : MRI changes in intracranial hypotension. Neurology 43 : 919-926, 1993 https://doi.org/10.1212/WNL.43.5.919
  15. Reich JB, Seirra J, Deck MD, Plum F : Magnetic resonance imaging measurements and clinical changes accompanying transtentorial and foramen magnum brain herniation. Ann Neurol 33 : 159-170, 1993 https://doi.org/10.1002/ana.410330205
  16. Schievink WI, Meyer FB, Atkinson JL, Mokri B : Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 84 : 598-605, 1996 https://doi.org/10.3171/jns.1996.84.4.0598
  17. Schievink WI, Tourje J : Intracranial hypotension without meningeal enhancement on magnetic resonance imaging. Case report. J Neurosurg 92 : 475-477, 2000 https://doi.org/10.3171/jns.2000.92.3.0475
  18. Waguri N, Tomita M, Hayatsu K, Okamoto K, Shimoji K : Epidural blood patch for treatment of spontaneous intracranial hypotension. Acta Anaesthesiol Scand 46 : 747-750, 2002 https://doi.org/10.1034/j.1399-6576.2002.460620.x

피인용 문헌

  1. Development of Postdural Puncture Headache Following Therapeutic Acupuncture Using a Long Acupuncture Needle vol.47, pp.2, 2009, https://doi.org/10.3340/jkns.2010.47.2.140
  2. Isolated Cortical Vein Thrombosis After Epidural Anesthesia: Report of Three Cases vol.120, pp.6, 2009, https://doi.org/10.3109/00207451003778751
  3. Sinus Thrombosis in a Patient with Intracranial Hypotension: A Suggested Hypothesis of Venous Stasis : A Case Report vol.17, pp.2, 2011, https://doi.org/10.1177/159101991101700218
  4. Spontaneous Intracranial Hypotension Without Intracranial Hypotension vol.31, pp.3, 2011, https://doi.org/10.1097/wno.0b013e3181fcc04a
  5. Normal pressure form of the spontaneous intracranial hypotension: a case report with pituitary enlargement and asymptomatic pituitary haemorrhage vol.32, pp.5, 2009, https://doi.org/10.1007/s10072-011-0584-6
  6. Brain herniation induced by drainage of subdural hematoma in spontaneous intracranial hypotension vol.8, pp.2, 2009, https://doi.org/10.4103/1793-5482.116390
  7. Spinal Epidural Hematoma Related to Intracranial Hypotension vol.10, pp.3, 2013, https://doi.org/10.14245/kjs.2013.10.3.203
  8. A systematic literature review of intracranial hypotension following chiropractic vol.68, pp.3, 2009, https://doi.org/10.1111/ijcp.12247
  9. Severe respiratory failure following ventriculopleural shunt vol.19, pp.11, 2015, https://doi.org/10.4103/0972-5229.169359
  10. Results of Isotope Cisternography in 175 Patients with a Suspected Hydrocephalus vol.11, pp.1, 2015, https://doi.org/10.13004/kjnt.2015.11.1.11
  11. Liquorverlustsyndrom : Indikation, Technik und Ergebnisse der Behandlung mit „blood patch“ vol.55, pp.6, 2009, https://doi.org/10.1007/s00117-014-2804-6
  12. Overshunting-associated myelopathy: report of 2 cases vol.41, pp.3, 2016, https://doi.org/10.3171/2016.7.focus16179
  13. The usefulness of MDCT-myelography for patients with spontaneous intracranial hypotension vol.5, pp.1, 2009, https://doi.org/10.1186/s40064-016-2060-5
  14. Early Epidural Blood Patch to Treat Intracranial Hypotension after Iatrogenic Cerebrospinal Fluid Leakage from Lumbar Tubular Microdiscectomy vol.10, pp.11, 2018, https://doi.org/10.7759/cureus.3633
  15. Cerebrospinal fluid leak causing spontaneous intracranial hypotension vol.21, pp.2, 2019, https://doi.org/10.4103/jmms.jmms_46_18
  16. Cerebral Venous Thrombosis and Subdural Collection in a Comatose Patient: Do Not Forget Intracranial Hypotension. A Case Report vol.60, pp.10, 2020, https://doi.org/10.1111/head.13977
  17. Cerebrospinal fluid hypovolemia: A case report of a red herring vol.16, pp.4, 2021, https://doi.org/10.4103/ajns.ajns_239_21
  18. A Case of Miyazaki Syndrome Caused by Arachnoid Cyst-Peritoneal Shunt vol.146, pp.None, 2009, https://doi.org/10.1016/j.wneu.2020.10.094