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. 2017 Jul;18(7):577-585.
doi: 10.1631/jzus.B1600343.

Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

Ling-Ling Yao  1 , Xing-Yue Hu  1
Affiliations

Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

Ling-Ling Yao et al. J Zhejiang Univ Sci B. 2017 Jul.

Abstract

Objective: Spontaneous intracranial hypotension (SIH) is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid (CSF) pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure (CSF OP) and explore the factors affecting CSF OP in SIH patients.

Methods: We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables (including demographic data, body mass index (BMI), duration of symptoms, and brain imaging findings). Univariate and multivariate analyses were performed to identify the potential factors affecting CSF OP.

Results: In a total of 114 (55.3%) cases the CSF OP was ≤60 mmH2O (1 mmH2O=9.806 65 Pa), in 90 (43.7%) cases it was between 60 and 200 mmH2O, and in 2 (1.0%) cases it was >200 mmH2O. Univariate analysis showed that the duration of symptoms (P<0.001), BMI (P<0.001), and age (P=0.024) were positively correlated with CSF OP. However, multivariate analysis suggested that only the duration of symptoms (P<0.001) and BMI (P<0.001) were strongly correlated with CSF OP. A relatively high R2 of 0.681 was obtained for the multivariate model.

Conclusions: Our study indicated that in patients without a low CSF OP, a diagnosis of SIH should not be excluded. BMI and the duration of symptoms can influence CSF OP in SIH patients, and other potential factors need further investigation.

Keywords: Spontaneous intracranial hypotension; Low cerebrospinal fluid opening pressure; Body mass index; Magnetic resonance imaging.

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Conflict of interest statement

Compliance with ethics guidelines: Ling-ling YAO and Xing-yue HU declare that they have no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Figures

Fig. 1
Fig. 1
Histogram of CSF opening pressure in SIH patients Distribution of CSF opening pressure (OP) based on a bin size of 20 mmH2O
Fig. 2
Fig. 2
Case of a 60-year-old male, presenting with a CSF opening pressure of 220 mmH2O (a) Axial CT image shows bilateral subdural hematomas along the frontotemporoparietal area (white arrows) and decrease in size of the ventricles. Axial (b) and coronal (c) T1-weighted MR images with gadolinium enhancement show diffuse dural enhancement (white arrows). (d) Midsagittal T1-weighted MR image show downward displacement of the cerebellar tonsil (white arrows). (e, f) CT myelographs show contrast tracking along bilateral and unilateral nerve roots, respectively (white arrows). Images were taken at segments T1-2 (e) and C6-7 (f)
Fig. 3
Fig. 3
Univariate analysis of continuous variables Scatterplots present the relationship between CSF opening pressure (OP) and duration of symptoms (a), body mass index (BMI) (b), and age (c)
Fig. 4
Fig. 4
Univariate analysis of categorical variables Box-and-whisker plots present the relationships between CSF opening pressure (OP) and gender (a), magnetic resonance imaging (MRI) findings (b), active CSF leakage (c), and subdural hematoma (SDH) (d). “ο”: mild outliers
See this image and copyright information in PMC

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