scholarly journals Orthostatic Headaches Associated With Spontaneous Intracranial Hypotension and Autonomic Dysfunction—A Case Series in Young Patients

2021 ◽  
Vol 8 ◽  
pp. 2329048X2110567
Author(s):  
Ankita Ghosh ◽  
Yen X. Tran ◽  
Leon Grant ◽  
Mohammed T. Numan ◽  
Rajan Patel ◽  
...  
Keyword(s):  
Autonomic Dysfunction ◽  
Intracranial Hypotension ◽  
Orthostatic Intolerance ◽  
Spontaneous Intracranial Hypotension ◽  
Young Patients ◽  
Case Series ◽  
Tilt Table ◽  
Epidural Blood Patching ◽  
Persistent Symptoms ◽  
Head Up Tilt

Background: Orthostatic headaches can be noted in spontaneous intracranial hypotension and orthostatic intolerance. We present a case series of young patients diagnosed with spontaneous intracranial hypotension and were treated for the same but subsequently developed orthostatic intolerance. Methods: We retrospectively reviewed charts for seven young patients with orthostatic headaches related to spontaneous intracranial hypotension and orthostatic intolerance. Results: Patients were diagnosed with spontaneous intracranial hypotension. Diagnosis was confirmed by identifying epidural contrast leakage and three of seven patients were noted to have early renal contrast excretion on computerized tomography myelography. Patients were treated with epidural blood patches. All patients showed persistent symptoms of autonomic dysfunction after treatment of spontaneous intracranial hypotension and orthostatic intolerance was confirmed with head-up tilt table test. Conclusions: Patients with spontaneous intracranial hypotension failing to improve following epidural blood patching should be evaluated for orthostatic intolerance.

scholarly journals Intravenous Cyclophosphamide Treatment for Systemic Lupus Erythematosus with Severe Autonomic Disorders Confirmed by Head-Up Tilt Table Test: A Case Series

2021 ◽  
Author(s):  
Masataka Umeda ◽  
Hiroaki Kawano ◽  
Yushiro Endo ◽  
Ayuko Takatani ◽  
Tomohiro Koga ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Orthostatic Intolerance ◽  
Therapeutic Option ◽  
Case Series ◽  
Therapeutic Effects ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Autonomic Disorders ◽  
Cyclophosphamide Treatment ◽  
Head Up Tilt

Abstract Autonomic disorders are common in patients with SLE, but the therapeutic strategy and methods for evaluating the effects of therapy have not been established. We describe the three cases of SLE patients who developed severe autonomic disorders as demonstrated by the head-up tilt table test (HUT). All three patients were treated by intensive immunosuppressive treatments including cyclophosphamide (IVCY); their HUT results all became negative. Our cases suggest that IVCY treatment can be a good therapeutic option for severe autonomic disorders in SLE patients. The HUT is a useful objective method for the diagnosis of and the evaluation of longitudinal therapeutic effects on autonomic disorders in SLE patients with orthostatic intolerance.

scholarly journals Delayed Subdural Hematoma After Epidural Blood Patching in a Patient With Spontaneous Intracranial Hypotension

2010 ◽  
Vol 50 (6) ◽  
pp. 479-481 ◽  
Author(s):  
Hao-Kuang WANG ◽  
Po-Chou LILIANG ◽  
Cheng-Loong LIANG ◽  
Kang LU ◽  
Kuo-Chuan HUNG ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Epidural Blood Patching

Clinical and radiological prognostic factors in spontaneous intracranial hypotension: a case series

2020 ◽  
Vol 41 (S2) ◽  
pp. 475-477
Author(s):  
Umberto Pensato ◽  
Cristina Russo ◽  
Valentina Favoni ◽  
Luigi Cirillo ◽  
Gian Maria Asioli ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series

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 Intracranial Hypotension for Anesthesiologists: What We Should Know

2019 ◽  
pp. 69-76
Author(s):  
Maria Eugenia Calvo
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series ◽  
Low Flow ◽  
Csf Leak ◽  
Common Denominator ◽  
Invasive Treatment ◽  
Blood Patch ◽  
Mechanism Of Trauma ◽  
Csf Leaks

The common denominator of spontaneous intracranial hypotension (SIH), postsurgical cerebral spinal fluid (CSF) leaks, and postpuncture headache (PPH) is a decrease in CSF volume. The typical presentation is orthostatic headaches, but atypical headaches can be difficult to diagnose and challenging to treat. Management is based on clinical suspicion and characterization of the headache, followed by imaging (noninvasive or invasive). Treatment ranges from conservative to different modalities of epidural blood patches, fibrin glue injections, or surgical exploration and repair. We report 5 cases with great variation in clinical and radiological presentations. Two cases of SIH involved difficult diagnosis and treatment, 2 others featured postsurgical high-flow CSF leaks, and one case presented with a low-flow CSF leak that needed closer evaluation in relation to hardware manipulation. In all cases, recommendations for diagnosis and management of intracranial hypotension were followed, even though in 3 cases the mechanism of trauma was not related to spontaneous hypotension. All cases of headache were resolved. The actual recommendations for SIH are very effective for PPH and postsurgical CSF leaks. With this case series, we illustrate how anatomical and clinical considerations are paramount in choosing appropriate imaging modalities and clinical management. Key words: CSF leak, epidural blood patch, intracranial hypotension, postural headaches, subdural hematomas

Management of Spontaneous Intracranial Hypotension During Pregnancy: A Case Series

2020 ◽  
Vol 60 (8) ◽  
pp. 1777-1787
Author(s):  
Enrico Ferrante ◽  
Michele Trimboli ◽  
Giuseppe Petrecca ◽  
Francesco Allegrini ◽  
Mirko Maria Ferrante ◽  
...  
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Case Series

Behavioral Variant Frontotemporal Dementia as a Serious Complication of Spontaneous Intracranial Hypotension

2018 ◽  
Vol 15 (5) ◽  
pp. 505-515 ◽  
Author(s):  
Wouter I Schievink ◽  
M Marcel Maya ◽  
Zachary R Barnard ◽  
Franklin G Moser ◽  
Stacey Jean-Pierre ◽  
...  
Keyword(s):  
Frontotemporal Dementia ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Behavioral Variant Frontotemporal Dementia ◽  
Clinical Criteria ◽  
Epidural Blood Patching ◽  
Early Onset Dementia ◽  
Percutaneous Procedures ◽  
Brain Sagging

Abstract BACKGROUND Behavioral variant frontotemporal dementia (bvFTD) is a devastating early onset dementia. Symptoms of bvFTD may be caused by spontaneous intracranial hypotension (SIH), a treatable disorder, but no comprehensive study of such patients has been reported. OBJECTIVE To describe detailed characteristics of a large cohort of patients with SIH and symptoms of bvFTD. METHODS We identified patients with SIH who met clinical criteria for bvFTD. Patients were compared to a cohort of SIH patients without bvFTD. RESULTS The mean age for the 21 men and 8 women was 52.9 yr (range, 37–65 yr). All 29 patients with bvFTD symptoms had hypersomnolence. Magnetic resonance imaging showed brain sagging in all patients, cerebrospinal fluid (CSF) opening pressure low in about half of patients, but a spinal CSF leak could not be detected in any patient. All patients underwent epidural blood patching, but 26 patients eventually underwent 1 or more surgical procedures. Overall, a good outcome was obtained in 21 patients (72%); 20 (91%) of 22 patients who had not undergone prior Chiari surgery compared to 1 (14%) of 7 patients who did undergo Chiari surgery (P < .003). Compared to SIH patients without symptoms of bvFTD (n = 547), those with bvFTD symptoms were older, more often male, less often demonstrated CSF leak on spinal imaging, and more often underwent surgery (P < .02). CONCLUSION bvFTD in SIH is rare and associated with brain sagging and hypersomnolence. Spinal CSF leaks are rarely detected. bvFTD symptoms are often refractory to the usual percutaneous procedures but most patients can be cured.

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