Spontaneous intracranial hypotension with bilateral subdural hemorrhage: Is conservative management adequate? (original) (raw)
Related papers
International Journal of General Medicine, 2014
Spontaneous intracranial hypotension is an infrequent cause of secondary headache due to cerebrospinal fluid (CSF) hypovolemia. Objective: To describe a case of headache revealing spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture. Observation: A 34-year-old man presented with acute postural headache. The first cerebral computed tomography scan was normal. Lumbar puncture showed hyperproteinorachy at 2 g/L with six lymphocytic cells. The headache became very intense. At admission, clinical examination was normal. Ophthalmological examination did not show any abnormalities. Encephalic magnetic resonance imaging (MRI) showed bilateral subdural hematoma with tonsillar descent simulating Chiari type I malformation. After surgical drainage and symptomatic treatment, the patient was discharged with no recurrence. Conclusion: Spontaneous intracranial hypotension is associated with simple clinical presentation, orthostatic headache, and characteristic MRI findings. Misdiagnosed, it leads to unnecessary procedures.
Cranial cerebrospinal fluid leak and intracranial hypotension syndrome – a case report
Journal of Medicine and Life
Spontaneous intracranial hypotension is a rare clinical entity caused in most cases by a cerebrospinal fluid leak occurring at the level of the spinal cord. Cranial dural leaks have been previously reported as a cause of orthostatic headaches but, as opposed to spinal dural leaks, were not associated with other findings characteristic of spontaneous intracranial hypotension. We present the case of a male admitted for severe orthostatic headache. The patient had a history of intermittent postural headaches, dizziness, and symptoms consistent with post-nasal drip, which appeared several years after head trauma. Brain imaging showed signs consistent with intracranial hypotension: bilateral hygromas, subarachnoid hemorrhage, superficial siderosis, diffuse contrast enhancement of the pachymeninges, and superior sagittal sinus engorgement. No spinal leak could be identified by magnetic resonance imaging, and the patient had a rapid remission of symptoms with conservative management. Furth...
Surgical neurology, 2008
Spontaneous intracranial hypotension is an increasingly recognized cause of new-onset, daily, persistent headaches. Although these headaches are similar to post-lumbar puncture headaches, characteristic differences include intracranial pachymeningeal enhancement, subdural fluid collections, and downward displacement of the brain. The identification of upper cervical epidural fluid collections as a false localizing sign in patients with SIH has provided significant insight into the selection of management options. We review a case of a 57-year-old woman who presented to our institution with progressive orthostatic headaches relieved by recumbency. The patient had no recent history of lumbar puncture, spinal, or intracranial procedure. The patient isolated the onset of symptoms to 3 weeks prior, when she was lifting heavy items in her home, and was diagnosed with SIH. Subsequently, she was found to have a C1-C2 epidural fluid collection. After much diagnostic consideration and review ...
Spontaneous intracranial hypotension: Two cases including one treated with epidural blood patch
Annals of Indian Academy of Neurology, 2009
of migraine. He had been experiencing a diff erent type of a more severe, persistent, nuchal and occipital headache since the last three weeks. The pain was nonthrobbing and unassociated with nausea or vomiting. It had developed over a week and had slowly grown in intensity, and had begun to bother his work while he sat in his offi ce chair. It would begin within 15 minutes of sitt ing or standing, and subside within 30 minutes aft er lying down. He would notice a peculiar feeling of "something moving inside his head" when he would sit up or stand. The past history was remarkable for a shoulder dislocation suff ered three years ago. Examination showed subtle marfanoid features such as tall stature and long slender fi ngers. Neurological examination was normal. MRI brain showed bilateral subdural hygromas, "sagging" of the brainstem [Figure 1], DPME, and engorged venous sinuses. Routine MRI spine revealed a CSF leak at T6 vertebral level with a localized CSF collection in the posterior right epidural space [Figure 2]. The patient was treated with bed rest and liberal fl uid intake for four weeks with complete symptomatic relief. He was able to resume his normal activities thereaft er and had no recurrence of symptoms. One year later, follow-up MRI showed almost complete resolution of subdural collections, and signifi cantly less brainstem "sagging". MRI spine findings, however, remained unchanged.
Neuroimmunology and Neuroinflammation, 2016
Spontaneous intracranial hypotension treatment can be complicated by concomitant cerebral venous thrombosis and subdural hematoma. A 48 years old male, presenting orthostatic headache and neck pain for 1 month displayed sagittal sinus thrombosis and bilateral subdural effusions, as well as extradural fluid collection at T3-T8 level, upon magnetic resonance imaging. Cerebrospinal fluid opening pressure was 50 mmH 2 O, and a leak was confirmed at C2-C3 level by computed tomography (CT) myelogram. The presence of subdural hematoma precluded anticoagulation treatments. An autologous epidural blood patch at C2-C3 level under CT guidance improved the patient's condition, remaining free of residual symptoms or recurrence at six-month follow-up.
Headache and intracranial hypotension: neuroradiological findings
Neurological Sciences, 2004
The cardinal and classic features of postural headache and low cerebrospinal fluid (CSF) pressure in intracranial hypotension may not dominate the clinical picture of the syndrome and may be associated with additional various neurological symptoms and signs. Reports of unusual clinical presentations continue to appear in the literature. Despite the considerable variability of the clinical spectrum, neuroradiological studies reveal more constant and characteristic features. Brain MRI findings include intracranial pachymeningeal thickening and post-contrast enhancement, subdural fluid collections and downward displacement or "sagging" of the brain. Spinal MRI findings include collapse of the dural sac with a festooned appearance, intense epidural enhancement owing to dilatation of the epidural venous plexus, and possible epidural fluid collections. In fact, spinal studies may demonstrate CSF leakage from spinal dural defects, which are considered the most common cause of the syndrome. Myelo-MR may suggest the possible point of CSF leakage, by demonstrating an irregular root sleeve; myelo-CT and radioisotope myelocisternography (RMC) are often needed to confirm the point of CSF leakage. Neuroimaging studies are, therefore, essential for suggesting and confirming the diagnosis.
New-onset headaches secondary to spontaneous intracranial hypotension
BMJ case reports, 2018
We describe the case of a 54-year-old man who presented with new-onset positional headaches and seizures, which were determined to be secondary to spontaneous intracranial hypotension due to a cervicothoracic spinal cerebrospinal fluid leak, and its associated complications.
Spontaneous Intracranial Hypotension Syndrome: AnUnknown and Benign Condition
2020
Background: Spontaneous intracranial hypotension (SIH) is considered to be an uncommon disease caused by cerebrospinal fluid leakage. It is characterized by an orthostatic headache without history in the past of trauma or dural puncture. There is no consensus about level, volume and number of epidural blood patch (EBP) for SIH treatment in literature. Methods: Our objective was to report a 38-year-old woman with SIH at two different levels (lumbar and cervical) as demonstrated by spine MRI and SPECT CT, treated by single lumbar low-volume EBP. Results: The patient achieved good symptoms relief, with complete remission of headache, nausea and vomits. Besides, no complications occurred as consequence of the procedure and the discharged happened two days afterwards. Conclusion: In spite of low volume used in the blood patch and of the existence of another CSF leak in a distant site, it is possible to obtain good results and at same time, to minimize complications due to higher blood vo...