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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intracranial hypotension is usually seen in middle-aged adults and appears with orthostatic headache. It is characterized by low cerebrospinal fluid (CSF) pressure and pachymeningeal-dural thickening on magnetic resonance imaging (MRI). Lumbar puncture, dural rupture with CSF leakage secondary to spinal anesthesia or spinal traumas, and under-production or over-absorption of CSF due to some metabolic events such as dehydration, uremia and diabetic coma are the main etiologic factors. It is sometimes considered as idiopathic when no etiologic factor is present. In addition, some connective tissue disorders have risk of CSF leakage due to spontaneous dural rupture. Neck pain, tinnitus, nausea and vomiting, and diplopia may accompany headache. CSF leakage can be identified by computerized tomography (CT) myelography, CSF-flow MRI, and radionuclide cisternography. Bed rest, fluid resuscitation, caffeine, theophylline, and non-steroidal antiinflammatory drugs (NSAIDs) are important treatment options. In patients resistant to therapy, interventional measures such as epidural saline or blood patch can be applied. In this case report, we evaluated the results of pain treatment options in a patient having headache due to intracranial hypotension who was hospitalized in the Neurology Department of Ege University Hospital.
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PMID:[Epidural blood patch treatment in a patient with chronic headache related to spontaneous intracranial hypotension]. 2115 36

Intracranial hypotension syndrome (IHS) is a rare disorder characterized by postural headache, low cerebrospinal fluid (CSF) pressure, dural thickening and pachymeningeal contrast enhancement as a consequence of decreased CSF volume. The present report is a case of spontaneous IHS due to dural leak at the level of T12-L1. The site of CSF leakage was not detectable on either conventional magnetic resonance imaging (MRI) or T2-weighted MR myelography. However, it was evident on contrast-enhanced MR myelography (CE-MRM). The present report discusses the efficacy of CE-MRM in the detection of CSF leaks according to the literature so far.
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PMID:Detection of CSF leaks with magnetic resonance imaging in intracranial hypotension syndrome. 2121 52

Intracranial hypotension is not an uncommon diagnosis after lumbar puncture or neurosurgery. However, spontaneous intracranial hypotension (SIH) is a poorly understood entity that can present with a wide variety of symptoms/signs ranging from headache to coma. SIH may result from an occult spinal cerebrospinal fluid (CSF) leak. Alternatively, because a CSF leak is not always found, some posit that SIH is caused by venous hypotension that results in increased CSF absorption. The true incidence of SIH is unknown and the diagnosis is frequently missed given the wide range of presenting symptoms and imaging findings that are mistaken for other diagnoses (ie, subdural hematomas, Chiari malformation). Here, based on a comprehensive literature review, we describe the epidemiology, presentation, diagnostic workup and treatment of SIH.
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PMID:Spontaneous intracranial hypotension: dilemmas in diagnosis. 2136 1

Alterations of the intracranial pressure (ICP) may be present in several conditions. The aim of this brief review is to focus on two relatively rare conditions characterized by alterations in cerebro-spinal fluid dynamics--Spontaneous Intracranial hypotension (SIH) and Idiopathic Intracranial hypertension (IIH)--in which headache is one of the key symptoms. The most relevant clinical features, the expected MRI findings, and the therapeutic options regarding both conditions are discussed.
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PMID:Treatment of alterations in CSF dynamics. 2153 26

We report a case of cranial subdural hematoma with intracranial hypotension. A 34-year-old woman had laparoscopic ovarial cysterectomy under general anesthesia combined with epidural anesthesia. Two days later, she developed a severe headache and nausea. She underwent cranial magnetic resonance imaging (MRI) scanning, and was diagnosed with cranial subdural hematoma with intracranial hypotension. The patient had had no anticoagulant therapy before the surgery. She was managed conservatively with bed rest and additional intravenous infusion. Her symptoms gradually improved except a slight headache, and she was discharged on the 38th postoperative day. Intracranial hypotension is a syndrome characterized by orthostatic headaches and hypovolemia of cerebrospinal fluid (CSF). There were typical findings on MRI, which include linear enhancement of the pachymeninges, pituitary hyperemia and subdural hemorrhage. We thought that these were due to epidural anesthesia first, but there was no evidence of dural puncture. It was also considered that it is influenced by change in CSF pressure, and intracranial venous engorgement may be due to Trendelenburg position for several hours. Because cranial subdural hematoma is a life-threatening complication, it is necessary to reconsider application of epidural anesthesia for laparoscopic surgery with Trendelenburg position.
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PMID:[Cranial subdural hematoma with intracranial hypotension related to epidural anesthesia and Trendelenburg position: a case report]. 2186 21

Intracranial hypotension is a rare cause of persistent headache mostly originating from a dural CSF leak. If a conservative treatment fails, a minimally invasive EBP can lead to a successful sealing of such a leak. Independent of the leakage site, an EBP is usually applied at the lumbar level with varying success. We used CT myelography to detect the site of the dural leakage, then immediately applied a targeted EBP at the corresponding level to patch the leak. Seven patients from our clinic were treated with a single targeted EBP in the lumbar or cervical spine. Within 24 hours, 6 patients experienced a considerable relief of symptoms; 1 patient went into remission after a repeat procedure. Our preliminary data suggest that a CT-guided, CT myelography-assisted targeted EBP is a safe and effective treatment for persistent spinal CSF leaks.
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PMID:CT myelography for the planning and guidance of targeted epidural blood patches in patients with persistent spinal CSF leakage. 2219 76

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.
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PMID:Epidural Blood Patch for the Treatment of Abducens Nerve Palsy due to Spontaneous Intracranial Hypotension -A Case Report-. 2251 80

Intracranial hypotension is a disorder of CSF hypovolemia due to iatrogenic or spontaneous spinal CSF leakage. Rarely, positional headaches may progress to coma, with frequent misdiagnosis. The authors review reported cases of verified intracranial hypotension-associated coma, including 3 previously unpublished cases, totaling 29. Most patients presented with headache prior to neurological deterioration, with positional symptoms elicited in almost half. Eight patients had recently undergone a spinal procedure such as lumbar drainage. Diagnostic workup almost always began with a head CT scan. Subdural collections were present in 86%; however, intracranial hypotension was frequently unrecognized as the underlying cause. Twelve patients underwent one or more procedures to evacuate the collections, sometimes with transiently improved mental status. However, no patient experienced lasting neurological improvement after subdural fluid evacuation alone, and some deteriorated further. Intracranial hypotension was diagnosed in most patients via MRI studies, which were often obtained due to failure to improve after subdural hematoma (SDH) evacuation. Once the diagnosis of intracranial hypotension was made, placement of epidural blood patches was curative in 85% of patients. Twenty-seven patients (93%) experienced favorable outcomes after diagnosis and treatment; 1 patient died, and 1 patient had a morbid outcome secondary to duret hemorrhages. The literature review revealed that numerous additional patients with clinical histories consistent with intracranial hypotension but no radiological confirmation developed SDH following a spinal procedure. Several such patients experienced poor outcomes, and there were multiple deaths. To facilitate recognition of this treatable but potentially life-threatening condition, the authors propose criteria that should prompt intracranial hypotension workup in the comatose patient and present a stepwise management algorithm to guide the appropriate diagnosis and treatment of these patients.
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PMID:Intracranial hypotension producing reversible coma: a systematic review, including three new cases. 2272 82

Intracranial hypotension syndrome typically occurs spontaneously or iatrogenically. It can be associated with headache, drowsy mentality and intracranial heamorrhage. Iatrogenic intracranial hypotension can occur due to dural pucture, trauma and spine surgery. Treatment may include conservative therapy and operation. We report a case of a 54-year-old man who was successfully treated with epidural blood patches for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the lumbosacral area after spine surgery.
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PMID:Treatment with epidural blood patch for iatrogenic intracranial hypotension after spine surgery. 2311 72

Hypertrophic cranial pachymeningitis is a rare chronic fibrosing inflammatory disease characterised by localized or diffuse thickening of duramater, leptomeninges, and tentorium. The etiology is diverse and includes infectious, granulomatous and inflammatory disorders, collagen vascular disorders, carcinoma, lymphoma, meningioma en plaque, sarcoidosis, haemodialysis, mucopolysaccharidosis, intrathecal drug administration, and meningeal carcinomatosis diseases. Intracranial hypotension is also an important image mimicker. Most often patients present with complaint of headache, vomiting, cranial nerve palsy, ataxia, raised intracranial pressure and focal neurological deficit. Other signs and symptoms are inconstant and variable. The imaging features of hypertrophic cranial pachymeningitis include dural thickening, dural mass, sinus thrombosis, venous congestion with white matter changes. Extensive preoperative imaging studies usually are essential by Computerised Tomography (CT) or Magnetic Resonance Imaging (MRI). The radiological findings may be characteristic of hypertrophic cranial pachymeningitis, may not divulge the underlying etiology. Meningeal biopsy is essential for diagnosing the cause. We reviewed a case of a tuberculous hypertrophic cranial pachymeningitis.
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PMID:Tuberculous hypertrophic pachymeningitis presenting as visual blurring and headaches. 2313 87


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