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Spontaneous Intracranial Hypotension

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https://www.readbyqxmd.com/read/29217497/prevalence-of-hyperdense-paraspinal-vein-sign-in-patients-with-spontaneous-intracranial-hypotension-without-dural-csf-leak-on-standard-ct-myelography
#1
Michael S Clark, Felix E Diehn, Jared T Verdoorn, Vance T Lehman, Greta B Liebo, Jonathan M Morris, Kent R Thielen, John T Wald, Neeraj Kumar, Patrick H Luetmer
PURPOSE: A recently identified and treatable cause of spontaneous intracranial hypotension (SIH) is cerebrospinal fluid (CSF)-venous fistula, and a recently described computed tomography myelogram (CTM) finding highly compatible with but not diagnostic of this entity is the hyperdense paraspinal vein sign. We aimed to retrospectively measure the prevalence of the hyperdense paraspinal vein sign on CTMs in SIH patients without dural CSF leak, in comparison with control groups. METHODS: Three CTM groups were identified: 1) SIH study group, which included dural CSF leak-negative standard CTMs performed for SIH, with early and delayed imaging; 2) Early control CTMs, which were performed for indications other than SIH, with imaging shortly after intrathecal contrast administration; 3) Delayed control CTMs, which included delayed imaging...
December 7, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
https://www.readbyqxmd.com/read/29150776/hyperpyrexia-as-the-presenting-symptom-of-intracranial-hypotension
#2
Omar Hussein, Michel Torbey
INTRODUCTION: Hyperpyrexia is a severely elevated core body temperature secondary to an elevated hypothalamic set thermo-regulatory threshold. Hyperthermia is an elevated core body temperature beyond the normal hypothalamic set thermo-regulatory threshold. Intracranial hypotension can present with a wide variety of symptoms ranging from orthostatic headache up to coma. We report a rare case of hyperpyrexia associated with intracranial hypotension. METHODS: A case report of a 55-year-old female patient with a history of angiogram-negative subarachnoid hemorrhage status post-ventriculoperitoneal (VP) shunt placement six years prior to admission who suddenly developed encephalopathy and high fever...
November 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29140961/cervical-foraminal-epidural-blood-patch-for-the-targeted-treatment-of-refractory-cerebrospinal-fluid-leakage-from-a-dural-sleeve
#3
Nuj Tontisirin, Pannawit Benjhawaleemas, Sasikaan Nimmaanrat, Pornchai Sathirapanya, Teeranan Laohawiriyakamol, De Q Tran, Roderick J Finlayson
Epidural blood patches (EBPs) are routinely used to treat symptoms (eg, headaches) associated with spontaneous intracranial hypotension. Although cerebrospinal fluid leakage commonly involves the periforaminal areas of the cervical or thoracic spine, EBPs have been historically performed at the lumbar level. Recent evidence suggests that targeting the causative spinal segment may provide greater clinical benefits. While previous reports have targeted foraminal leaks with segmental thoracic or cervical injections, we present a case report detailing the novel use of a navigable epidural catheter to perform a selective EBP at the C7/T1 foramen...
November 14, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29110769/impaired-cerebrospinal-fluid-pressure
#4
Jan Hoffmann
Abnormalities of cerebrospinal fluid (CSF) pressure are relatively common and may lead to a variety of symptoms, with headache usually being the most prominent one. The clinical presentation of alterations in CSF pressure may vary significantly and show a striking similitude to several primary headache syndromes. While an increase in CSF pressure may be of primary or secondary origin, a pathologic decrease of CSF pressure is usually the result of a meningeal rupture with a resulting leakage of CSF. The pathophysiologic mechanisms of idiopathic intracranial hypertension (IIH) remain largely unknown...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29103382/spontaneous-intracranial-hypotension-induced-headaches-and-onabotulinum-toxin-a-a-case-report
#5
Tommy L H Chan, Werner J Becker, William Y Hu, Farnaz Amoozegar
No abstract text is available yet for this article.
November 6, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/29052799/treatment-and-outcome-of-subdural-hematoma-in-patients-with-spontaneous-intracranial-hypotension-a-report-of-35-cases
#6
Enrico Ferrante, Fabio Rubino, Federica Beretta, Caroline Regna-Gladin, M Mirko Ferrante
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, low CSF pressure and diffuse pachymeningeal enhancement on brain MRI. SIH results from spontaneous CSF leakage leading to brain sag. Sometimes, tearing of bridging veins may produce subdural hematomas (SDHs). Patients with SDH were identified retrospectively from 212 consecutive SIH patients. Data were collected on demographics, clinical courses, neuroimaging findings, treatment and outcome of SDH. Thirty-five patients (16%), (6 women, 29 men; aged 33-68; mean, 50 years) with SDH were recruited...
October 20, 2017: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/29023155/csf-venous-fistulas-in-spontaneous-intracranial-hypotension-imaging-characteristics-on-dynamic-and-ct-myelography
#7
Peter G Kranz, Timothy J Amrhein, Linda Gray
OBJECTIVE: The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). MATERIALS AND METHODS: We retrospectively reviewed the records of patients with SIH caused by CSF venous fistulas who received treatment at our institution. The anatomic details of each fistula were recorded. Attenuation of the veins involved by the fistula was compared with that of adjacent control veins on CT myelography (CTM)...
December 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28984516/multilevel-ultra-large-volume-epidural-blood-patch-for-the-treatment-of-neurocognitive-decline-associated-with-spontaneous-intracranial-hypotension-case-report
#8
Michael D Staudt, Stephen H Pasternak, Manas Sharma, Sachin K Pandey, Miguel F Arango, David M Pelz, Stephen P Lownie
Spontaneous intracranial hypotension (SIH) is a progressive clinical syndrome characterized by orthostatic headaches, nausea, emesis, and occasionally focal neurological deficits. Rarely, SIH is associated with neurocognitive changes. An epidural blood patch (EBP) is commonly used to treat SIH when conservative measures are inadequate, although some patients require multiple EBP procedures or do not respond at all. Recently, the use of a large-volume (LV) EBP has been described to treat occult leak sites in treatment-refractory SIH...
October 6, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28969244/spontaneous-intracranial-hypotension
#9
Ankit Balani, Sandhya Shantilal Sarjare, Amit Kumar Dey, Anjani D Kumar, Sapna S Marda
No abstract text is available yet for this article.
August 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28755201/update-on-the-diagnosis-and-treatment-of-spontaneous-intracranial-hypotension
#10
REVIEW
Peter G Kranz, Michael D Malinzak, Timothy J Amrhein, Linda Gray
PURPOSE OF REVIEW: The purpose of this study is to provide an update on recent developments in the understanding, diagnosis, and treatment of spontaneous intracranial hypotension (SIH). RECENT FINDINGS: SIH is an important cause of headaches caused by spinal cerebrospinal fluid (CSF) leaks, with an increasingly broad spectrum of clinical presentations and diagnostic findings. A simple conception of the condition as being defined by the presence of low CSF pressure is no longer sufficient or accurate...
August 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28754752/reversible-holmes-tremor-due-to-spontaneous-intracranial-hypotension
#11
Rajesh Shankar Iyer, Pandurang Wattamwar, Bejoy Thomas
Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH)...
July 27, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28735438/adenosine-assisted-neurovascular-surgery-initial-case-series-and-review-of-literature
#12
REVIEW
Alaa Al-Mousa, Gahan Bose, Katharine Hunt, Ahmed K Toma
Cerebral aneurysms in complex anatomical locations and intraoperative rupture of aneurysms are challenging for neurosurgeons and anaesthetists alike. Mechanical and non-mechanical methods to reduce blood flow into aneurysms are well-recognised techniques to facilitate aneurysm exclusion from the circulation. Mechanical methods like temporary clipping of parent arteries, carotid artery ligation and endovascular balloon occlusion are commonly used in clinical practice. However, non-mechanical techniques such as rapid ventricular pacing and adenosine-induced cardiac standstill with hypotension are still emerging strategies...
July 22, 2017: Neurosurgical Review
https://www.readbyqxmd.com/read/28681582/factors-affecting-cerebrospinal-fluid-opening-pressure-in-patients-with-spontaneous-intracranial-hypotension
#13
Ling-Ling Yao, Xing-Yue Hu
OBJECTIVE: Spontaneous intracranial hypotension (SIH) is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid (CSF) pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure (CSF OP) and explore the factors affecting CSF OP in SIH patients. METHODS: We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables (including demographic data, body mass index (BMI), duration of symptoms, and brain imaging findings)...
July 2017: Journal of Zhejiang University. Science. B
https://www.readbyqxmd.com/read/28679427/comparison-of-the-sagittal-sinus-cross-sectional-area-between-patients-with-multiple-sclerosis-hydrocephalus-intracranial-hypertension-and-spontaneous-intracranial-hypotension-a-surrogate-marker-of-venous-transmural-pressure
#14
Grant A Bateman, Jeannette Lechner-Scott, Ross Copping, Christopher Moeskops, Swee Leong Yap
There is evidence that patients with multiple sclerosis (MS) and hydrocephalus share some common pathophysiological mechanisms. Alterations in CSF pressure are known to affect cerebral venous sinus geometry. To further explore these mechanisms, we measured the superior sagittal sinus (SSS) cross-sectional area 3 cm above the torcular using T2 images in 20 MS, 10 spontaneous intracranial hypotension (SIH), 21 hydrocephalus and 20 idiopathic intracranial hypertension (IIH) patients and compared with 20 matched controls...
July 6, 2017: Fluids and Barriers of the CNS
https://www.readbyqxmd.com/read/28653430/misdiagnosis-of-spontaneous-intracranial-hypotension-as-a-risk-factor-for-subdural-hematoma
#15
Youn-Jung Kim, Hyun-Young Cho, Dong-Woo Seo, Chang Hwan Sohn, Shin Ahn, Yoon-Seon Lee, Won Young Kim, Kyung Soo Lim
OBJECTIVE: This study aimed to evaluate the association between misdiagnosis of spontaneous intracranial hypotension (SIH) and subdural hematoma development. BACKGROUND: Although SIH is more prevalent than expected and causes potentially life-threatening complications including subdural hematoma (SDH), the association between misdiagnosis of SIH and SDH development is not yet evaluated. METHODS: Retrospective observational study was conducted between January 1, 2005, and December 31, 2014...
June 26, 2017: Headache
https://www.readbyqxmd.com/read/28652945/spontaneous-intracranial-hypotension-after-vestibular-schwannoma-resection-due-to-an-unexpected-pathology-tarlov-cysts
#16
Seth E Pross, Jeffrey D Sharon, Michael Lim, Abhay Moghekar, Aruna Rao, John P Carey
While infrequent, cerebrospinal fluid (CSF) leaks are known to occur after surgical resection of vestibular schwannomas. Early signs of CSF leak often include headache and altered mental status. If untreated, life-threatening complications can occur, including brainstem herniation and meningitis. The appropriate surgical treatment for a CSF leak requires accurate localization of the source. While the most likely location of a CSF leak after lateral skull base surgery is through the aerated portions of the temporal bone, we present a unique case of a man with a prolonged CSF leak after an acoustic tumor removal who was ultimately found to have an occult spinal perineural (Tarlov) cyst as the source...
May 19, 2017: Curēus
https://www.readbyqxmd.com/read/28623115/association-of-cerebral-venous-thrombosis-and-intracranial-hypotension-review-of-3-cases
#17
Leen Sinnaeve, Ludo Vanopdenbosch, Koen Paemeleire
Cerebral venous thrombosis is a rare complication of intracranial hypotension. We describe 3 cases in which this phenomenon occurred, as a result of a lumbar puncture or due to a spontaneous cerebrospinal fluid leak. We emphasize the importance of early detection of the intracranial hypotension syndrome, the most common clinical manifestation being orthostatic headache. It is not an innocent condition as it is associated with other potential complications such as subdural hygroma/hematoma, cranial nerve palsies, cerebellar tonsillar descent, and even brainstem manifestations...
June 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28574328/cerebrospinal-fluid-outflow-resistance-as-a-diagnostic-marker-of-spontaneous-cerebrospinal-fluid-leakage
#18
Jürgen Beck, Christian Fung, Christian T Ulrich, Michael Fiechter, Jens Fichtner, Heinrich P Mattle, Marie-Luise Mono, Niklaus Meier, Pasquale Mordasini, Werner J Z'Graggen, Jan Gralla, Andreas Raabe
OBJECTIVE Spinal CSF leakage causes spontaneous intracranial hypotension (SIH). The aim of this study was to characterize CSF dynamics via lumbar infusion testing in patients with and without proven spinal CSF leakage in order to explore possible discriminators for the presence of an open CSF leak. METHODS This analysis included all patients with suspected SIH who were treated at the authors' institution between January 2012 and February 2015. The gold standard for "proven" CSF leakage is considered to be extrathecal contrast accumulation after intrathecal contrast injection...
August 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28540126/neurological-complications-of-lumbar-and-cervical-dural-punctures-with-a-focus-on-epidural-injections
#19
Nancy E Epstein
BACKGROUND: Various types of lumbar dural punctures may contribute to neurological injury. The etiologies of dural injury include; inadvertent dural punctures due to epidurals placed for labor anesthesia, epidural steroid injections (ESI/transforaminal TESI; approximately 9 million ESI performed in the US per year), deliberate placement of intradural pain devices, and spontaneous cerebrospinal fluid (CSF) fistulas. Resulting neurological complications may include; spinal headaches/intracranial hypotension, subdural hematomas, and 6(th) nerve cranial palsies...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28538330/simultaneous-surgical-decompression-of-bilateral-subdural-hematoma-and-an-administration-of-epidural-blood-patch-for-spontaneous-intracranial-hypotension
#20
Ramamani Mariappan, Amitav Philip, Edmond J Gandham, Krishnaprabhu Raju
No abstract text is available yet for this article.
May 19, 2017: Journal of Neurosurgical Anesthesiology
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