The Syndrome of Spontaneous Intracranial Hypotension

Cephalalgia ◽  
1999 ◽  
Vol 19 (2) ◽  
pp. 80-87 ◽  
Author(s):  
CP O'Carroll ◽  
M Brant-Zawadzki
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Subdural Effusion ◽  
Resonance Imaging ◽  
Mri Findings ◽  
The Past ◽  
Downward Displacement ◽  
Prior Literature ◽  
Magnetic Resonance Imaging Mri

The authors report four cases of headache and other symptomatology related to the syndrome of intracranial hypotension. They were seen in a routine clinical practice over the past 3 years. The clinical features, magnetic resonance imaging (MRI) findings, and follow-up of these patients are described. Review of the prior literature on the topic is also included. All four patients presented with orthostatic headache syndrome. Three of the four demonstrated diffuse leptomeningeal thickening and enhancement on MRI studies. One subsequently developed a subdural effusion. One patient demonstrated downward displacement of the posterior fossa initially, which resolved on follow-up MRI scanning. Possible pathophysiologies of the syndrome are discussed.

The Timing of MRI Determines the Presence or Absence of Diffuse Pachymeningeal Enhancement in Patients with Spontaneous Intracranial Hypotension

Cephalalgia ◽  
2008 ◽  
Vol 28 (4) ◽  
pp. 318-322 ◽  
Author(s):  
J-L Fuh ◽  
S-J Wang ◽  
T-H Lai ◽  
S-S Hseu
Keyword(s):  
Intracranial Hypotension ◽  
Age Of Onset ◽  
Spontaneous Intracranial Hypotension ◽  
Tertiary Hospital ◽  
Resonance Imaging ◽  
Mri Examination ◽  
Headache Onset ◽  
Magnetic Resonance Imaging Mri ◽  
Diffuse Pachymeningeal Enhancement

The timing and clinical relevance of diffuse pachymeningeal enhancement (DPE) in the magnetic resonance imaging (MRI) examination of patients with spontaneous intracranial hypotension (SIH) remain undetermined. We reviewed 53 consecutive SIH patients (30 F/23 M, mean age of onset 41.7 ± 11.3 years) in a tertiary hospital. Thirteen (24.5%) patients did not have DPE on their initial cranial MRIs. They had significantly shorter latency between the time of MRI examinations and the time of headache onset compared with those with DPE (6.5 ± 4.4 vs. 20.4 ± 16.3 days, t-test, P < 0.001). Eight of these 13 patients received a follow-up MRI (mean duration 30.3 ± 16.6 days, range 6-59 days) and six of them revealed DPE. Among patients with DPE, the enhancement disappeared as early as 25 days after headache onset. The outcome did not differ between patients with and without DPE. The presence of DPE was associated with the timing of the MRI examination.

scholarly journals Spontaneous Intracranial Hypotension: Case Series of Rare Clinical Presentations

2011 ◽  
Vol 38 (1) ◽  
pp. 54-58 ◽  
Author(s):  
N. Chaudhary ◽  
P. Cooper ◽  
S.P. Lownie ◽  
W. Ng ◽  
N. Duggal
Keyword(s):  
Intracranial Hypotension ◽  
Fluid Pressure ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series ◽  
Mri Findings ◽  
Surgical Interventions ◽  
Clinical Presentations ◽  
Lateral Decubitus ◽  
Magnetic Resonance Imaging Mri ◽  
Diffuse Pachymeningeal Enhancement

Abstract:Background:Spontaneous intracranial hypotension (SIH) is an increasingly described entity, with over 70 cases reported in the literature. The classic triad includes orthostatic headache, diffuse pachymeningeal enhancement on magnetic resonance imaging (MRI) with gadolinium, and low cerebrospinal fluid pressure (CSF) in the lateral decubitus (<60 mm H2O) and sitting positions.Method:We present four rare clinical presentations of SIH, two of which have not been previously described in the literature, to the best of our knowledge.Results:Patient 1 presented with dyspnea, dysphagia, bilateral ptosis, diplopia and seizures. Patient 2 presented with a paradoxical positional pattern of orthostatic hypotension. In Patient 3, bilateral subdural hematomas (SDH) were encountered; while in Patient 4, a recurrent unilateral SDH requiring multiple surgical interventions was demonstrated.Conclusion:Although uncommon clinical presentations, all four cases of intracranial hypotension were spontaneous, demonstrated diagnostic MRI findings, and responded favorably to blood patches or saline injections.

scholarly journals Perioperative ultrasound imaging versus magnetic resonance imaging in management of lumbosacral spinal dysraphisms

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Wael Abd Elrahman Ali Elmesallamy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ultrasound Imaging ◽  
Resonance Imaging ◽  
University Hospitals ◽  
Mri Findings ◽  
True Negative ◽  
Magnetic Resonance Imaging Mri ◽  
Cystic Masses

Abstract Objectives The purpose of this study was to correlate lumbosacral spinal ultrasound (LUS) and magnetic resonance imaging (MRI) findings in patients with lumbosacral spinal dysraphisms to evaluate the value of LUS in diagnosis, intraoperative use, and during follow-up of those patients. Methods A total of 24 patients aged up to 6 years old were operated for lumbosacral spinal dysraphisms at the Neurosurgery Department of Zagazig University hospitals during the period from January 2017 to August 2018. All patients were investigated preoperatively, intraoperatively, and on follow-up by LUS to compare the data with preoperative and follow-up MRI of the spine. Results The median age was 11 months at the time of surgery. The most common anatomical description from the LUS study was thickened filum (18 cases). Using MRI findings as the standard reference, the sensitivity of LUS in detecting a thickened filum was 77.8% preoperatively and 62.5% postoperatively, with a specificity of 100%. The sensitivity and specificity of detecting conus level, solid masses, and cystic masses were 100%. Conclusions Lumbosacral spinal dysraphisms can be evaluated well by ultrasound imaging in age group up to 6 years old with 100% specificity (true negative) in comparison with MRI.

scholarly journals Anti-GFAP-antibody positive postinfectious acute cerebellar ataxia and myoclonus after COVID-19: a case report

2021 ◽  
Vol 14 ◽  
pp. 175628642110628
Author(s):  
Livia Asan ◽  
Stephan Klebe ◽  
Christoph Kleinschnitz ◽  
Mark Stettner ◽  
Martin Köhrmann
Keyword(s):  
Cerebellar Ataxia ◽  
Steroid Treatment ◽  
High Dose ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Limb Ataxia ◽  
Acute Cerebellar Ataxia ◽  
Cerebellar Ataxias ◽  
Magnetic Resonance Imaging Mri

We present a case of acute cerebellar ataxia and myoclonus with detected anti-GFAP-antibodies in a patient recently recovered from COVID-19. Main symptoms consisted of acute gait and limb ataxia and myoclonus. The patient improved considerably upon treatment with high-dose intravenous (IV) steroids. While cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) findings were unremarkable, anti-GFAP-antibodies were detected in the patient’s serum and disappeared upon clinical remission at a 3-month follow-up. This case suggests that anti-GFAP-antibodies might be associated with some of the increasingly observed cases of postinfectious acute cerebellar ataxias in COVID-19 patients and aid in the diagnosis of this autoimmune complication. We recommend searching for these antibodies in serum and CSF in suspected cases. Early steroid treatment may prove beneficial for these patients.

Bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension: diagnostic and management strategies

2002 ◽  
Vol 96 (5) ◽  
pp. 956-959 ◽  
Author(s):  
Nedal Hejazi ◽  
Muder Al-Witry ◽  
Alfred Witzmann
Keyword(s):  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Management Strategies ◽  
Spontaneous Intracranial Hypotension ◽  
Optic Chiasm ◽  
Subdural Effusion ◽  
Meningeal Enhancement ◽  
Content Type ◽  
Blood Patch ◽  
Downward Displacement

✓ The authors describe two patients with bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension (SIH) and discuss the possible pathophysiological origins of these abnormalities. The signs seen on magnetic resonance imaging in both cases, such as tonsillar descent, subdural effusion, meningeal enhancement, downward displacement of the optic chiasm, and crowding of this structure and the hypothalamus between the pituitary gland and brain, can help to establish the diagnosis of SIH. Therapy with a lumbar epidural blood patch resulted in the rapid resolution of all symptoms and most morphological abnormalities. The authors propose diagnostic and management strategies based on their own experiences and the reported cases of SIH in the medical literature.

Enhanced Imaging Modalities in Atrial Fibrillation

2010 ◽  
Vol 6 (4) ◽  
pp. 54
Author(s):  
Matthew Wright ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Imaging Modalities ◽  
Resonance Imaging ◽  
Ablation Procedure ◽  
The Past ◽  
Magnetic Resonance Imaging Mri ◽  
Enhanced Imaging ◽  
Mapping Systems ◽  
Repeat Procedures

The wealth of imaging options for the practising electrophysiologist has exploded over the last decade, primarily due to the ability to effectively ablate patients with atrial fibrillation (AF). Currently, an electrophysiologist is able to chose to from pre-procedural computed tomography (CT), magnetic resonance imaging (MRI), procedural fluoroscopy, ultrasound, electroanatomic mapping systems and various combinations of these imaging modalities to help plan and perform the ablation procedure. Increasingly these imaging tools are also being used in follow-up to assess scar formation and help guide repeat procedures when necessary. This article will focus predominantly on the development of fluoroscopic techniques over the past decade.

Expert Commentary: Role of Surgery for the Management of CSF Leaks

Cephalalgia ◽  
2008 ◽  
Vol 28 (12) ◽  
pp. 1357-1360 ◽  
Author(s):  
B Mokri
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intracranial Hypotension ◽  
Dural Puncture ◽  
Spontaneous Intracranial Hypotension ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Expert Commentary ◽  
Csf Leaks

Spontaneous intracranial hypotension (SIH) was described nearly 70 years ago, and for years it was essentially equated with post dural puncture headaches (PDPH) (1). The interest in this entity substantially increased after the magnetic resonance imaging (MRI) abnormalities of this disorder were recognized in the early 1990s (2-6), and consequently many more patients were diagnosed than before and a far broader clinical spectrum of this disorder began to become apparent. It also came to be recognized that the overwhelming majority if not all cases of SIH result from spontaneous cerebrospinal (CSF) leaks and that the independent pathogenic parameter is loss of CSF volume (7).

Frühdiagnostik des Morbus Perthes: Wertigkeit von Skelettszintigraphie und Kernspintomographie im Vergleich zu Röntgenbefunden

1991 ◽  
Vol 30 (06) ◽  
pp. 265-271 ◽  
Author(s):  
J. Rütt ◽  
A. Linden ◽  
Kamilla Smolarz ◽  
E. Voth ◽  
H. Schicha ◽  
...  
Keyword(s):  
Bone Scintigraphy ◽  
Resonance Imaging ◽  
Radiological Findings ◽  
Mri Findings ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri ◽  
Conventional Radiology ◽  
Initial Results

The value of conventional radiology, bone scintigraphy and magnetic resonance imaging (MRI) in the early diagnosis of Legg-Calvé-Perthes disease (LCPD) was assessed. The initial results were compared with the clinical and radiological findings of long-term follow-up in 43 children. Radiological and scintigraphic examination resulted in a relatively high number of equivocal findings (16% and 10%, respectively). MRI findings were less equivocal (3%). Depending on whether such findings were classified as normal or as pathological, the diagnostic accuracy ranged as follows: radiography 88–93%, bone scintigraphy 88-91%, and MRI 97–99%. Therefore, MRI by itself seems to be sufficient to detect or exclude LCPD. The results of this study and the radiation exposure associated with radiography and scintigraphy raise the question whether MRI should be the diagnostic method of choice in patients with suspected LCPD.

Hyperprolactinemia due to spontaneous intracranial hypotension

2015 ◽  
Vol 122 (5) ◽  
pp. 1020-1025 ◽  
Author(s):  
Wouter I. Schievink ◽  
Miriam Nuño ◽  
Todd D. Rozen ◽  
M. Marcel Maya ◽  
Adam N. Mamelak ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
Brain Mri ◽  
Age At Onset ◽  
Spontaneous Intracranial Hypotension ◽  
Pituitary Hormones ◽  
Resonance Imaging ◽  
Normal Range ◽  
Mri Findings ◽  
Pituitary Enlargement ◽  
Brain Sagging

OBJECT Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. METHODS Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. RESULTS The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17–72 years). Hyperprolactinemia was detected in 10 patients (24%), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3–14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8–23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60% of patients with hyperprolactinemia and in 19% of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. CONCLUSIONS Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia.

scholarly journals Cerebral X-linked adrenoleukodystrophy: follow-up with magnetic resonance imaging

2006 ◽  
Vol 64 (4) ◽  
pp. 1033-1035 ◽  
Author(s):  
Emerson L. Gasparetto ◽  
Juliana Mecunhe Rosa ◽  
Taísa Davaus ◽  
Arnolfo de Carvalho Neto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Mri ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Occipital Lobes ◽  
The Brain

OBJECTIVE: To report a case of childhood cerebral X-linked adrenoleukodystrophy (X-ADL), emphasizing the magnetic resonance imaging (MRI) findings at initial evaluation and at the follow-up. CASE REPORT: Five year-old boy, who was asymptomatic, presented with diagnosis of X-ADL for MRI evaluation. The initial brain MRI showed a focal area of enhancement at the splenium of the corpus calosum. One year later, the follow-up MRI showed a progression of the corpus calosus lesion, as well as other lesions in the parietal and occipital lobes. CONCLUSION: The brain MRI follow-up of patients with X-ADL is important to show the progression of the lesions.

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