Hostname: page-component-745bb68f8f-v2bm5 Total loading time: 0 Render date: 2025-01-22T20:06:40.736Z Has data issue: false hasContentIssue false
  • English
  • Français

Spontaneous Intracranial Hypotension: Case Series of Rare Clinical Presentations

Published online by Cambridge University Press:  02 December 2014

N. Chaudhary ,
P. Cooper ,
S.P. Lownie ,
W. Ng  and
N. Duggal
N. Chaudhary
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
P. Cooper
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Division of Neurology, London Health Sciences Center, London, Ontario, Canada
S.P. Lownie
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
W. Ng
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
N. Duggal*
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
*
Division of Neurosurgery, University Hospital, London Health Sciences Center, 339 Windermere Rd, London, Ontario, N6A 5A5, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Spontaneous intracranial hypotension (SIH) is an increasingly described entity, with over 70 cases reported in the literature. The classic triad includes orthostatic headache, diffuse pachymeningeal enhancement on magnetic resonance imaging (MRI) with gadolinium, and low cerebrospinal fluid pressure (CSF) in the lateral decubitus (<60 mm H2O) and sitting positions.

Method:

We present four rare clinical presentations of SIH, two of which have not been previously described in the literature, to the best of our knowledge.

Results:

Patient 1 presented with dyspnea, dysphagia, bilateral ptosis, diplopia and seizures. Patient 2 presented with a paradoxical positional pattern of orthostatic hypotension. In Patient 3, bilateral subdural hematomas (SDH) were encountered; while in Patient 4, a recurrent unilateral SDH requiring multiple surgical interventions was demonstrated.

Conclusion:

Although uncommon clinical presentations, all four cases of intracranial hypotension were spontaneous, demonstrated diagnostic MRI findings, and responded favorably to blood patches or saline injections.

Résumé:

Résumé:Contexte:

L'hypotension intracrânienne spontanée (HIS) est une entité décrite de plus en plus fréquemment dont il existe plus de 70 cas dans la littérature. La triade classique comprend la céphalée orthostatique, un rehaussement pachyméningé à l'imagerie par résonance magnétique (IRM) avec gadolinium et une pression du liquide céphalorachidien basse en décubitus latéral (< 60 mm H2O) et en position assise.

Méthode:

Nous présentons les observations de quatre patients atteints de HIS dont le mode de présentation est rare. À notre connaissance, deux de ces modes de présentation n'ont jamais été décrits dans la littérature.

Résultats:

Le premier patient a consulté pour dyspnée, dysphagie, ptose bilatérale, diplopie et convulsions. Le deuxième patient a consulté pour une hypotension orthostatique dont la modalité positionnelle était paradoxale. Le troisième patient était porteur d'hématomes sous-duraux (HSD) bilatéraux et le quatrième patient présentait un HSD unilatéral récurrent nécessitant plusieurs chirurgies.

Conclusion:

Bien que ces tableaux cliniques soient peu fréquents, ces quatre cas d'hypotension intracrânienne étaient spontanés, avaient des observations à l'IRM qui étaient diagnostiques et ont répondu favorablement à des “blood patches” ou à des injections de solution physiologique.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 54 - 58
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

References

1 Ferrante, E, Savino, A, Sances, F, et al. Spontaneous intracranial hypotension syndrome: report of twelve cases. Headache. 2004;44:615–22.CrossRefGoogle ScholarPubMed
2 Binder, DK, Dillon, WP, Fishman, R, et al. Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report. Neurosurgery. 2002;51:830–7.CrossRefGoogle ScholarPubMed
3 Haritanti, A, Karacostas, D, Drevelengas, A, et al. Spontaneous intracranial hypotension: clinical and neuroimaging findings in six cases with literature review. Eur J Radiol. 2009;69(2):253–9.CrossRefGoogle ScholarPubMed
4 Moayeri, NN, Henson, JW, Schaeffer, PW, et al. Spinal dural enhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension. J Neurosurg. 1998;88:912–8.CrossRefGoogle ScholarPubMed
5 Nakajima, H, Sakai, T, Aoki, N, et al. Bilateral chronic subdural hematomas associated with intracranial hypotension: case report. Neurol Med Chir (Tokyo). 1996;36:647–9.CrossRefGoogle ScholarPubMed
6 Rando, TA, Fishman, RA. Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology. 1992;42:481–7.CrossRefGoogle ScholarPubMed
7 Renowden, SA, Gregory, R, Hyman, N, et al. Spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry. 1995;59:511–5.CrossRefGoogle ScholarPubMed
8 Sayer, FT, Bodelsson, M, Larsson, E, et al. Spontaneous intracranial hypotension resulting in coma: case report. Neurosurgery. 2006; 58:E204–5.Google Scholar
9 Schievink, WI, Meyer, FB, Atkinson, JLD, et al. Spontaneous spinal cerebrovascular fluid leaks and intracranial hypotension. J Neurosurg. 1996;84:598–605.CrossRefGoogle Scholar
10 Schoffer, KL, Benstead, TJ, Grant, I. Spontaneous intracranial hypotension in the absence of magnetic resonance imaging abnormalities. Can J Neurol Sci. 2002;29:253–7.CrossRefGoogle ScholarPubMed
11 Vaidhyanath, R, Kenningham, R, Khan, A, et al. Spontaneous intracranial hypotension: a cause of severe acute headache. Emerg Med. 2007;J24:739–41.Google Scholar
12 Weber, WEJ, Heidandal, GAK, de Krom, M. Primary intracranial hypotension and abnormal radionuclide cisternography. Clin Neurol Neurosurg. 1991;93(1):55–60.CrossRefGoogle ScholarPubMed
13 Zada, G, Pezeshkian, P, Giannotta, S. Spontaneous intracranial hypotension and immediate improvement following epidural blood patch placement demonstrated by intracranial pressure monitoring. J Neurosurg. 2007;106:1089–90.CrossRefGoogle ScholarPubMed
14 Arai, M, Takada, T. A case of spontaneous intracranial hypotension with multiple CSF leaks in the thoracic region. Rinsho Shinkeigaku [article in Japanese]. 2005;45(9):679–81.Google ScholarPubMed
15 Asano, N, Taki, K, Kondo, T, et al. A case of spontaneous intracranial hypotension effectively treated with cervical epidural blood patch. Masui [article in Japanese]. 2004;53(10):1185–8.Google ScholarPubMed
16 Nakajima, M, Hirano, T, Sasamoto, N, et al. A case of spontaneous intracranial hypotension without any history of positional headaches. No To Shinkei [article in Japanese]. 2002;54(11):991–5.Google Scholar
17 Rojas, JI, Romano, M, Patrucco, L, et al. Spontaneous intracranial hypotension. Medicinia [article in Spanish]. 2006;66(5):447–9.Google ScholarPubMed
18 Tijssen, CC, van Gulik, S, Sluzewski, M, et al. Ned Tijdschr Geneeskd [article in Dutch]. 2005;149(18):996–1000.Google Scholar
19 Atkinson, JLD, Weinshenker, BG, Miller, GM, et al. Acquired chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg. 1998;88:237–42.CrossRefGoogle ScholarPubMed
20 Tsui, EYK, Ng, SH, Cheung, YK, et al. Spontaneous intracranial hypotension with diffuse dural enhancement of the spinal canal and transient enlargement of the pituitary gland. Eur J Radiol. 2001;38:59–63.CrossRefGoogle ScholarPubMed
21 Ferrante, E, Savino, A, Bioschi, A, et al. Transient oculomotor cranial palsy in spontaneous intracranial hypotension. J Neurol Sci. 1998;42(3):177–80.Google ScholarPubMed
22 Shievink, WI, Reimer, R, Folger, WN. Surgical treatment of spontaneous intracranial hypotension associated with a spinal arachnoid diverticulum. J Neurosurg. 1994;80:736–9.CrossRefGoogle Scholar
23 Schaltenbrand, G. Neuere anschauugen zur pathophysiologie der liquorzirkulation. Zentralbl Neurochir. 1938;3:290–300.Google Scholar
24 The International Classification of Headache Disorders, 2nd ed. International Headache Society in. Cephalalgia. 2004;24 Suppl 1):16–7.Google Scholar
25 Capobianco, DJ, Kuczler, FJ. Case report: primary intracranial hypotension. Mil Med. 1990;155:64–6.CrossRefGoogle ScholarPubMed
26 Raskin, NH. Lumbar puncture headache: a review. Headache. 1990;30:197–200.CrossRefGoogle ScholarPubMed
27 Chung, SJ, Kim, JS, Lee, MC. Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcomes. Neurology. 2000;55:1321–7.CrossRefGoogle Scholar
28 Leibold, RA, Yealy, DM, Coppolla, M, et al. Post-dural-puncture headhache: characteristics, management and prevention. Ann Emerg Med. 1993;22:1863–70.CrossRefGoogle Scholar
29 Mokri, B, Maher, CO, Sencakova, D. Spontaneous CSF leaks: underlying disorder of connective tissue. Neurology. 2002;58:814–6.CrossRefGoogle ScholarPubMed
30 Schrjver, I, Schievink, WI, Godfrey, M, et al. Spontaneous spinal cerebrospinal fluid leaks and minor skeletal features of Marfan's syndrome: a microfibrillopathy. J Neurosurg. 2002;96:483–9.CrossRefGoogle Scholar
31 Schoffer, KL, Benstead, TJ, Grant, I. Spontaneous intracranial hypotension in the absence of magnetic resonance imaging abnormalities. Can J Neurol Sci. 2002;29:253–7.CrossRefGoogle ScholarPubMed
32 Garcia-Albea, E, Cabrera, F, Tejeiro, J, et al. Delayed post-exertional headache, intracranial hypotension, and racket sports. J Neurol Neurosurg Psychiatry. 1992;55:975.CrossRefGoogle Scholar
33 Schievink, WI, Morreale, VM, Atkinson, JLD, et al. Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg. 1998;88:243–6.CrossRefGoogle ScholarPubMed
34 Fishman, RA, Dillon, WP. Dural enhancement and cerebral displacement secondary to intracranial hypotension. Neurology. 1993;43:609–11.CrossRefGoogle ScholarPubMed
35 Paldino, M, Mogilner, AY, Tenner, MS. Intracranial hypotension syndrome: a comprehensive review. Neurosurg Focus. 2003;12 (6):ECP2.Google Scholar
36 Brightbill, TC, Goodwin, RS, Ford, RF. Magnetic resonance imaging of the intracranial hypotension syndrome with pathophsyiologic correlation. Headache. 2000;40:292–9.CrossRefGoogle ScholarPubMed
37 Franzini, A, Messina, G, Nazzi, V, et al. Spontaneous intracranial hypotension syndrome: a novel speculative hypophysiologic hypothesis and a novel patch method in a series of 28 consecutive patients. J Neurosurg. 2010;112:300–6.CrossRefGoogle Scholar
38 Lay, C, Campbell, K, Mokri, B. Low cerebrospinal fluid headache, in Goadsby, PJ, Silberstein, SD, editors. Headache. Boston: Butterworth-Heinemann; 1997. p. 355–67.Google Scholar