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. 2009 Jan;45(1):1-4.
doi: 10.3340/jkns.2009.45.1.1. Epub 2009 Jan 31.

Spontaneous intracranial hypotension: clinical presentation, imaging features and treatment

Eun-Soo Park  1 , Ealmaan Kim
Affiliations

Spontaneous intracranial hypotension: clinical presentation, imaging features and treatment

Eun-Soo Park et al. J Korean Neurosurg Soc. 2009 Jan.

Abstract

Objective: In the present study, the authors investigated the clinical and imaging features as well as the therapeutic outcomes of SIH (spontaneous intracranial hypotension) patients.

Methods: A retrospective review of 12 SIH patients was carried out. The diagnostic work-up included lumbar tapping and measurement of CSF opening pressure, radioisotope cisternography, brain and spinal magnetic resonance imaging (MRI), and computed tomography (CT) myelography. Autologous epidural blood patching was performed in patients who did not respond to conservative therapies, including analgesics, steroids, hydration and rest.

Results: Typical postural headache was found in 11 (91%) patients. Nine (75%) patients showed pachymeningeal enhancement on their initial T1-weighted MR images. The CSF opening pressure was less than 60 mmH(2)O in 9 of 11 patients. Autologous epidural blood patching was performed in 7 patients, and all of them showed good responses.

Conclusion: SIH can present with various clinical presentations and neuroimaging findings. Autologous epidural blood patching is thought to be the treatment of choice for patients with SIH.

Keywords: Blood patch; Cerebrospinal fluid leak; Dural enhancement; Headache; Intracranial hypotension; Magnetic resonance imaging.

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Figures

Fig. 1
Fig. 1
A : Axial gadolinium-enhanced T1-weighted magnetic resonance image shows intense diffuse pachymeningeal enhancement. B : Computed tomography-myelography showing abnormal contrast extravasation in the psoas muscle. C : Follow-up image shows some resolution of meningeal enhancement on the third day after epidural patching.
See this image and copyright information in PMC

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