Subdural Haematoma in Patients With Spontaneous Intracranial Hypotension

Cephalalgia ◽  
2007 ◽  
Vol 27 (2) ◽  
pp. 133-138 ◽  
Author(s):  
T-H Lai ◽  
J-L Fuh ◽  
J-F Lirng ◽  
P-H Tsai ◽  
S-J Wang
Keyword(s):  
Supportive Care ◽  
Intracranial Hypotension ◽  
Subdural Haematoma ◽  
Posterior Cerebral Artery ◽  
Spontaneous Intracranial Hypotension ◽  
Tertiary Hospital ◽  
Male Gender ◽  
Severe Headache ◽  
Neurological Deficits ◽  
Fluid Collections

The incidence and clinical relevance of subdural haematoma (SDH) in patients with spontaneous intracranial hypotension (SIH) remain undetermined. We reviewed 40 consecutive SIH patients (18 female, 22 male) in a tertiary hospital. Eight (20%) of them had SDH and nine (23%), non-haemorrhagic subdural collections. The presence of SDH was associated with higher frequencies of male gender, recurrence of severe headache and neurological deficits. Outcomes were satisfactory after supportive care or epidural blood patches except for one SDH patient, who developed transtentorial herniation resulting in Duret haemorrhage and infarctions of bilateral posterior cerebral artery territories. In conclusion, subdural fluid collections were common in patients with SIH. SDH was associated with headache worsening or neurological deficits. Patients with SDH generally recovered well; however, serious sequela might occur.

Clinical Features of Patients With Spontaneous Intracranial Hypotension Complicated With Bilateral Subdural Fluid Collections

2019 ◽  
Vol 59 (5) ◽  
pp. 775-786 ◽  
Author(s):  
Jang Hun Kim ◽  
Haewon Roh ◽  
Won‐Ki Yoon ◽  
Taek‐Hyun Kwon ◽  
Kyuha Chong ◽  
...  
Keyword(s):  
Clinical Features ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Fluid Collections

Spontaneous Intracranial Hypotension and MRI

1998 ◽  
Vol 11 (2) ◽  
pp. 203-206
Author(s):  
I. Muras ◽  
A. Scuotto ◽  
M. Maisto ◽  
F.P. Bernini
Keyword(s):  
Intracranial Hypotension ◽  
Medical Condition ◽  
Spontaneous Intracranial Hypotension ◽  
Bed Rest ◽  
Csf Leak ◽  
Meningeal Enhancement ◽  
Csf Leakage ◽  
Downward Displacement ◽  
Fluid Collections ◽  
The Brain

Postural headache due to low intracranial pressure is a well-known entity and is most commonly encountered following lumbar puncture. It may occur as a consequence of a medical condition (dehydratation, uremia, etc.) but in some cases no precipitating event is apparent and the intracranial hypotension is believed to have developed spontaneously. In such cases the underlying cause of the syndrome is rarely established and treatment is non specific. We describe three patients with spontaneous intracranial hypotension examined with MRI of the brain. Women are more commonly affected than men in the third or fourth decades of life. Schaltenbrand (1938) proposed three mechanisms by which spontaneous intracranial hypotension may be explained: diminished CSF production; CSF hyperabsorption, CSF leakage. The defect causing a CSF leak usually remains obscure. Several cases of diffuse meningeal enhancement on MRI have recently been described, probably due to meningeal hyperaemia resulting from the low CSF pressure. Subdural fluid collections have also been detected as a result of rupture of bridging veins due to the decrease in CSF volume and downward displacement of the brain. In our cases, MRI showed a diffuse dural thickening, hyperintense in T2. Spontaneous intracranial hypotension is often a self-limiting disease, responding well to bed rest and a generous intake of oral or parenteral fluid and salt.

scholarly journals Risk Factors for Subdural Haematoma in Patients with Spontaneous Intracranial Hypotension

PLoS ONE ◽  
2015 ◽  
Vol 10 (4) ◽  
pp. e0123616 ◽  
Author(s):  
Ping Xia ◽  
Xing-Yue Hu ◽  
Jin Wang ◽  
Bei-Bei Hu ◽  
Qing-Lin Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Hypotension ◽  
Subdural Haematoma ◽  
Spontaneous Intracranial Hypotension

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.

Spectrum of subdural fluid collections in spontaneous intracranial hypotension

2005 ◽  
Vol 103 (4) ◽  
pp. 608-613 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Franklin G. Moser ◽  
James Tourje
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Mass Effect ◽  
Csf Leak ◽  
Radiographic Findings ◽  
Content Type ◽  
Fluid Collections ◽  
Significant Mass Effect ◽  
Fine Print ◽  
Significant Mass

Object. Spontaneous intracranial hypotension is a noteworthy but commonly misdiagnosed cause of new daily persistent headaches. Subdural fluid collections are frequent radiographic findings, but they can be interpreted as primary rather than secondary pathological entities, and uncertainties exist regarding their optimal management. The authors therefore reviewed their experience with subdural fluid collections in 40 consecutive patients with spontaneous spinal cerebrospinal fluid (CSF) leaks and intracranial hypotension. Methods. The mean age of the 26 female and 14 male patients was 43 years (range 13–72 years). Subdural fluid collections were present in 20 patients (50%); 12 of these patients (60%) had subdural hygromas alone, and eight (40%) had subacute to chronic subdural hematomas (SDHs) associated with significant mass effect. The subdural hygromas resolved within several days to weeks following treatment of the underlying CSF leak. Three patients with SDHs underwent evacuation of the hematoma prior to the establishment of the diagnosis of spontaneous intracranial hypotension, but the SDHs did not resolve until the underlying spinal CSF leak was treated. In the remaining five patients, the CSF leak was treated primarily and the SDHs resolved over a 1- to 3-month period without the need for evacuation. Conclusions. Subdural fluid collections are common in spontaneous intracranial hypotension, varying in appearance from thin subdural hygromas to large SDHs associated with significant mass effect. These collections can be safely managed by directing treatment at the underlying CSF leak without the need for hematoma evacuation.

scholarly journals Multilevel, ultra-large-volume epidural blood patch for the treatment of neurocognitive decline associated with spontaneous intracranial hypotension: case report

2018 ◽  
Vol 129 (1) ◽  
pp. 205-210 ◽  
Author(s):  
Michael D. Staudt ◽  
Stephen H. Pasternak ◽  
Manas Sharma ◽  
Sachin K. Pandey ◽  
Miguel F. Arango ◽  
...  
Keyword(s):  
Large Volume ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Spontaneous Intracranial Hypotension ◽  
Clinical Syndrome ◽  
Neurological Deficits ◽  
Blood Patch ◽  
Treatment Refractory ◽  
Multiple Levels ◽  
Neurocognitive Decline

Spontaneous intracranial hypotension (SIH) is a progressive clinical syndrome characterized by orthostatic headaches, nausea, emesis, and occasionally focal neurological deficits. Rarely, SIH is associated with neurocognitive changes. An epidural blood patch (EBP) is commonly used to treat SIH when conservative measures are inadequate, although some patients require multiple EBP procedures or do not respond at all. Recently, the use of a large-volume (LV) EBP has been described to treat occult leak sites in treatment-refractory SIH. This article describes the management of a patient with profound neurocognitive decline associated with SIH, who was refractory to conservative management and multiple interventions. The authors describe the successful use of an ultra-LV-EBP of 120 ml across multiple levels, the largest volume reported in the literature, and describe the technical aspects of the procedure. This procedure has resulted in dramatic and sustained symptom resolution.

scholarly journals Spontaneous CSF Collection in the Cervical Spine may Cause Neurological Deficit and Intra-cranial Hypotension

2013 ◽  
Vol 7 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Rasheed Zakaria ◽  
Martin Wilby ◽  
Nicholas A Fletcher
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Spine ◽  
Intracranial Hypotension ◽  
Cervical Spinal Cord ◽  
Fluid Collection ◽  
Spontaneous Intracranial Hypotension ◽  
Motor Deficit ◽  
Limb Weakness ◽  
Meningeal Enhancement ◽  
Fluid Collections

Objective:a case is described of a spontaneously occurring cerebrospinal fluid collection in the ventral cervical spine which caused radiculopathy and spontaneous intracranial hypotension. Case:a sixty eight year old Caucasian man presented with a 2 year history of proximal upper limb weakness with a his-tory of trivial cervical trauma many years previously. Methods:the patient was investigated with blood tests for causes of peripheral neuropathy, nerve conduction and electro-myography studies, lumbar puncture and MRI of the brain and spine with contrast. Results:a cerebrospinal fluid collection was identified in the ventral cervical spinal cord causing mass effect associated with cord atrophy and there were signs of spontaneous intracranial hypotension on the MRI brain including subdural cere-brospinal fluid collections, meningeal enhancement and slumped posterior fossa. Conclusions:this is the first description of a spontaneous spinal fluid collection causing direct compression and cord sig-nal change, manifest as a motor deficit, with intracranial signs of spontaneous hypotension. Spinal imaging is recom-mended in cases of spontaneous intracranial hypotension and cerebrospinal fluid collections in the spine may rarely be a cause of radiculopathy in such cases.

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