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Madhavan AA, Kranz PG, Carlton Jones L, Ahn ES, Amrhein TJ, Brinjikji W, Callen A, Cutsforth-Gregory JK, Mamlouk MD, Silvera VM, Guerin JB. Spontaneous Intracranial Hypotension in Children: A Multi-Institutional Review of Spinal CSF Leaks Localized on Advanced Myelography. AJNR Am J Neuroradiol 2024:ajnr.A8430. [PMID: 39389774 DOI: 10.3174/ajnr.a8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/08/2024] [Indexed: 10/12/2024]
Abstract
Spontaneous intracranial hypotension is an increasingly recognized syndrome caused by a spinal CSF leak, with most reported cases occurring in adults. The use of specialized or advanced myelography to localize spinal CSF leaks has evolved substantially in recent years, particularly since the initial description of CSF-venous fistulas in 2014. To our knowledge, no prior series have evaluated the use of specialized myelographic techniques to localize CSF leaks in children with spontaneous intracranial hypotension, likely because the disease is rare in this patient population. This issue may be compounded by a hesitation to perform invasive procedures in children. In this clinical report, we conducted a multi-institutional review of pediatric patients with spontaneous spinal CSF leaks localized using advanced myelographic techniques, such as prone and decubitus digital subtraction and CT myelography, as well as dynamic CT myelography. We report the clinical features of these patients, as well as imaging findings, types of leaks discovered, and method of treatment. We found that the primary types of spontaneous spinal CSF leaks that occur in adults, including dural tears and CSF fistulas, can be seen in children, too. Furthermore, we show that specialized myelographic techniques can successfully localize these leaks and facilitate effective targeted treatment.
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Affiliation(s)
- Ajay A Madhavan
- From the Division of Neuroradiology (A.A.M., W.B., V.M.S., J.B.G.), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Peter G Kranz
- Division of Neuroradiology (P.G.K., T.J.A.), Department of Radiology, Duke Health, Durham, North Carolina
| | - Lalani Carlton Jones
- Department of Radiology (L.C.J.), Guys and St Thomas's and Kings College Hospitals NHS Foundation Trusts, London, UK
| | - Edward S Ahn
- Department of Neurosurgery (E.S.A.), Mayo Clinic, Rochester, Minnesota
| | - Timothy J Amrhein
- Division of Neuroradiology (P.G.K., T.J.A.), Department of Radiology, Duke Health, Durham, North Carolina
| | - Waleed Brinjikji
- From the Division of Neuroradiology (A.A.M., W.B., V.M.S., J.B.G.), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Andrew Callen
- Department of Radiology (A.C.), University of Colorado Hospital, Aurora, Colorado
| | | | - Mark D Mamlouk
- Department of Radiology (M.D.M.), Permanente Medical Group, Kaiser Permanente Medical enter Santa Clara, Santa Clara, California
| | - V Michelle Silvera
- From the Division of Neuroradiology (A.A.M., W.B., V.M.S., J.B.G.), Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Julie B Guerin
- From the Division of Neuroradiology (A.A.M., W.B., V.M.S., J.B.G.), Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Parikh SK. Rebound Intracranial Hypertension. Curr Pain Headache Rep 2024; 28:395-401. [PMID: 38430310 PMCID: PMC11126494 DOI: 10.1007/s11916-024-01231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Rebound intracranial hypertension (RIH) is a post-procedural treatment complication in patients with spontaneous intracranial hypotension (SIH) characterized by transient high-pressure headache symptoms. This article reviews the epidemiology, clinical features, risk factors, and treatment options for RIH. RECENT FINDINGS This article discusses how changes in underlying venous pressure and craniospinal elastance can explain symptoms of RIH, idiopathic intracranial hypertension (IIH), and SIH. The pathophysiology of RIH provides a clue for how high and low intracranial pressure disorders, such as IIH and SIH, are connected on a shared spectrum.
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Affiliation(s)
- Simy K Parikh
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
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3
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Bin Wan Hassan WMN, Mistretta F, Molinaro S, Russo R, Bosco G, Gambino A, Bergui M. Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation. J Clin Med 2023; 12:jcm12093287. [PMID: 37176727 PMCID: PMC10179697 DOI: 10.3390/jcm12093287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Spontaneous intracranial hypotension (SIH) occurs due to a leakage of the cerebrospinal fluid (CSF) lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. As a result of less support provided by CSF pressure, intracranial structures are stretched downward, leading to a constellation of more or less typical MRI findings, including venous congestion, subdural effusions, brainstem sagging and low-lying cerebellar tonsils. Clinic examination and an MRI are usually enough to allow for the diagnosis; however, finding the location of the dural tear is challenging. SIH shares some MRI features with Chiari malformation type I (CM1), especially low-lying cerebellar tonsils. Since SIH is likely underdiagnosed, these findings could be interpreted as signs of CM1, leading to a misdiagnosis and an incorrect treatment pathway. Medical treatment, including steroids, bed rest, hydration caffeine, and a blind epidural blood patch, have been used in this condition with variable success rates. For some years, CSF venous fistulas have been described as the cause of SIH, and a specific diagnostic and therapeutic pathway have been proposed. The current literature on SIH with a focus on diagnosis, treatment, and differential diagnosis with CM1, is reviewed and discussed.
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Affiliation(s)
| | - Francesco Mistretta
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Stefano Molinaro
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Riccardo Russo
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Giovanni Bosco
- Department of Neuroscience, Stroke Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Andrea Gambino
- Department of Surgical Sciences, Radiology Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Mauro Bergui
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, 10126 Turin, Italy
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Catheter-guided multilevel epidural blood patches in an adolescent boy. Reg Anesth Pain Med 2022; 47:430-433. [DOI: 10.1136/rapm-2022-103487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
BackgroundThere is increasing evidence for the use of multilevel epidural catheter-guided blood patches to treat spontaneous cerebrospinal fluid leaks in adults. Yet, there are scarce data for their use in children. Furthermore, higher level epidural blood patches are uncommon in both adult and pediatric populations.Case presentationAn adolescent boy with multilevel cerebrospinal fluid leaks associated with status migrainosus failed conservative pain management treatment. As he remained severely symptomatic, epidural blood patches were required to mitigate his symptoms. Given his multilevel leaks, a catheter-guided blood patch approach was used to treat multiple cervicothoracic and thoracolumbar leaks. After three separate uneventful blood patch procedures, the patient was free of symptoms. Other than some rebound intracranial hypertension, the patient maintained full neurological capacity without further complications. Following the resolution of treatment, he has not sought help for pain since his last blood patch over a year ago.ConclusionsMultilevel catheter-guided blood patches have the potential to be administered to higher level spinal regions to the pediatric population suffering from multiple spontaneous cerebrospinal fluid leaks.
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Magnetic resonance imaging findings of intracranial hypotension. Neurol Sci 2022; 43:3343-3351. [DOI: 10.1007/s10072-021-05782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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6
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Roos C. Ipotensione intracranica spontanea. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)45998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Peterson EE, Riley BL, Windsor RB. Pediatric Intracranial Hypotension and Post-Dural Puncture Headache. Semin Pediatr Neurol 2021; 40:100927. [PMID: 34749914 DOI: 10.1016/j.spen.2021.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
Pediatric intracranial hypotension can occur acutely following iatrogenic dural puncture for diagnostic or therapeutic purposes, or chronically from cerebrospinal fluid leak. The incidence of intracranial hypotension in children is not fully known. However, many steps can be taken to reduce the risk of a child developing a post-dural puncture headache. Other causes of intracranial hypotension, such as spontaneous intracranial hypotension or CSF fistulas, are rare and with little pediatric data to guide evaluation and management. This manuscript reviews the risk factors, diagnostic evaluations, and treatments for post-dural puncture headache, as well as a limited discussion of spontaneous intracranial hypotension as it may pertain to children and adolescents.
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Affiliation(s)
- Elisha E Peterson
- Division of Anesthesiology, Children's National Hospital, George Washington University School of Medicine, Washington, DC
| | - Bobbie L Riley
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Blake Windsor
- Department of Pediatrics, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, SC.
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Nisson PL, Schreck R, Graham JM, Maya MM, Schievink WI. Spontaneous intracranial hypotension secondary to congenital spinal dural ectasia and genetic mosaicism for tetrasomy 10p: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE213. [PMID: 35855416 PMCID: PMC9265171 DOI: 10.3171/case213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spontaneous intracranial hypotension has historically been a poorly understood pathology that is often unrecognized and undertreated. Even more rarely has it been described in pediatric patients with an otherwise benign past medical history. OBSERVATIONS Herein the authors describe one of the youngest patients ever reported, a 2-year-old girl who developed severe headaches, nausea, and vomiting and experienced headache relief after lying down. Imaging revealed tonsillar herniation 14 mm below the foramen magnum, presumed to be a Chiari malformation, along with extensive dural cysts starting from thoracic level T2 down to the sacrum. She was found to have streaky skin pigmentary variation starting from the trunk down to her feet. Genetic analysis of skin biopsies revealed mosaicism for an isodicentric marker chromosome (10p15.3–10q11.2 tetrasomy) in 27%–50% of cells. After undergoing a suboccipital and cervical decompression at an outside institution, she continued to be symptomatic. She was referred to the authors’ hospital, where she was diagnosed with spontaneous intracranial hypotension. LESSONS After receiving a series of epidural blood patches, the patient experienced almost complete relief of her symptoms. To the authors’ knowledge, this is the first time this chromosomal anomaly has ever been reported in a living child, and this may represent a new genetic association with dural ectasia.
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Affiliation(s)
| | | | | | - Marcel M. Maya
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
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Luetzen N, Dovi-Akue P, Fung C, Beck J, Urbach H. Spontaneous intracranial hypotension: diagnostic and therapeutic workup. Neuroradiology 2021; 63:1765-1772. [PMID: 34297176 PMCID: PMC8528761 DOI: 10.1007/s00234-021-02766-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is an orthostatic headache syndrome with typical MRI findings among which engorgement of the venous sinuses, pachymeningeal enhancement, and effacement of the suprasellar cistern have the highest diagnostic sensitivity. SIH is in almost all cases caused by spinal CSF leaks. Spinal MRI scans showing so-called spinal longitudinal extradural fluid (SLEC) are suggestive of ventral dural tears (type 1 leak) which are located with prone dynamic (digital subtraction) myelography. As around half of the ventral dural tears are located in the upper thoracic spine, additional prone dynamic CT myelography is often needed. Leaking nerve root sleeves typically associated with meningeal diverticulae (type 2 leaks) and CSF-venous fistulas (type 3 leaks) are proven via lateral decubitus dynamic digital subtraction or CT myelography: type 2 leaks are SLEC-positive if the tear is proximal and SLEC-negative if it is distal, and type 3 leaks are always SLEC-negative. Although 30–70% of SIH patients show marked improvement following epidural blood patches applied via various techniques definite cure mostly requires surgical closure of ventral dural tears and surgical ligations of leaking nerve root sleeves associated with meningeal diverticulae or CSF-venous fistulas. For the latter, transvenous embolization with liquid embolic agents via the azygos vein system is a novel and valuable therapeutic alternative.
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Affiliation(s)
- Niklas Luetzen
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64 , 79106, Freiburg, Germany
| | - Philippe Dovi-Akue
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64 , 79106, Freiburg, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Juergen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64 , 79106, Freiburg, Germany.
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10
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D'Antona L, Jaime Merchan MA, Vassiliou A, Watkins LD, Davagnanam I, Toma AK, Matharu MS. Clinical Presentation, Investigation Findings, and Treatment Outcomes of Spontaneous Intracranial Hypotension Syndrome: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:329-337. [PMID: 33393980 PMCID: PMC7783594 DOI: 10.1001/jamaneurol.2020.4799] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Question What are the clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension? Findings This systematic review and meta-analysis of 144 articles provides a summary of the evidence on spontaneous intracranial hypotension and demonstrates that a significant minority of patients may have nonorthostatic headache, normal lumbar punctures, or normal imaging results. Treatment with 1 epidural blood patch is often successful, with large-volume blood patches giving better outcomes. Meaning A diagnosis of spontaneous intracranial hypotension should not be excluded based on the absence of one of its typical features; large epidural blood patches should be attempted if conservative treatment has failed. Importance Spontaneous intracranial hypotension (SIH) is a highly disabling but often misdiagnosed disorder. The best management options for patients with SIH are still uncertain. Objective To provide an objective summary of the available evidence on the clinical presentation, investigations findings, and treatment outcomes for SIH. Data Sources Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline–compliant systematic review and meta-analysis of the literature on SIH. Three databases were searched from inception to April 30, 2020: PubMed/MEDLINE, Embase, and Cochrane. The following search terms were used in each database: spontaneous intracranial hypotension, low CSF syndrome, low CSF pressure syndrome, low CSF volume syndrome, intracranial hypotension, low CSF pressure, low CSF volume, CSF hypovolemia, CSF hypovolaemia, spontaneous spinal CSF leak, spinal CSF leak, and CSF leak syndrome. Study Selection Original studies in English language reporting 10 or more patients with SIH were selected by consensus. Data Extraction and Synthesis Data on clinical presentation, investigations findings, and treatment outcomes were collected and summarized by multiple observers. Random-effect meta-analyses were used to calculate pooled estimates of means and proportions. Main Outcomes and Measures The predetermined main outcomes were the pooled estimate proportions of symptoms of SIH, imaging findings (brain and spinal imaging), and treatment outcomes (conservative, epidural blood patches, and surgical). Results Of 6878 articles, 144 met the selection criteria and reported on average 53 patients with SIH each (range, 10-568 patients). The most common symptoms were orthostatic headache (92% [95% CI, 87%-96%]), nausea (54% [95% CI, 46%-62%]), and neck pain/stiffness (43% [95% CI, 32%-53%]). Brain magnetic resonance imaging was the most sensitive investigation, with diffuse pachymeningeal enhancement identified in 73% (95% CI, 67%-80%) of patients. Brain magnetic resonance imaging findings were normal in 19% (95% CI, 13%-24%) of patients. Spinal neuroimaging identified extradural cerebrospinal fluid in 48% to 76% of patients. Digital subtraction myelography and magnetic resonance myelography with intrathecal gadolinium had high sensitivity in identifying the exact leak site. Lumbar puncture opening pressures were low, normal (60-200 mm H2O), and high in 67% (95% CI, 54%-80%), 32% (95% CI, 20%-44%), and 3% (95% CI, 1%-6%), respectively. Conservative treatment was effective in 28% (95% CI, 18%-37%) of patients and a single epidural blood patch was successful in 64% (95% CI, 56%-72%). Large epidural blood patches (>20 mL) had better success rates than small epidural blood patches (77% [95% CI, 63%-91%] and 66% [95% CI, 55%-77%], respectively). Conclusions and Relevance Spontaneous intracranial hypotension should not be excluded on the basis of a nonorthostatic headache, normal neuroimaging findings, or normal lumbar puncture opening pressure. Despite the heterogeneous nature of the studies available in the literature and the lack of controlled interventional studies, this systematic review offers a comprehensive and objective summary of the evidence on SIH that could be useful in guiding clinical practice and future research.
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Affiliation(s)
- Linda D'Antona
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Melida Andrea Jaime Merchan
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Anna Vassiliou
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Laurence Dale Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Indran Davagnanam
- UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Ahmed Kassem Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Manjit Singh Matharu
- UCL Queen Square Institute of Neurology, London, United Kingdom.,Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Soderlund KA, Mamlouk MD, Shah VN, Roland JL, Dillon WP. Cerebrospinal fluid-lymphatic fistula causing spontaneous intracranial hypotension in a child with kaposiform lymphangiomatosis. Pediatr Radiol 2021; 51:2093-2097. [PMID: 34286352 PMCID: PMC8294238 DOI: 10.1007/s00247-021-05132-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
Spontaneous intracranial hypotension is an uncommon etiology of secondary headaches in children. We report a unique case of a girl with kaposiform lymphangiomatosis who developed postural headaches and imaging features of spontaneous intracranial hypotension without a spinal extradural collection. The girl underwent dynamic computed tomography myelography which revealed a cerebrospinal fluid (CSF)-lymphatic fistula related to a lymphatic malformation associated with the right T10 nerve. She underwent surgical ligation of the CSF-lymphatic fistula, resulting in resolution of the headaches. Spinal CSF-lymphatic fistulas are rare and have previously been reported in two patients with Gorham-Stout disease. The current report suggests that patients with systemic lymphatic anomalies who develop postural headaches should undergo evaluation for spontaneous intracranial hypotension and a CSF-lymphatic fistula. If discovered, surgical ligation is a potential treatment.
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Affiliation(s)
- Karl A Soderlund
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA, 94143, USA.
| | - Mark D Mamlouk
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA, 94143, USA
- Department of Radiology, The Permanente Medical Group, Kaiser Permanente Medical Center, Santa Clara, CA, USA
| | - Vinil N Shah
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA, 94143, USA
| | - Jarod L Roland
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA, 94143, USA
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Fiaschi P, Morana G, Anania P, Rossi A, Consales A, Piatelli G, Cama A, Pavanello M. Tonsillar herniation spectrum: more than just Chiari I. Update and controversies on classification and management. Neurosurg Rev 2019; 43:1473-1492. [DOI: 10.1007/s10143-019-01198-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023]
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13
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Chiari I malformation and altered cerebrospinal fluid dynamics-the highs and the lows. Childs Nerv Syst 2019; 35:1711-1717. [PMID: 31203396 DOI: 10.1007/s00381-019-04233-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This paper reviews the altered cerebrospinal fluid dynamics that can be associated with paediatric Chiari I malformation and we present our own institutional experience. METHODS We conducted a thorough review of the literature and retrospectively analyzed all cases of operatively managed paediatric Chiari 1 malformation at our institution between February 2006 and February 2019. RESULTS Acquired Chiari malformation (ACM) can radiologically mimic Chiari I and has been associated with both intracranial hypotension (either secondary to lumboperitoneal shunting or spontaneous CSF hypotension) and idiopathic intracranial hypertension (IIH). At our institution, 61 paediatric cases (range, 2-15 years) underwent foramen magnum decompression (FMD) for Chiari I malformation. Whilst 80% (50/61) of cases underwent FMD with no preceding or post-operative problems of CSF dynamics, 8% (5/61) of cases had hydrocephalus at initial presentation requiring CSF diversion followed by FMD for persistent Chiari, and 10% (6/61) developed hydrocephalus following FMD and required long-term CSF diversion. CONCLUSIONS In paediatric ACM, the management of intracranial hypotension involves thorough radiological assessment and inclusion/adjustment of a valve in the case of lumboperitoneal shunting or epidural blood patch or interventional techniques in the case of spontaneous CSF leak. Thereby, unwarranted posterior fossa decompression surgery is avoided. In the case of IIH and Chiari I malformation, children who have recurrent symptoms despite adequate posterior fossa decompression surgery (failed Chiari), there is a strong role for intracranial pressure monitoring as raised intracranial pressure may indicate long-term CSF diversion.
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14
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Chan SM, Chodakiewitz YG, Maya MM, Schievink WI, Moser FG. Intracranial Hypotension and Cerebrospinal Fluid Leak. Neuroimaging Clin N Am 2019; 29:213-226. [DOI: 10.1016/j.nic.2019.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Ferrante E, Pontrelli G. Letter to the Editor. Epidural blood patch reversing acquired Chiari malformation due to chronic CSF leak. J Neurosurg Pediatr 2019; 23:531-532. [PMID: 30660110 DOI: 10.3171/2018.10.peds18637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Schievink WI, Maya MM, Jean-Pierre S, Moser FG, Nuño M, Pressman BD. Rebound high-pressure headache after treatment of spontaneous intracranial hypotension: MRV study. Neurol Clin Pract 2019; 9:93-100. [PMID: 31041122 PMCID: PMC6461412 DOI: 10.1212/cpj.0000000000000550] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/25/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rebound high-pressure headaches may complicate treatment of spontaneous intracranial hypotension (SIH), but no comprehensive study of such patients has been reported and little is known about its frequency and risk factors. We therefore studied patients undergoing treatment for SIH and performed magnetic resonance venography (MRV) to assess for cerebral venous sinus stenosis, a risk factor for idiopathic intracranial hypertension. METHODS We studied a consecutive group of patients who underwent treatment for SIH. Rebound high-pressure headache was defined as a reverse orthostatic headache responsive to acetazolamide. MRV was obtained in all patients and lateral sinus stenosis was scored according to the system published by Higgins et al., with 0 being normal and 4 signifying bilateral signal gaps. RESULTS The mean age of the 46 men and 67 women was 45.9 years (range 13-71 years) at the time of onset of SIH. Rebound high-pressure headache was diagnosed in 31 patients (27.4%); 14% of patients with an MRV score of 0, 24% with a score of 1, and 46% with a score of 2 or 3 (p = 0.0092). Also, compared to SIH patients who did not develop rebound high-pressure headaches (n = 82), those with rebound high-pressure headaches were younger, more often female, and more often had an extradural CSF collection on spinal imaging. CONCLUSIONS Rebound high-pressure headache occurs in about one-fourth of patients following treatment of SIH and is more common in those with restriction of cerebral venous outflow.
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Affiliation(s)
- Wouter I Schievink
- Departments of Neurosurgery (WIS, SJ-P) and Imaging (MMM, FGM, BDP), Cedars-Sinai Medical Center, Los Angeles; and Department of Public Health Sciences, Division of Biostatistics (MN), University of California, Davis
| | - M Marcel Maya
- Departments of Neurosurgery (WIS, SJ-P) and Imaging (MMM, FGM, BDP), Cedars-Sinai Medical Center, Los Angeles; and Department of Public Health Sciences, Division of Biostatistics (MN), University of California, Davis
| | - Stacey Jean-Pierre
- Departments of Neurosurgery (WIS, SJ-P) and Imaging (MMM, FGM, BDP), Cedars-Sinai Medical Center, Los Angeles; and Department of Public Health Sciences, Division of Biostatistics (MN), University of California, Davis
| | - Franklin G Moser
- Departments of Neurosurgery (WIS, SJ-P) and Imaging (MMM, FGM, BDP), Cedars-Sinai Medical Center, Los Angeles; and Department of Public Health Sciences, Division of Biostatistics (MN), University of California, Davis
| | - Miriam Nuño
- Departments of Neurosurgery (WIS, SJ-P) and Imaging (MMM, FGM, BDP), Cedars-Sinai Medical Center, Los Angeles; and Department of Public Health Sciences, Division of Biostatistics (MN), University of California, Davis
| | - Barry D Pressman
- Departments of Neurosurgery (WIS, SJ-P) and Imaging (MMM, FGM, BDP), Cedars-Sinai Medical Center, Los Angeles; and Department of Public Health Sciences, Division of Biostatistics (MN), University of California, Davis
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17
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Önal H, Ersen A, Gemici H, Adal E, Güler S, Sander S, Albayram S. Acquired Chiari I Malformation Secondary to Spontaneous Intracranial Hypotension Syndrome and Persistent Hypoglycemia: A Case Report. J Clin Res Pediatr Endocrinol 2018. [PMID: 29513222 PMCID: PMC6280325 DOI: 10.4274/jcrpe.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a rare and potentially serious condition in childhood. Cerebrospinal fluid (CSF) volume depletion is thought to be the main causative feature for intracranial hypotension and results from a spontaneous CSF leak, often at the spine level. SIH is increasingly diagnosed in clinical practice, although it manifests a varied symptomatology. The downward displacement of the brain, sometimes mimicking a Chiari I malformation, has rarely been reported. We present a case of a SIH with Chiari I malformation accompanied by an unusual clinical presentation of persistent hypoglycemia.
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Affiliation(s)
- Hasan Önal
- University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolism, İstanbul, Turkey,* Address for Correspondence: University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolism, İstanbul, Turkey Phone: +90 532 509 29 88 E-mail:
| | - Atilla Ersen
- University of Health Sciences, Okmeydanı Training and Research Hospital, Clinic of Pediatrics, İstanbul, Turkey
| | - Hakan Gemici
- University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatrics, İstanbul, Turkey
| | - Erdal Adal
- University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology and Metabolism, İstanbul, Turkey
| | - Serhat Güler
- Bezmialem Vakıf University Faculty of Medicine, Department of Pediatric Neurology, İstanbul, Turkey
| | - Serdar Sander
- University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Surgery, İstanbul, Turkey
| | - Sait Albayram
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Radiology, İstanbul, Turkey
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18
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Qureshi AI, Kherani D, Waqas MA, Singh B, Raja FM, Wallery SS. Chest Pain as a Manifestation of Intracranial Hypotension: Report of Four Cases. J Emerg Med 2018; 55:e37-e41. [PMID: 29793814 DOI: 10.1016/j.jemermed.2018.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chest pain has not been recognized as a manifestation of intracranial hypotension secondary to cerebrospinal fluid leakage. CASE REPORT We report on 4 patients with intracranial hypotension diagnosed by the pattern of headaches, temporal proximity to dural puncture, magnetic resonance imaging findings, and resolution of symptoms after epidural blood patch who presented with chest pain. The chest pain was episodic, located in the sternal and interscapular region for the first 3 patients, with no radiation to any other region and no clear relationship to exertion. The fourth patient had episodic chest pain located in the subclavicular and suprascapular region. Two patients reported dyspnea with chest pain. Underlying coronary artery ischemia was excluded using a combination of the electrocardiogram and cardiac enzyme assays. The pain resolved after epidural blood patch treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians should be aware of chest pain that can be seen with intracranial hypotension and cerebrospinal leakage to ensure appropriate diagnostic tests and treatment.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota; University of Illinois and Mercyhealth, Rockford, Illinois
| | | | | | | | - Faisal M Raja
- University of Illinois and Mercyhealth, Rockford, Illinois
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19
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Yılmaz TF, Aralasmak A, Toprak H, Kocaman G, Alkan A. Pontine bleeding following drainage of subdural hematoma in craniospinal hypotension. Radiol Case Rep 2018; 13:228-232. [PMID: 29552262 PMCID: PMC5853140 DOI: 10.1016/j.radcr.2017.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/29/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022] Open
Abstract
Craniospinal hypotension is the syndrome of orthostatic headache associated with low cerebrospinal fluid pressure. Imaging findings are usually explained by Monro-Kellie hypothesis stating that the craniospinal compartment is incompressible and any increase in volume of one of the craniospinal constituents (blood, cerebrospinal fluid, and parenchyma) must be compensated by a decrease in volume of another constituent or vice versa. We report a case of craniospinal hypotension in whom drainage of subdural hematoma upon clinical impairments resulted in pontine hemorrhage, supporting Monro-Kellie hypothesis.
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Affiliation(s)
- Temel Fatih Yılmaz
- Department of Radiology, Kars State Hospital, Yenişehir Mahallesi, İsmail Aytemiz Bulvarı, No:55, 36200 Kars, Turkey
| | - Ayse Aralasmak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey, Adnan Menderes Bulvarı, Vatan Caddesi, 34093 Fatih/İstanbul, Turkey
| | - Huseyin Toprak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey, Adnan Menderes Bulvarı, Vatan Caddesi, 34093 Fatih/İstanbul, Turkey
| | - Gulsen Kocaman
- Department of Neurology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Vatan Caddesi, 34093 Fatih/İstanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey, Adnan Menderes Bulvarı, Vatan Caddesi, 34093 Fatih/İstanbul, Turkey
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20
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Schönberger J, Möhlenbruch M, Seitz A, Bußmann C, Bächli H, Kölker S. Chiari-like displacement due to spontaneous intracranial hypotension in an adolescent: Successful treatment by epidural blood patch. Eur J Paediatr Neurol 2017; 21:678-681. [PMID: 28283371 DOI: 10.1016/j.ejpn.2017.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/14/2017] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
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. On spinal MRI, myelographic sequences revealed a large collection of CSF around the first sacral roots. CT myelography proved extensive spinal CSF leakage. Hence, we applied epidural patches at multiple levels. Afterwards, symptoms and radiologic findings, including Chiari-like displacement, completely resolved. CONCLUSION A Chiari-like descent of the cerebellar tonsils alone does not secure the diagnosis of a Chiari I malformation. Especially if other findings indicate spinal CSF leakage, a systematic work-up should be initiated. In most cases, interventional techniques seal the leak successfully, resulting in a favorable outcome.
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Affiliation(s)
- Jan Schönberger
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Klinik Kinderheilkunde I, Sektion für Neuropädiatrie und Stoffwechselmedizin, Germany.
| | - Markus Möhlenbruch
- Universitätsklinikum Heidelberg, Neurologische Klinik, Abteilung für Neuroradiologie, Germany.
| | - Angelika Seitz
- Universitätsklinikum Heidelberg, Neurologische Klinik, Abteilung für Neuroradiologie, Germany.
| | - Cornelia Bußmann
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Klinik Kinderheilkunde I, Sektion für Neuropädiatrie und Stoffwechselmedizin, Germany.
| | - Heidi Bächli
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Germany.
| | - Stefan Kölker
- Universitätsklinikum Heidelberg, Zentrum für Kinder- und Jugendmedizin, Klinik Kinderheilkunde I, Sektion für Neuropädiatrie und Stoffwechselmedizin, Germany.
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21
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Lin JP, Zhang SD, He FF, Liu MJ, Ma XX. The status of diagnosis and treatment to intracranial hypotension, including SIH. J Headache Pain 2017; 18:4. [PMID: 28091819 PMCID: PMC5236046 DOI: 10.1186/s10194-016-0708-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/07/2016] [Indexed: 01/03/2023] Open
Abstract
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. Multiple imaging tests are optional in CSF leakage identification while clinicians are still confronted with difficulties when making selection resulting from superiorities and disadvantages of different imaging tests. Treatments for intracranial hypotension are multifarious but evidence is anecdotal. Values of autologous epidural blood patching (EBP), the mainstay of first-line interventional treatment currently, is getting more and more regards while there are no systematic review of its efficacy and risks. Hereby, the purpose of this review was to reveal the present strategy of intracranial hypotension diagnosis and treatment by reviewing literatures, coupled with our experience in clinical work.
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Affiliation(s)
- Jin-Ping Lin
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - Shu-Dong Zhang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - Fei-Fang He
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China.
| | - Min-Jun Liu
- Department of Anesthesiology & Pain Management, Center for Intracranial Hypotension Management, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
| | - Xiao-Xu Ma
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, #3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China
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22
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Eristavi A, Sabin I. Spontaneous intracranial hypotension caused by cervical CSF fistulae mimicking subarachnoid haemorrhage - a case report. Br J Neurosurg 2016; 31:267-269. [PMID: 27341482 DOI: 10.1080/02688697.2016.1199778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We describe an unusual and rarely documented site of SIH supported by clear radiological evidence: a case of spontaneous cerebrospinal fluid (CSF) fistulae involving the C7 and C8 nerve root sheaths, presenting with sudden onset headache and requiring surgical intervention to seal the leaks. Investigations confirmed the leaks and the typical MRI findings of meningeal enhancement, which were resolved after surgery.
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Affiliation(s)
- Archil Eristavi
- a Department of Neurosurgery , The Wellington Hospital , London , UK
| | - Ian Sabin
- a Department of Neurosurgery , The Wellington Hospital , London , UK
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23
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Chu JK, Miller BA, Bazylewicz MP, Holbrook JF, Chern JJ. Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old. J Neurosurg Pediatr 2016; 17:13-8. [PMID: 26431246 DOI: 10.3171/2015.5.peds15194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.
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Affiliation(s)
| | | | | | - John F Holbrook
- Radiology, Emory University School of Medicine, Atlanta; and
| | - Joshua J Chern
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Georgia
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24
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Nguyen HS, Lozen A, Doan N, Gelsomin M, Shabani S, Maiman D. Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:219-22. [PMID: 26692704 PMCID: PMC4660503 DOI: 10.4103/0974-8237.167887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Dural ectasia is frequently associated with connective tissue disorders or inflammatory conditions. Presentation in a patient without known risk factors is rare. Moreover, the literature regarding the treatment options for symptomatic dural ectasia is controversial, variable, and limited. A 62-year-old female presents with intractable, postural headaches for years. A lumbar puncture revealed opening pressure 3 cm of water. A computed tomography myelogram of the spine demonstrated erosion of her sacrum due to a large lumbosacral dural ectasia. An initial surgery was attempted to reduce the size of the expansile dura, and reconstruct the dorsal sacrum with a titanium plate (Depuy Synthes, Westchester, PA, USA) to prevent recurrence of thecal sac dilatation. Her symptoms initially improved, but shortly thereafter recurred. A second surgery was then undertaken to obliterate the thecal sac distal to the S2 nerve roots. This could not be accomplished through simple ligation of the thecal sac circumferentially as the ventral dura was noted to be incompetent and attempts to develop an extradural tissue plane were unsuccessful. Consequently, an abundance of fibrin glue was injected into the thecal sac distal to S2, and the dural ectasia was marsupialized rostrally, effectively obliterating the distal thecal sac while further reducing the size of the expansile dura. This approach significantly improved her symptoms at 5 months follow-up. Treatment of dural ectasia is not well-defined and has been variable based on the underlying manifestations. We report a rare patient without risk factors who presented with significant lumbosacral dural ectasia. Moreover, we present a novel method to treat postural headaches secondary to dural ectasia, where the thecal sac is obliterated distal to the S2 nerve roots using an abundance of fibrin glue followed by marsupialization of the thecal sac rostally. This method may offer an effective therapy option as it serves to limit the expansile dura, reducing the cerebrospinal fluid sump and the potential for intracranial hypotension.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew Lozen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Gelsomin
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Dennis Maiman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
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25
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Ducros A, Biousse V. Headache arising from idiopathic changes in CSF pressure. Lancet Neurol 2015; 14:655-68. [DOI: 10.1016/s1474-4422(15)00015-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 12/24/2022]
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Intracranial hypotension: clinical presentation, imaging findings, and imaging-guided therapy. Curr Opin Neurol 2015; 27:414-24. [PMID: 24978633 DOI: 10.1097/wco.0000000000000105] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW To illustrate clinical presentations, imaging findings, and diagnostic and therapeutic approaches associated with various conditions of intracranial hypotension. RECENT FINDINGS Intracranial hypotension occurs spontaneously, following (lumbar) dural puncture, accidental dural opening, or excessive surgical cerebrospinal fluid drainage. The typical clinical manifestation - orthostatic headache - may be masqueraded by atypical clinical findings, including coma, frontotemporal dementia, leptomeningeal hemosiderosis-associated symptoms, and others. MRI signs are highly specific, but the imaging strategy to search for spinal cerebrospinal fluid leaks (none, computed tomography myelography, magnetic resonance myelography with gadolinium, digital subtraction myelography) is a matter of debate. The same is true for the mode of treatment (bed rest, blind, fluoroscopy or computed tomography-guided epidural blood patching, fibrin patching, surgery). SUMMARY Clinical presentation as well as diagnostic and therapeutic approaches in intracranial hypotension are very heterogenous.
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27
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Abstract
The specific aim of this review is to report the features of intracranial pressure changes [spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH)] in children and adolescents, with emphasis on the presentation, diagnosis, and treatment modalities. Headache associated with intracranial pressure changes are relatively rare and less known in children and adolescents. SIH is a specific syndrome involving reduced intracranial pressure with orthostatic headache, frequently encountered connective tissue disorders, and a good prognosis with medical management, initial epidural blood patching, and sometimes further interventions may be required. IIH is an uncommon condition in children and different from the disease in adults, not only with respect to clinical features (likely to present with strabismus and stiff neck rather than headache or pulsatile tinnitus) but also different in outcome. Consequently, specific ICP changes of pediatric ages required specific attention both of exact diagnosis and entire management.
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28
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Roos C. Ipotensione intracranica spontanea. Neurologia 2015. [DOI: 10.1016/s1634-7072(14)69822-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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30
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Abstract
In this review article the clinical manifestations, imaging findings, diagnostic and therapeutic approaches for intracranial hypotension are described. The typical manifestation, orthostatic headache, may sometimes be masked by atypical manifestations including coma, frontotemporal dementia and symptoms associated with leptomeningeal hemosiderosis. Spinal and cranial magnetic resonance imaging (MRI) findings are not always unequivocal and the diagnostic and therapeutic approaches are controversially discussed: Searching for the underlying spinal leak(s) of cerebral spinal fluid (CSF) is considered to be unnecessary or done with different modalities, such as computed tomography (CT) myelography, gadolinium-enhanced myelography and digital subtraction myelography. Various treatment approaches including conservative therapy, blind, fluoroscopy-guided and CT-guided epidural blood patches, CT-guided fibrin injection and surgery exist.
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Affiliation(s)
- H Urbach
- Klinik für Neuroradiologie, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland,
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31
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Komazaki Y, Fujiwara T, Ogawa T, Sato M, Suzuki K, Yamagata Z, Moriyama K. Association between malocclusion and headache among 12- to 15-year-old adolescents: a population-based study. Community Dent Oral Epidemiol 2014; 42:572-80. [PMID: 24954448 DOI: 10.1111/cdoe.12111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 05/02/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Headaches are a common problem among adolescents, and malocclusion is a possible risk factor. The purpose of this study was to investigate the association between malocclusion and headache among Japanese adolescents aged 12-15 years using a population-based sample. METHODS A total of 938 adolescents (94.7% of the target population in Koshu City) participated. A modified version of the Index of Orthodontic Treatment Need (IOTN) was used by orthodontists to evaluate occlusal characteristics, and the frequency of headaches (none, rarely, sometimes) was assessed via questionnaire (N = 938). Ordered logistic regression analyses were used to analyze the association between malocclusion and headache. RESULTS The prevalence of malocclusion diagnosed using the modified version of the IOTN was 44.9%. Multiple ordered logistic regression analyses showed that the odds ratio (OR) of having malocclusion for headache was 1.38 (95% confidence interval [CI]: 1.06-1.80), after adjustment for demographics, lifestyle, and dental status including orthodontic treatment history and tooth size. Moreover, among occlusal traits, lower crowding was independently associated with headache (OR: 1.64, 95% CI: 1.07-2.51). CONCLUSIONS We found that malocclusion, especially lower crowding, was associated with headache in a population-based sample of adolescents aged 12-15 years in Japan. Further study is needed to elucidate the mechanisms by which malocclusion affects headache.
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Affiliation(s)
- Yuko Komazaki
- Section of Maxillofacial Orthognathics Department of Maxillofacial Reconstruction and Function, Division of Maxillofacial/Neck Reconstruction, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
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32
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Graff-Radford SB, Schievink WI. High-pressure headaches, low-pressure syndromes, and CSF leaks: diagnosis and management. Headache 2014; 54:394-401. [PMID: 24433511 DOI: 10.1111/head.12283] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Headache resulting from idiopathic intracranial hypertension (IIH) in a population of moderately to obese women of childbearing age. The causes overall remain unclear. With this review, we provide an overview of clinical treatment and management strategies. RESULTS IIH management is dependent on the signs and symptoms presented. Symptomatic treatment should attempt to lower intracranial pressure, reduce pain, and protect the optic nerves. Consideration for lumbar puncture and draining fluid as an option for reducing pressure may be helpful; however, repeated treatment is not usually favored by patients. Traditional prophylactic medications used in migraine may help reduce the primary headache often induced by raised intracranial pressure. We suggested surgical intervention for patients experiencing visual loss or impending visual loss and not responding to medication therapy. CONCLUSION In this review, we discuss headache associated with IIH and spontaneous intracranial hypotension. Much needs to be learned about treatment options for patients with cerebrospinal fluid leaks including methods to strengthen the dura.
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33
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Millichap JG. Spontaneous Intracranial Hypotension. Pediatr Neurol Briefs 2013. [DOI: 10.15844/pedneurbriefs-27-10-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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34
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Novel Neuroimaging Modalities in the Evaluation of Spontaneous Cerebrospinal Fluid Leaks. Curr Neurol Neurosci Rep 2013; 13:358. [DOI: 10.1007/s11910-013-0358-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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