scholarly journals Methodical history taking may help in timely diagnosis of spontaneous intracranial hypotension

2019 ◽  
Vol 12 (8) ◽  
pp. e229103
Author(s):  
Jin Irie ◽  
Kensuke Shiga
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Physical Activities ◽  
Orthostatic Headache ◽  
History Taking ◽  
Detailed History ◽  
Timely Diagnosis ◽  
Headache Relief ◽  
Lying Down

Orthostatic headache (OH) is a key symptom of spontaneous intracranial hypotension (SIH). However, there is no optimal history taking for OH. A 35-year-old man complained of headache that prevented him from performing routine physical activities, which was relieved on lying down. We initially considered migraine as the most likely diagnosis. However, detailed history taking revealed that his headache worsened on standing, and he was finally diagnosed with SIH. Headache relief on lying down is not a specific indicator of OH associated with SIH. Thus, with regard to headache history taking, we suggest it important to confirm headache aggravation on standing.

scholarly journals Thoracic Epidural Blood Patches in the Treatment of Spontaneous Intracranial Hypotension: A Retrospective Case Series

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. 343-348
Author(s):  
Paolo Feltracco
Keyword(s):  
Intracranial Hypotension ◽  
Autologous Blood ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Blood Patch ◽  
Epidural Puncture ◽  
Headache Relief

Background: Spontaneous intracranial hypotension (SIH) results from leaks developing in the dura mater. The major symptom is orthostatic headache which gradually disappears after lying down. Lumbar epidural blood patches (EBPs) can be effective in relieving headaches, however, thoracic and cervical EBPs have also been applied to alleviate the symptoms. Objective and Methods: Retrospective collection of the main characteristics of SIH, site and amount of blood injection, and clinical outcomes of 18 patients who underwent thoracic EBPs for intractable SIH. { Study Design: Retrospective case series Results: All thoracic autologous EBPs except 3 were performed in the sitting position. Patients undergoing epidural puncture at lower thoracic levels (T10-T12) received 25 mL of autologous blood, 15 mL and 18 mL were injected at spinal segments T5-T7 (mid-thoracic) and T2-T4 (upperthoracic), respectively. Thoracic EBPs did not lead to immediate resolution of symptoms in 3 of 18 patients; one of them underwent early repetition with complete headache relief, one refused a second EBP, and one experienced partial resolution, followed by a recurrence, and then satisfactory improvement with a second high thoracic EBP. In long-term follow-up only 2 patients complained of symptoms or relapses. Limitations: Retrospective nature of the case series, single center experience. Conclusions: Performing thoracic-targeted EBPs as the preferred approach theoretically improves results with respect to those observed with lumbar EBPs. The immediate response was comparable with that of other reports, but the long-term success rate (90%) turned out to be very effective in terms of both quality of headache relief and very low incidence of recurrence. Key words: Central pain, cerebrospinal fluid leak, headache disorders, low intracranial pressure syndrome, epidural blood patch, occipital headache

scholarly journals Greater occipital nerve blockade using ultrasound guidance for the headache of spontaneous intracranial hypotension - A case report -

2021 ◽  
Author(s):  
Ji Hee Hong ◽  
Ho Woo Lee ◽  
Yong Ho Lee
Keyword(s):  
Intracranial Hypotension ◽  
Ultrasound Guidance ◽  
Spontaneous Intracranial Hypotension ◽  
Pain Clinic ◽  
Orthostatic Headache ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Blockade ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Blood Patch

BackgroundSpontaneous intracranial hypotension occurs due to cerebrospinal fluid leakage from the spinal column, and orthostatic headache is the most common clinical presentation. Recent studies showed that bilateral greater occipital nerve blockade demonstrated clinical efficacy in relieving post-dural puncture headache after caesarean section. CaseA 40-year-old male who presented severe orthostatic headache was consulted to our pain clinic from neurology department. He initially felt a dull nature pain over the whole occipital area which then spread over the frontal and parietal areas. His headache was combined with nausea and vomiting. An epidural blood patch was delayed until final cisternography, and bilateral greater occipital nerve blockade using ultrasound guidance was performed instead. After the blockade, the previously existing headache around the occipital and parietal areas disappeared completely, but mild headache persisted around the frontal area.ConclusionsGreater occipital nerve blockade could be a good therapeutic alternative to improve headache resulting from spontaneous intracranial hypotension.

Application of IHS Criteria to Headache Attributed to Spontaneous Intracranial Hypotension in a Large Population

Cephalalgia ◽  
2009 ◽  
Vol 29 (4) ◽  
pp. 418-422 ◽  
Author(s):  
E Mea ◽  
L Chiapparini ◽  
M Savoiardo ◽  
A Franzini ◽  
D Grimaldi ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
International Headache Society ◽  
Large Population ◽  
Spontaneous Intracranial Hypotension ◽  
Final Diagnosis ◽  
Orthostatic Headache ◽  
Cerebral Magnetic Resonance Imaging ◽  
Blood Patch ◽  
Standing Up ◽  
Ihs Criteria

We applied the recent International Headache Society (IHS) criteria for headache related to spontaneous intracranial hypotension (SIH) to 90 consecutive patients with a final diagnosis of SIH confirmed by cerebral magnetic resonance imaging with contrast. Orthostatic headache (developing within 2 h of standing or sitting up) was present in 67 patients (75%) but appeared within 15 min after standing or sitting—as required by point A of the criteria—in only 53 (59%). Forty-four (49%) patients did not satisfy point A, including 22 (24%) with non-orthostatic headache and 14 (16%) with headache developing ≥ 15 min after standing or sitting up; 80 (89%) did not satisfy point D. Only three (3%) patients had headache fully satisfying the IHS criteria. These findings indicate that the current IHS criteria do not capture most patients with SIH-associated headache. Excluding the requirement for response to epidural blood patch (criterion D) and considering headaches appearing within 2 h of sitting or standing up would capture more patients.

scholarly journals A rare case of orthostatic headache due to spontaneous intracranial hypotension

2015 ◽  
Vol 4 (2) ◽  
pp. 192-194 ◽  
Author(s):  
Sabrina Arshed ◽  
Souad Enakuaa ◽  
Qiang Nai ◽  
Mohammad Amir Hossain ◽  
Sunil Tulpule ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
Rare Case ◽  
Spontaneous Intracranial Hypotension ◽  
Orthostatic Headache

scholarly journals Clinical symptoms and results of autonomic function testing overlap in spontaneous intracranial hypotension and postural tachycardia syndrome

2018 ◽  
Vol 1 ◽  
pp. 251581631877377 ◽  
Author(s):  
Nina Graf ◽  
Ana Mafalda Fernandes Santos ◽  
Christian T Ulrich ◽  
Christian Fung ◽  
Andreas Raabe ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Intracranial Hypotension ◽  
Autonomic Function ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Spontaneous Intracranial Hypotension ◽  
Orthostatic Headache ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Function Testing

Background and purpose: Orthostatic headache is a hallmark of patients with spontaneous intracranial hypotension (SIH) but may also occur in patients with postural tachycardia syndrome (POTS). Our aim was to compare the clinical symptoms and findings of autonomic function testing in patients with SIH and POTS. Methods: This was a retrospective analysis of the clinical symptoms and findings of autonomic function testing, including sympathetic vasoconstrictor and parasympathetic cardiac function as well as head-up tilt in patients with SIH and POTS. Results: Nine patients with confirmed SIH and 48 with POTS (neuropathic N = 35, hyperadrenergic N = 5, deconditioned N = 8) were included. SIH patients experienced on average a shorter disease duration than patients with POTS. Orthostatic headache was present in all patients with SIH and 27% of patients with POTS. There was a broad overlap of other clinical symptoms of orthostatic intolerance. Screening autonomic function testing revealed normal sympathetic and parasympathetic function in all patients. All patients with SIH showed an excessive clinically symptomatic heart rate increase during standing, fulfilling the diagnostic criteria for POTS. Conclusion: Clinical symptoms and results of autonomic function testing overlap in SIH and POTS. Hence, patients with prominent orthostatic headache fulfilling the diagnostic criteria for POTS should also be evaluated for further testing of a spinal cerebrospinal fluid leak, in the absence of a history of lumbar puncture.

scholarly journals Intracranial Hypotension with Severe Neurological Symptoms Resolved by Epidural Blood Patch

2004 ◽  
Vol 31 (4) ◽  
pp. 569-571 ◽  
Author(s):  
Philip W.H. Peng
Keyword(s):  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Short Term Memory ◽  
Spontaneous Intracranial Hypotension ◽  
Memory Loss ◽  
Sensorineural Deafness ◽  
Brain Structures ◽  
Neurological Symptoms ◽  
Orthostatic Headache ◽  
Blood Patch

Background:A patient with a constellation of severe neurological symptoms caused by spontaneous intracranial hypotension, which was successfully managed by epidural blood patch, was described.Case history:A 50-year-old woman presented to the neurological service with a two-month history of orthostatic headache. Associated clinical features included sensorineural deafness, ataxia and short-term memory loss. Magnetic resonance imaging showed downward displacement of brain structures, bilateral subdural collections and the postgadolinium images demonstrated diffuse dural enhancement suggestive of the diagnosis of spontaneous intracranial hypotension.Results:Following a lumbar epidural blood patch, all symptoms improved significantly and her headache resolved.Conclusion:The principal presentation of spontaneous intracranial hypotension is orthostatic headache. The patient described presented a combination of various neurological symptoms, ataxia, memory loss and deafness, which all responded well to epidural blood patch.

Spontaneous intracranial hypotension combined with subarachnoid hemorrhage: report of 2 cases

2020 ◽  
Author(s):  
Ya Cao ◽  
Weinan Na ◽  
Hui Su ◽  
Xiaolin Wang ◽  
Zhao Dong ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Brain Mri ◽  
Intrathecal Injection ◽  
Spontaneous Intracranial Hypotension ◽  
Orthostatic Headache ◽  
Csf Pressure ◽  
Brain Ct ◽  
Blood Patch

Abstract Background: Spontaneous intracranial hypotension (SIH) combined with subarachnoid hemorrhage (SAH) has rarely been reported. Herein, we report two patients with SIH who suffered from diffuse non-aneurysmal SAH and expanded the symptom spectrum of SIH.Case report: ① A 55-year-old male was diagnosed with SIH based on orthostatic headache and diffuse pachymeningeal enhancement on brain MRI. One more month later, his headache was exacerbated, and brain CT showed diffuse SAH. Lumber puncture showed bloody CSF with a low CSF pressure of 20 mmH2O after a 30 ml intrathecal injection of saline. The patient was treated with a lumbar epidural blood patch and recovered. ② A 41-year-old male presented with orthostatic headache and nuchal pain. The brain CT scan confirmed the diagnosis of SAH. Brain MRI revealed diffuse dural thickening and bilateral frontoparietal subdural fluid collection. Lumber puncture showed bloody CSF with low CSF pressure. Then, an epidural blood patch was performed with satisfactory results.Conclusion: Dilation and rupture of intracranial venous structures might play significant roles in SIH combined with SAH. We should be alert to SIH patients who develop a new persistent severe headache without relief after lying down or a suddenly changed state of consciousness.

Sign in / Sign up

Export Citation Format

Share Document