scholarly journals Spontaneous Intracranial Hypotension: Recommendations for Management

2013 ◽  
Vol 40 (2) ◽  
pp. 144-157 ◽  
Author(s):  
Farnaz Amoozegar ◽  
Darryl Guglielmin ◽  
William Hu ◽  
Denise Chan ◽  
Werner J. Becker
Keyword(s):  
Computed Tomography ◽  
Clinical Trials ◽  
Mr Imaging ◽  
Intracranial Hypotension ◽  
Literature Search ◽  
Spontaneous Intracranial Hypotension ◽  
Normal Brain ◽  
Non Invasive ◽  
Radionuclide Cisternography ◽  
Mr Myelography

A literature search found no clinical trials or guidelines addressing the management of spontaneous intracranial hypotension (SIH). Based on the available literature and expert opinion, we have developed recommendations for the diagnosis and management of SIH. For typical cases, we recommend brain magnetic resonance (MR) imaging with gadolinium to confirm the diagnosis, and conservative measures for up to two weeks. If the patient remains symptomatic, up to three non-directed lumbar epidural blood patches (EBPs) should be considered. If these are unsuccessful, non-invasive MR myelography, radionuclide cisternography, MR myelography with intrathecal gadolinium, or computed tomography with myelography should be used to localize the leak. If the leak is localized, directed EPBs should be considered, followed by fibrin sealant or neurosurgery if necessary. Clinically atypical cases with normal brain MR imaging should be investigated to localize the leak. Directed EBPs can be used if the leak is localized; non-directed EBPs should be used only if there are indirect signs of SIH.

The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography

Cephalalgia ◽  
2016 ◽  
Vol 36 (13) ◽  
pp. 1291-1295 ◽  
Author(s):  
Teshamae S Monteith ◽  
Stephen F Kralik ◽  
William P Dillon ◽  
Randall A Hawkins ◽  
Peter J Goadsby
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Ct Myelography ◽  
Leak Location ◽  
Perineural Cyst ◽  
Mr Myelography ◽  
Csf Leaks

Objective The objective of this report is to compare computed tomography (CT) and magnetic resonance (MR) myelography with radioisotope cisternography (RC) for detection of spinal cerebrospinal (CSF) leaks. Methods We retrospectively reviewed 12 spontaneous intracranial hypotension (SIH) patients; CT and RC were performed simultaneously. Three patients had MR myelography. Results CT and/or MR myelography identified CSF leaks in four of 12 patients. RC detected spinal leaks in all three patients confirmed by CT myelography; RC identified the CSF leak location in two of three cases, and these were due to osteophytic spicules and/or discs. RC showed only enlarged perineural activity. Only intrathecal gadolinium MR myelography clearly identified a slow leak from a perineural cyst. In eight remaining cases, the leak site was unknown; however, two of these showed indirect signs of CSF leak on RC. CSF slow leaks from perineural cysts were the most common presumed etiology; and the cysts were best visualized on myelography. Conclusion RC is comparable to CT myelography but has spatial limitations and should be limited to atypical cases.

Diagnosis of spontaneous intracranial hypotension by using magnetic resonance myelography

2000 ◽  
Vol 92 (5) ◽  
pp. 873-876 ◽  
Author(s):  
Akira Matsumura ◽  
Izumi Anno ◽  
Hiroshi Kimura ◽  
Eiichi Ishikawa ◽  
Tadao Nose
Keyword(s):  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Direct Evidence ◽  
Spontaneous Intracranial Hypotension ◽  
Content Type ◽  
Highly Sensitive ◽  
Csf Leakage ◽  
Leakage Site ◽  
A Site ◽  
Mr Myelography

✓ The authors describe a case of spontaneous intracranial hypotension in which the leakage site was determined by using magnetic resonance (MR) myelography. This technique demonstrated the route of cerebrospinal fluid (CSF) leakage, whereas other methods failed to show direct evidence of leakage. Magnetic resonance myelography is a noninvasive method that is highly sensitive in detecting CSF leakage. This is the first report in which a site of CSF leakage was detected using MR myelography.

Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension

2001 ◽  
Vol 94 (4) ◽  
pp. 642-645 ◽  
Author(s):  
Chikanori Inenaga ◽  
Tokutaro Tanaka ◽  
Naoki Sakai ◽  
Shigeru Nishizawa
Keyword(s):  
Computerized Tomography ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Upright Position ◽  
Breath Holding ◽  
Content Type ◽  
Radionuclide Cisternography ◽  
Csf Leakage ◽  
Upper Cervical ◽  
Fine Print

✓ The authors present the case of a 55-year-old man suffering from intractable spontaneous intracranial hypotension, in whom conservative treatment with 19 weeks of bed rest was not effective. In this period the patient twice underwent surgery for bilateral chronic subdural hematoma, a complication of spontaneous intracranial hypotension. Conventional radionuclide cisternography, magnetic resonance imaging, and computerized tomography myelography did not demonstrate cerebrospinal fluid (CSF) leakage. Repeated radionuclide cisternography with the patient in an upright position revealed leakage of the tracer at upper cervical levels. Computerized tomography myelography with breath holding also showed CSF leakage of the contrast medium bilaterally at upper cervical levels. The patient underwent surgery, and bilateral C-2 and C-3 spinal nerve root pouches were sealed off from the subarachnoid space with oxidized cellulose cotton and fibrin glue. Epiarachnoid spaces around the root sleeves were also sealed to ensure complete resolution of the CSF leakage. After the surgery, the patient was completely free of the disease. In the case of intractable persistent spontaneous intracranial hypotension, surgical treatment is preferable to long-term conservative management. To identify CSF leakage, radionuclide cisternography with the patient in the upright position is useful. When obvious leakage is encountered, surgical sealing of the lesion should be performed via a subarachnoid approach.

Cervical bone spur presenting with spontaneous intracranial hypotension

1998 ◽  
Vol 89 (3) ◽  
pp. 483-484 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Wouter I. Schievink ◽  
Jonathan J. Baskin ◽  
Volker K. H. Sonntag
Keyword(s):  
Mr Imaging ◽  
Intracranial Hypotension ◽  
Cervical Spinal Cord ◽  
Contrast Material ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Presumptive Diagnosis ◽  
Content Type ◽  
Hindbrain Herniation

✓ Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The exact cause of these CSF leaks often remains unknown. The authors treated a 32-year-old man with a unique cause of spontaneous intracranial hypotension. He suffered an excruciating headache that was exacerbated by his being in an upright position. The results of four-vessel cerebral angiography were negative; however, magnetic resonance (MR) imaging of the brain revealed pachymeningeal enhancement and hindbrain herniation. A presumptive diagnosis of spontaneous intracranial hypotension was made. Myelography revealed extrathecal contrast material ventral to the cervical spinal cord as well as an unusual midline bone spur at C5–6. The patient's symptoms did not resolve with the application of epidural blood patches, and he subsequently underwent an anterior approach to the C5–6 spur. After discectomy, a slender bone spur that had pierced the thecal sac was found. After its removal, the dural rent was closed using two interrupted prolene sutures. The patient was discharged home 2 days later. On follow up his symptoms had resolved, and on MR imaging the pachymeningeal enhancement had resolved and the cerebellar herniation had improved slightly.

scholarly journals History and modern trends in the treatment of spleen injuries in children

2021 ◽  
Vol 25 (1) ◽  
pp. 29-36
Author(s):  
A. L. Gorelik ◽  
O. V. Karaseva ◽  
K. E. Utkina
Keyword(s):  
Computed Tomography ◽  
Conservative Treatment ◽  
Literature Search ◽  
Surgical Techniques ◽  
Modern Concept ◽  
Surgical Practice ◽  
Non Invasive ◽  
Medical Technologies ◽  
The Past ◽  
Ultrasound Computed Tomography

Introduction. Over the past 50 years, the concept of treating spleen injuries has undergone significant changes from no alternative to splenectomy to conservative treatment, and this concept is still being actively discussed. The present review shows evolution of views and approaches to the diagnostics and treatment of spleen injuries in children.Material and methods. The literature search was done using keywords in eLIBRARY, MEDLINE and GOOGLESCHOLAR. 65 sources have been selected.Results. The modern concept of spleen injury care has been formed under constantly improving techniques of non-invasive imaging of injuries (ultrasound, computed tomography), under constantly developing endoscopic and endovascular surgical techniques. Currently, conservative treatment of spleen injuries is close to 90-95%.Conclusion. The evolution of views as to the treatment of spleen injuries in children is demonstrating fundamental changes which take place in traditional surgical practice as well as in medical technologies.

Radionuclide Cisternography in Spontaneous Intracranial Hypotension

1998 ◽  
Vol 23 (3) ◽  
pp. 150-151 ◽  
Author(s):  
MYRIAM BENAMOR ◽  
CATHERINE TAINTURIER ◽  
PHILIPPE GRAVELEAU ◽  
LAURENT PIEROT
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Radionuclide Cisternography

Headache attributed to spontaneous intracranial hypotension

2020 ◽  
pp. 346-355
Author(s):  
Farnaz Amoozegar ◽  
Esma Dilli ◽  
Rashmi B. Halker ◽  
Amaal J. Starling
Keyword(s):  
Intracranial Hypotension ◽  
Clinical Symptoms ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Non Invasive ◽  
Appropriate Treatment ◽  
Clinical Presentations ◽  
Blood Patch ◽  
Underlying Pathophysiology ◽  
Diagnostic Investigations

Spontaneous intracranial hypotension (SIH) caused by a spontaneous cerebrospinal fluid (CSF) leak, results in CSF hypovolaemia. Owing to the variety of clinical presentations and numerous possible diagnostic investigations, diagnosis and appropriate treatment remains challenging in many patients. Although the typical presentation of SIH is an orthostatic headache, the clinical spectrum includes a variety of headache types, focal neurological symptoms, and even spinal manifestations. The underlying pathophysiology of SIH varies depending on the clinical scenario. However, a deeper understanding of the pathophysiology has led to the recognition of risk factors and an explanation for clinical symptoms and abnormalities on diagnostic investigations. Multiple diagnostic investigations can be used to determine if a CSF leak is present or not. Magnetic resonance imaging of the head with and without contrast is sensitive and non-invasive. However, computed tomography myelography remains the study of choice to locate the site of the leak. The rate of flow of the CSF leak can pose a challenge to standard diagnostic investigations. To date, a large-volume blind epidural blood patch is the mainstay of treatment, although more targeted approaches are used for more refractory cases.

scholarly journals Subdural Effusions in the Posterior Fossa Associated with Spontaneous Intracranial Hypotension

2006 ◽  
Vol 33 (2) ◽  
pp. 205-208 ◽  
Author(s):  
Arata Watanabe ◽  
Toru Horikoshi ◽  
Mikito Uchida ◽  
Hidehito Koizumi ◽  
Hiromichi Yamazaki ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Lumbar Puncture ◽  
Posterior Fossa ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
The Other ◽  
Mr Images ◽  
Subdural Effusions

ABSTRACT:Background:Misdiagnosis of spontaneous intracranial hypotension remains a problem, despite increasing recognition.Methods:Three patients with spontaneous intracranial hypotension presented with typical findings on lumbar puncture, magnetic resonance (MR) imaging, and radioisotope cisternography. All patients showed subdural effusions in the posterior fossa on axial T2-weighted MR imaging. Axial MR images of 112 patients with other conditions were also screened for this finding.Results:One of three patients had typical orthostatic headache, and the other two had continuous headache. The finding of subdural effusions in the posterior fossa on axial T2-weighted MR imaging disappeared after treatment. Similar findings were found in 14 of 112 patients with other conditions. Most of the patients were over 60 years old or had dementia or previous radiation therapy.Conclusion:Subdural effusions in the posterior fossa can be identified by T2-weighted axial MR imaging, and are useful for the diagnosis of spontaneous intracranial hypotension and for verifying the effectiveness of treatment.

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