Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-17T18:47:38.772Z Has data issue: false hasContentIssue false
  • English
  • Français

Spontaneous Intracranial Hypotension in the Absence of Magnetic Resonance Imaging Abnormalities

Published online by Cambridge University Press:  02 December 2014

Kerrie L. Schoffer ,
Timothy J. Benstead  and
Ian Grant
Kerrie L. Schoffer
Affiliation:
Division of Neurology, Dalhousie University, Halifax, NS Canada
Timothy J. Benstead
Affiliation:
Division of Neurology, Dalhousie University, Halifax, NS Canada
Ian Grant
Affiliation:
Division of Neurology, Dalhousie University, Halifax, NS 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 a neurologic syndrome of unknown etiology, characterized by features of low cerebral spinal fluid (CSF) pressure, postural headache and magnetic resonance imaging (MRI) abnormalities.

Methods:

Four symptomatic cases of SIH presented to our institution over a six-month period. Magnetic resonance imaging studies were performed in all four cases. Diagnostic lumbar puncture was done in all except one case.

Results:

All of the patients on whom lumbar punctures were performed demonstrated low CSF pressure and CSF protein elevation with negative cultures and cytology. Three out of the four patients exhibited MRI findings of diffuse spinal and intracranial pachymeningeal gadolinium enhancement and extradural or subdural fluid collections. One patient had no MRI abnormalities despite prominent postural headache and reduced CSF pressure at lumbar puncture. All patients recovered with intravenous fluids and conservative treatment.

Conclusion:

Magnetic resonance imaging abnormalities are found in most, but not all patients, with SIH. Cerebral spinal fluid abnormalities can be detected even in patients with normal MRI studies. It is important to recognize the variability of imaging results in this usually benign disorder.

Résumé:

RÉSUMÉ:Introduction:

L’hypotension intracrânienne spontanée (HIS) est un syndrome neurologique d’étiologie inconnue, caractérisé par des manifestations d’une pression basse du liquide cérébro-rachidien (LCR), de céphalée posturale et d’anomalies à l’imagerie par résonance magnétique (IRM).

Méthodes:

Quatre patients présentant des symptoms d’HIS ont été évalués dans notre institution sur une période de six mois. Des études d’IRM ont été effectuées dans les quatre cas et une ponction lombaire diagnostique a été faite chez trois d’entre eux.

Résultats:

Tous les patients qui ont subi une ponction lombaire avaient une pression du LCR qui était basse et une élévation des protéines avec culture et cytologie négatives. À l’IRM, trois des quatre patients avaient des signes diffus de rehaussement pachyméningé spinal et intracrânien au gadolinium, et des collections de liquide extraduraux ou sous-duraux. Un patient présentait une IRM normale malgré une céphalée posturale marquée et une pression basse du LCR à la ponction lombaire. Tous les patients ont récupéré avec une hydratation parentérale et un traitement conservateur.

Conclusions:

On trouve des anomalies à l’IRM chez la plupart des patients présentant une HIS. Des anomalies du LCR peuvent être présentes même chez les patients dont l’IRM est normale. Il est important de connaître la variabilité observée à l’imagerie dans ce désordre habituellement bénin.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 3 , August 2002 , pp. 253 - 257
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Schaltenbrand, G. Die akute Aliquorrhoe. Verh Dtsch Ges Inn Med 1940; 52: 473–481.Google Scholar
2. Mokri, B, Piepgras, DG, Miller, GM. Syndrome of orthostaticheadaches and diffuse pachymeningeal gadolinium enhancement. Mayo Clin Proc 1997; 72: 400–413.Google Scholar
3. Hochman, SM, Naidich, TP, Kobetz, SA, Fernandez-Maitin, A. Spontaneous intracranial hypotension with pachymeningeal enhancement on MRI. Neurology 1992; 42: 1628–1630.Google Scholar
4. Fishman, RA, Dillon, WP. Dural enhancement and cerebraldisplacement secondary to intracranial hypotension. Neurology 1993; 43: 609–611.Google Scholar
5. Schievink, WI, Tourje, J. Intracranial hypotension without meningealenhancement on magnetic resonance imaging. Case report. J Neurosurg 2000; 92: 475–477.CrossRefGoogle Scholar
6. Garcia-Albea, E, Cabrera, F, Tejeiro, J, et al. Delayed post-exertionalheadache, intracranial hypotension, and racket sports. J Neurol Neurosurg Psychiatry 1992; 55: 975.Google Scholar
7. Schievink, WI, Ebersold, MJ, Atkinson, JLD. Roller coaster headachedue to spinal cerebrospinal fluid leak. Lancet 1996; 347: 1409.Google Scholar
8. Rando, TA, Fishman, RA. Spontaneous intracranial hypotension:report of two cases and review of the literature. Neurology 1992; 42: 481–487.Google Scholar
9. Schievink, WI, Smith, KA. Nonpositional headache caused byspontaneous intracranial hypotension. Neurology 1998; 51:1768–1789.Google Scholar
10. Kunkle, EC, Ray, BS, Wolff, HG. Experimental studies on headache:analysis of the headache associated with changes in intracranial pressure. Arch Neurol Psychiatry 1943; 49: 323–358.Google Scholar
11. Renowden, SA, Gregory, R, Hyman, N, Hilton-Jones, D. Spontaneousintracranial hypotension. J Neurol Neurosurg Psychiatry 1995; 59: 511–515.Google Scholar
12. Hughson, W. A note on the relationship of cerebrospinal andintralabyrinthine pressures. Am J Physiol 1932; 101: 396–407.Google Scholar
13. Horton, JC, Fishman, RA. Neurovisual findings in the syndrome ofspontaneous intracranial hypotension from dural cerebrospinalfluid leak. Opthalmology 1994; 101: 244–251.Google Scholar
14. Ferrante, E, Savino, A, Brioschi, A, et al. Transient oculomotor cranialnerves palsy in spontaneous intracranial hypotension. J Neurosurg Sci 1998; 42: 177–179.Google Scholar
15. Moayeri, NN, Henson, JW, Schaefer, PW, Zervas, NT. Spinal duralenhancement on magnetic resonance imaging associated with spontaneous intracranial hypotension. Report of three cases andreview of the literature. J Neurosurg 1998; 88: 912–918.Google Scholar
16. Pleasure, SJ, Abosch, A, Friedman, J, et al. Spontaneous intracranialhypotension resulting in stupor caused by diencephalic compression. Neurology 1998; 50: 1854–1857.Google Scholar
17. Pakiam, AS, Lee, CL, Lang, AE. Intracranial hypotension withparkinsonism, ataxia, and bulbar weakness. Arch Neurol 1999;56: 869–872.Google Scholar
18. Mokri, B, Hunter, SF, Atkinson, JLD, Piepgras, DG. Orthostaticheadaches caused by CSF leak but with normal CSF pressures. Neurology 1998; 51: 786–790.Google Scholar
19. El Gammal, T, Sobol, W, Wadlington, VR, et al. Cerebrospinal fluidfistula: detection with MR cisternography. AJNR 1998; 19: 627–631.Google Scholar
20. Cloward, RB. Congenital spinal extradural cysts: case report withreview of literature. Ann Surg 1968; 168: 851–864.Google Scholar
21. Vishteh, AG, Schievink, WI, Baskin, JJ, Sonntag, VKH. Cervical bonespur presenting with spontaneous intracranial hypotension. J Neurosurg 1998; 89: 483–484.Google Scholar
22. Brightbill, TC, Goodwin, RS, Ford, RG. Magnetic Resonanceimaging of intracranial hypotension syndrome with pathophysiological correlation. Headache 2000; 40: 292–299.Google Scholar
23. Mokri, B, Parisi, JE, Scheithauer, BW, Piepgras, DG, Miller, GM. Meningeal biopsy in intracranial hypotension: meningeal enhancement on MRI. Neurology 1995; 45: 1801–1807.Google Scholar
24. Good, DC, Ghobrial, M. Pathological changes associated withintracranial hypotension and meningeal enhancement on MRI. Neurology 1993; 43: 2698–2700.Google Scholar
25. Burkhard, PR, Duff, JM. Bilateral subdural hematomas followingroutine lumbar diskectomy. Headache 2000; 40: 480–482.Google Scholar
26. Yousry, I, Forderreuther, BM, Moriggl, B. Cervical MR Imaging inPostural Headache: MR Signs and Pathophysiological Implications. AJNR 2001; 22: 1239–1250.Google Scholar
27. Dunbar, SA, Katz, NP. Failure of delayed epidural blood patching tocorrect persistent cranial nerve palsies. Anesth Analg 1994; 79: 806–807.Google Scholar
28. Benamor, M, Tainturier, C, Graveleau, P, Pierot, L. Radionuclidecisternography in spontaneous intracranial hypotension. Clin Nucl Med 1998; 23: 150–151.Google Scholar
29. Matsumura, A, Anno, I, Kimura, H, Ishikawa, E, Nose, T. Diagnosis ofspontaneous intracranial hypotension by using magnetic resonance myelography: case report. J Neurosurg 2000; 92: 873–876.Google Scholar
30. Chen, CC, Luo, CL, Wang, SJ, et al. Colour doppler imaging fordiagnosis of intracranial hypotension. Lancet 1999; 354: 826–829.Google Scholar
31. Copobianco, DJ, Kuczler, FJ. Case report: primary intracranialhypotension. Milit Med 1990; 155: 64–66.Google Scholar
32. Gaukroger, PB, Brownridge, P. Epidural blood patch in the treatment ofspontaneous low CSF pressure headache. Pain 1987;29:119–122.Google Scholar
33. Gibson, BE, Wedel, DJ, Faust, RJ, Petersen, RC. Continuous epiduralsaline infusion for the treatment of low CSF pressure headache. Anesthesiology 1988; 68: 789–791.Google Scholar
34. Schievink, WI, Morreale, VM, Atkinson, JLD, et al. Surgicaltreatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg 1998; 88: 243–246.Google Scholar
35. Szeinfeld, M, Ihmeidan, IH, Moser, MM, et al. Epidural blood patch:evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology 1986; 64: 820–822.Google Scholar
36. Weitz, SR, Drasner, K. Spontaneous intracranial hypotension: aseries. Anesthesiology 1996; 85: 923–925.Google Scholar
37. Rupp, SM, Wilson, CB. Treatment of spontaneous cerebrospinal fluidleak with epidural blood patch. J Neurosurg 1989; 70: 808–810.Google Scholar
38. Schievink, WI, Meyer, FB, Atkinson, JLD, Mokri, B. Spontaneouscerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 1996; 84: 598–605.Google Scholar
39. Fishman, RA, Dillon, WP. Intracranial hypotension. J Neurosurg 1997; 86: 165.Google Scholar