Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia
Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. Cephalalgia
(Impact Factor: 4.89).
01/2009; 28(12):1345-56. DOI: 10.1111/j.1468-2982.2008.01776.x
Spontaneous intracranial hypotension is an uncommon but not rare cause of new onset daily persistent headaches. A delay in diagnosis is the norm. Women are affected more commonly than men and most are in the fifth or sixth decade of life. The underlying cause is a spontaneous spinal cerebrospinal fluid (CSF) leak. Typically the headache is orthostatic in nature but other headache patterns occur as well. Associated symptoms are common and include neck pain, a change in hearing, diplopia, facial numbness, cognitive abnormalities and even coma. Typical imaging findings consist of subdural fluid collections, pachymeningeal enhancement, pituitary hyperaemia and brain sagging, but magnetic resonance imaging may be normal. Myelography is the study of choice to identify the CSF leak but is not always necessary to make the diagnosis. Treatment consists of bedrest, abdominal binder, epidural blood patching, percutaneous fibrin glue injection or surgical CSF leak repair. Outcomes have been poorly studied.
Available from: sciencedirect.com
- "Other clinical features include but are not limited to pain/stiff feeling in the neck, photophobia, interscapular pain, tinnitus, hypacusia and nausea or vomiting. This type of headache is usually present during the afternoon or the second half of the day.[1,4]. In many cases, this physiological event is associated after a lumbar puncture. "
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ABSTRACT: We report a 28 year old female who presented with a subacute onset of a severe throbbing and stabbing headache after a morning spin class 9 months ago. We confirmed the diagnosis of spontaneous intracranial hypotension cause by a cerebrospinal fluid leak. The headache finally resolved after a 55ml blood patch. Affecting an estimated 5/100,000 patients, spontaneous intracranial hypotension is considered rare in medical literature. Many patients with spontaneous intracranial hypotension are incapacitated for years and even decades. The misdiagnosis of intracranial hypotension can have serious consequences and lead to unnecessary testing and treatment. Healthcare professionals need to be aware of this diagnosis when evaluating a patient with acute head pain. Considering that physical exams are usually normal, clinicians must focus on the patient history and physical. Clues in the patient interviewing process can lead to an immediate and accurate diagnosis.
Available from: Christian Debry
- "Spontaneous intracranial hypotension (SIH) is a rare pathology, with annual incidence estimated at five per 100,000 of the population . It results from CSF leakage, the cause of which is unknown but which may be associated with trauma in a context of fragile spinal meninges (meningeal diverticula, abnormal support tissue) . The key symptom is orthostatic headache, but other less specific signs may be associated and may sometimes mislead diagnosis. "
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ABSTRACT: Spontaneous intracranial hypotension (SIH) is a rare pathology caused by unexplained and variably localized leakage of cerebrospinal fluid (CSF). The prime symptom is orthostatic headache, although other less specific clinical signs may predominate, and mislead diagnosis.
A 47-year-old man presented with Ménière-like symptoms of sudden onset. Secondary orthostatic headache led to the performance of cerebral MRI, which found signs suggestive of intracranial hypotension. A blood-patch was immediately carried out, and was followed by consciousness disorder associated with onset of bilateral subdural hematoma, which required iterative neurosurgical drainage. Myelo-CT confirmed CSF leakage facing the right 12th dorsal nerve root sheath. Radio-guided sealing with biologic glue provided complete regression of all symptoms.
Auditory signs may predominate in the clinical presentation of SIH. Their orthostatic character is suggestive. The present case is of a rare severe form. The role of neurosurgery in such cases remains to be defined.
Available from: Anthony Faivre
- "En cas de récidive, un second blood-patch peut être réalisé et permet dans près de trois quarts des cas la guérison complète  . Dans les rares formes résistantes au blood-patch, une chirurgie de colmatage peut être discutée . "
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