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Intracranial hypotension

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https://www.readbyqxmd.com/read/28283371/chiari-like-displacement-due-to-spontaneous-intracranial-hypotension-in-an-adolescent-successful-treatment-by-epidural-blood-patch
#1
Jan Schönberger, Markus Möhlenbruch, Angelika Seitz, Cornelia Bußmann, Heidi Bächli, Stefan Kölker
BACKGROUND: Spontaneous intracranial hypotension is a rarely diagnosed cause of headache, especially in children and adolescents. It is due to cerebrospinal fluid (CSF) leakage via spinal fistulae occurring without major trauma. CASE PRESENTATION: An adolescent patient presented with a 3-month history of strictly postural headache. Cranial magnetic resonance imaging (MRI) showed pronounced Chiari-like prolapse of the cerebellar tonsils, narrow ventricles and enlarged cerebral veins...
February 20, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/28254591/a-small-leak-will-sink-the-brain-targeted-c1-c2-patching
#2
Thomas Decramer, Pieter Jan Van Dyck-Lippens, Tom P Franken, Philippe Demaerel, Johannes van Loon, Tom Theys
BACKGROUND: Spontaneous intracranial hypotension (SIH) syndrome results from spontaneous spinal CSF leaks. The first treatment of choice consists of lumbar epidural blood patching. If this fails further imaging is mandatory to explore the possibility of targeted therapy. CASE DESCRIPTION: We describe a case of a 50-year old woman who developed spontaneous intracranial hypotension after minor blunt cervical trauma, complicated with bilateral subdural hematomas. Two lumbar epidural blood patches were unsuccessful...
February 27, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28230563/implementation-of-an-early-mobility-pathway-in-neurointensive-care-unit-patients-with-external-ventricular-devices
#3
Megan Moyer, Bethany Young, Joseph Borst, William Pino, Marisa Hart, Jesse LoBreglio, Derek Zaleski, Isaira Leonor, David Kung, Michelle Smith, Eric Zager, M Sean Grady, Monisha Kumar
BACKGROUND: Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH). METHODS: A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs...
February 23, 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28215135/rapid-response-team-diagnoses-frequencies-and-related-hospital-mortality
#4
Roger J Smith, John D Santamaria, Espedito E Faraone, Jennifer A Holmes, David A Reid
OBJECTIVES: To describe the frequency and hospital mortality of problems (diagnoses) encountered by a rapid response team (RRT), and to identify the most common diagnoses for RRT triggers and for treating units. DESIGN: For each RRT event in 2015 at a tertiary hospital for adults, we chose the diagnosis that best explained the RRT event from a pre-defined list after reviewing relevant test results and clinical notes. RESULTS: There were 937 RRT events during 700 admissions and there were 58 different RRT diagnoses in 11 diagnosis groups...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28202822/-idiopathic-intracranial-hypotension
#5
Iwao Takeshita, Satoshi O Suzuki, Toru Iwaki
Idiopathic intracranial hypotension (hypovolemia) is almost exclusively provoked by cerebrospinal fluid (CSF) leakage through spontaneously rent dural sac. An initial clinical feature of a severe headache with or without nausea/vomiting should be differentiated from a life-threatening stroke. An early diagnosis and proper therapy may guarantee a good outcome, while delays may promote complicated manifestations and irreversible poor outcome in a few patients. In this article, neuro-imaging studies of some demonstrable cases are presented and the outlets of the spinal CSF and spinal CSF pathways are shown with immunohistological staining...
February 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28192268/spontaneous-intracranial-hypotension-a-review-and-introduction-of-an-algorithm-for-management
#6
REVIEW
Benjamin Davidson, Farshad Nassiri, Alireza Mansouri, Jetan H Badhiwala, Christopher D Witiw, Mohammed F Shamji, Philip W Peng, Richard I Farb, Mark Bernstein
Spontaneous intracranial hypotension (SIH) is a condition of low cerebrospinal fluid (CSF) volume and pressure caused by a leak of CSF through a dural defect. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines for myelography, blood patching, and possible surgical repair. Patients should be monitored closely, as they can deteriorate into a coma or even death. There are no widely accepted guidelines for the management of SIH. Herein, we review the existing SIH literature, illustrate management challenges via a case review, and propose an algorithm developed by neurosurgeons, radiologists, and anesthesiologists intended to simplify and streamline the management of SIH...
February 9, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28188356/brain-trauma-foundation-guidelines-for-intracranial-pressure-monitoring-compliance-and-effect-on-outcome
#7
Alberto Aiolfi, Elizabeth Benjamin, Desmond Khor, Kenji Inaba, Lydia Lam, Demetrios Demetriades
BACKGROUND: Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring in patients who sustained severe traumatic brain injury (TBI). Compliance to BTF guidelines is variable, and the effect of ICP monitoring on outcomes remains a controversial issue. The purpose of this study was to assess guidelines compliance in patients who sustain a severe TBI and to analyze the effect of ICP monitoring on outcomes. METHODS: Trauma Quality Improvement Program database study, which included patients with isolated severe blunt head trauma (head Abbreviated Injury Scale ≥3 with Glasgow Coma Scale <9)...
February 10, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28166156/incidental-99mtc-dtpa-uptake-in-tarlov-cysts-on-radionuclide-spect-ct-cisternography
#8
Shankar Vamadevan, Ken Le, Chuong Bui, Robert Mansberg
Sacral perineural cysts are also known as Tarlov cysts. A 58-year-old man with suspected intracranial hypotension was evaluated with Tc-DTPA radionuclide cisternography. Radionuclide planar and SPECT/CT cisternography revealed Tc-DTPA uptake in sacral lesions. Spine MRI confirmed Tarlov cysts at the S1 and S2 levels.
February 3, 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28130464/spinal-meningeal-diverticula-spontaneous-intracranial-hypotension-and-superficial-siderosis
#9
Wouter I Schievink, M Marcel Maya
No abstract text is available yet for this article.
January 27, 2017: Neurology
https://www.readbyqxmd.com/read/28122469/dexmedetomidine-for-refractory-intracranial-hypertension
#10
Kendra J Schomer, Christian M Sebat, Jason Y Adams, Jeremiah J Duby, Kiarash Shahlaie, Erin L Louie
Dexmedetomidine (DEX) is a selective α2 adrenergic agonist that is commonly used for sedation in the intensive care unit (ICU). The role of DEX for adjunctive treatment of refractory intracranial hypertension is poorly defined. The primary objective of this study was to determine the effect of DEX on the need for rescue therapy (ie, hyperosmolar boluses, extraventricular drain [EVD] drainages) for refractory intracranial hypertension. Secondary objectives included the number of intracranial pressure (ICP) excursions, bradycardic, hypotensive, and compromised cerebral perfusion pressure episodes...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28110544/intracranial-structural-alteration-predicts-treatment-outcome-in-patients-with-spontaneous-intracranial-hypotension
#11
Hanna Choi, Mi Ji Lee, Hyun Ah Choi, Jihoon Cha, Chin-Sang Chung
Background Intracranial structural dislocation in spontaneous intracranial hypotension (SIH) can be measured by various intracranial angles and distances. We aimed to identify the clinical significance of structural dislocation in relation to treatment outcome in patients with SIH. Methods In this retrospective analysis, we identified patients with SIH who received an epidural blood patch (EBP) at Samsung Medical Center from January 2005 to March 2015. Structural dislocation in pretreatment MRIs of SIH patients was assessed by measuring tonsillar herniation, mamillopontine distance, the angle between the vein of Galen and straight sinus (vG/SS angle), the pontomesencephalic angle, and the lateral ventricular angle...
January 1, 2017: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/28091819/the-status-of-diagnosis-and-treatment-to-intracranial-hypotension-including-sih
#12
REVIEW
Jin-Ping Lin, Shu-Dong Zhang, Fei-Fang He, Min-Jun Liu, Xiao-Xu Ma
Intracranial hypotension, especially spontaneous intracranial hypotension (SIH), is a well-recognized entity associated with cerebrospinal fluid (CSF) leaks, and has being recognized better in resent years, while still woefully inadequate. An increasing number of factors including iatrogenic factors are realized to involve in development and progression of intracranial hypotension. The diagnosis remains difficult due to the various clinical manifestations, some of which are nonspecific and easily to be neglected...
December 2017: Journal of Headache and Pain
https://www.readbyqxmd.com/read/28079571/spontaneous-intracranial-hypotension-with-site-of-leak-detected-only-after-111in-dtpa-cisternogram
#13
Sana Parsian, Manuela C Matesan, Sachin Shivaji Kumbhar, David H Lewis
A 54-year-old man with a 3-week history of orthostatic headache and acute on chronic subdural hematoma presented with imaging findings suggestive of spontaneous intracranial hypotension. Three myelograms were negative for leak, and nontargeted epidural blood patches did not result in symptom relief. A cerebrospinal fluid leak study using In-DTPA with SPECT/CT demonstrated a focal area of asymmetric activity at the left C2 nerve root. A left C2 root tie-off, targeted epidural blood patch, and Dura seal glue resulted in resolution of patient symptomatology highlighting the importance of fused SPECT/CT images in detection of an occult cerebral spinal fluid leak...
April 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28057591/surgical-management-of-spontaneous-spinal-cerebrospinal-fluid-epidural-fistula
#14
Declan G Siedler, Imogen M Ibbett, Nova B Thani
BACKGROUND: Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid (CSF) fistula is a rare condition that can have serious sequelae. Early diagnosis and treatment can be challenging. CASE DESCRIPTION: We present the case of a 17-year-old male who presented with a history of sudden-onset, postural headaches associated with upper thoracic back pain. Magnetic resonance imaging (MRI) demonstrated a thoracic extradural fluid collection and slumping of the brain within the posterior fossa...
March 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28043956/factors-predicting-response-to-the-first-epidural-blood-patch-in-spontaneous-intracranial-hypotension
#15
Jr-Wei Wu, Shu-Shya Hseu, Jong-Ling Fuh, Jiing-Feng Lirng, Yen-Feng Wang, Wei-Ta Chen, Shih-Pin Chen, Shuu-Jiun Wang
Spontaneous intracranial hypotension results from cerebrospinal fluid leakage. Currently, the treatment of choice for spontaneous intracranial hypotension is the epidural blood patch, which has a variable response rate and no clear outcome predictors. This study aimed to identify predictors for response rate of a first targeted epidural blood patch in patients with spontaneous intracranial hypotension. We reviewed cases of patients with spontaneous intracranial hypotension who received targeted epidural blood patch at our hospital between 1 January 2007 and 1 July 2014...
February 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28036062/an-unusual-case-of-post-traumatic-headache-complicated-by-intracranial-hypotension
#16
Sara Siavoshi, Carrie Dougherty, Jessica Ailani, Kaustubh Yadwadkar, Frank Berkowitz
We present a case of post-traumatic headache complicated by intracranial hypotension resulting in an acquired Chiari malformation and myelopathy with syringomyelia. This constellation of findings suggest a possible series of events that started with a traumatic cerebral spinal fluid (CSF) leak, followed by descent of the cerebellar tonsils and disruption of CSF circulation that caused spinal cord swelling and syrinx. This unusual presentation of post-traumatic headache highlights the varying presentations and the potential sequelae of intracranial hypotension...
December 29, 2016: Brain Sciences
https://www.readbyqxmd.com/read/28017759/the-monro-kellie-doctrine-in-action-posterior-reversible-leukoencephalopathy-syndrome-caused-by-intracranial-hypotension-from-lumboperitoneal-shunt-placement
#17
Ioannis Karakis, Audrey H Nuccio, Jordan P Amadio, Arthur J Fountain
BACKGROUND: Posterior reversible leukoencephalopathy syndrome (PRES) is linked to various etiologies, including most importantly systemic hypertension. Its association with intracranial hypotension (IH), a potential sequela of various neurosurgical procedures, is underrecognized. We report a case of lumboperitoneal shunt-induced IH resulting in PRES with the goal to increase awareness and elaborate on the potential biologic mechanism, based on the Monro-Kellie hypothesis. CASE DESCRIPTION: A 26-year-old woman with acquired immunodeficiency syndrome and epilepsy was admitted for recurrent cryptococcal meningitis and breakthrough seizures...
February 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28006941/early-changes-of-brain-perfusion-after-subarachnoid-hemorrhage-the-effect-of-sodium-nitroprusside
#18
M Kolar, K Nohejlova, J Mares, J Pachl
Causes of early hypoperfusion after subarachnoid hemorrhage (SAH) include intracranial hypertension as well as vasoconstriction. The aim of the study was to assess the effect of intracerebroventricular (ICV) administration of sodium nitroprusside (SNP) on early hypoperfusion after SAH. Male Wistar rats (220-240 g) were used, SAH group received 250 microl of fresh autologous arterial blood into the prechiasmatic cistern; sham-operated animals received 250 microl of isotonic solution. Therapeutic intervention: ICV administration of 10 microg SNP; 5 microl 5 % glucose (SNP vehicle) and untreated control...
December 22, 2016: Physiological Research
https://www.readbyqxmd.com/read/27994919/frequency-of-nerve-root-sleeve-cysts-in-autosomal-dominant-polycystic-kidney-disease
#19
Murat Aşık, Fatih Tufan, Timur Selçuk Akpınar, Nilgül Akalın, Elvan Ceyhan, Necmeddin Tunç, Zehra Işık Hasıloğlu, Mehmet Rıza Altıparmak, Tevfik Ecder, Sait Albayram
BACKGROUND: There is sporadic data about the occurrence of spinal meningeal cysts in patients with autosomal dominant polycystic kidney disease (ADPKD). We suggest that there is a relationship with the frequency and size of spinal meningeal cysts and headache, intracranial aneurysms, and cerebrospinal fluid leakage in patients with ADPKD. AIM: To investigate the relationship with spinal meningeal cyst, cerebrospinal fluid leakage, and headache in patients with ADPKD...
November 2016: Balkan Medical Journal
https://www.readbyqxmd.com/read/27943273/granulomatosis-with-polyangiitis-associated-hypertrophic-pachymeningitis-mimicking-spontaneous-intracranial-hypotension-a-case-report
#20
Young Hee Jung, Mi Ji Lee, Chungbin Lee, Jihoon Cha, Chin-Sang Chung
BACKGROUND: Dural enhancement is a characteristic finding in both spontaneous intracranial hypotension and hypertrophic pachymeningitis. Positional headache is the most important feature that distinguishes the two diseases. We report a patient with granulomatosis with polyangiitis (formerly Wegener's granulomatosis) who initially manifested like spontaneous intracranial hypotension. CASE PRESENTATION: We report here the case of a 63-year old man who presented with severe positional headache...
December 10, 2016: Headache
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