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The Relationship Between the Myovertebral Structures and Idiopathic Cerebrospinal Fluid Leaks in Whiplash Injuries. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vukovic‐Cvetkovic V, Schytz HW. Airplane flights triggering spontaneous intracranial hypotension: Observations from the Danish headache centre. Acta Neurol Scand 2022; 146:92-98. [PMID: 35502151 PMCID: PMC9321836 DOI: 10.1111/ane.13626] [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: 01/17/2022] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022]
Abstract
Objective Spontaneous intracranial hypotension (SIH) manifests as orthostatic headache, which can be confirmed by radiological signs of low intracranial pressure on magnetic resonance imaging of the brain. The most common mechanisms of SIH are ruptured meningeal diverticula, ventral dural tears and CSF‐venous fistulas. SIH is associated with connective tissue disorders, and cases of SIH onset after trivial trauma have been reported. As SIH is often underdiagnosed, the aim of this study is to identify possible new risk factors of SIH onset in a case series of SIH patients. Materials and methods We retrospectively reviewed the medical records of 36 patients diagnosed with SIH. We reviewed and identified potential factors that led to or presented at headache onset in SIH patients. Results We identified 4/36 (11%) patients that had a close temporal relationship between the onset of SIH symptoms and airplane travel. In all four patients, the clinical and imaging features confirmed the diagnosis of SIH. Conclusion This is the first report of a case series of four patients with SIH that could be related to airplane travel. Describing four cases (11%) is not proof but should alert us to a possible causal relationship, which calls for further research. We suggest that when taking medical history, thorough details about the patient's activities, such as headache onset, should be documented because of their importance in correctly diagnosing SIH, which is a debilitating, yet treatable, disease.
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Affiliation(s)
| | - Henrik W. Schytz
- Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Copenhagen Denmark
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Schievink WI, Maya MM, Moser F, Prasad R, Wadhwa V, Cruz R, Nuño M. Multiple Spinal CSF Leaks in Spontaneous Intracranial Hypotension: Do They Exist? Neurol Clin Pract 2021; 11:e691-e697. [PMID: 34840885 DOI: 10.1212/cpj.0000000000001084] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Objective To determine the frequency of multiple spinal CSF leaks in a recent group of patients with spontaneous intracranial hypotension (SIH) who were investigated with digital subtraction myelography (DSM). Methods This observational study was conducted using data from a prospectively maintained data base of patients who meet the International Classification of Headache Disorders, third edition, criteria for SIH. The patient population consisted of a consecutive group of 745 patients with SIH who underwent DSM between March 2009 and February 2020. Based on the results of DSM, participants were classified according to the type and number of spinal CSF leaks. Results Among 398 patients with SIH and extradural CSF on spinal imaging, multiplicity of CSF leaks was observed in none of 291 patients with type 1a ventral leaks and in 4 (6.2%) of 65 patients with type 1b (postero-) lateral leaks. Among 97 patients with SIH from spinal CSF-venous fistulas (type 3 leaks) who did not have extradural CSF on spinal imaging, 9 patients (9.3%) had multiple fistulas (p < 0.0001 for comparison between groups). Type 3 and type 1a or 1b CSF leaks coexisted in an additional 5 patients. Conclusions Among patients with SIH, multiplicity of CSF leaks was observed radiographically in none of the patients with ventral leaks, in 6% of patients with lateral leaks, and in 9% of patients with CSF-venous fistulas. These results suggest that patients with SIH can be reassured that the occurrence of multiple CSF leaks is negligible to uncommon at most, depending on the type of CSF leak.
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Affiliation(s)
- Wouter I Schievink
- Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis
| | - M Marcel Maya
- Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis
| | - Franklin Moser
- Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis
| | - Ravi Prasad
- Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis
| | - Vikram Wadhwa
- Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis
| | - Rachelle Cruz
- Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis
| | - Miriam Nuño
- Department of Neurosurgery (WIS, RBC) and Department of Imaging (MM, FGM, RSP, VSW), Cedars-Sinai Medical Center, Los Angeles, CA; and Department of Public Health Sciences (MN), University of California, Davis
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Kitagawa T, Ohtonari T, Muroya Y, Miyachi H, Yamamoto J. Impact of dural hypoplasia in a patient with spontaneous cerebrospinal fluid leak at atlantoaxial level. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101034] [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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Ohtonari T, Noguchi S, Nishihara N. Acute-Phase Intraoperative Findings of Traumatic Spinal Cerebrospinal Fluid Leakage. World Neurosurg 2021; 148:90-92. [PMID: 33476775 DOI: 10.1016/j.wneu.2021.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
The acute-stage intraoperative findings of the spinal dural laceration in patients with traumatic cerebrospinal fluid (CSF) leakage have not been clearly revealed so far. Herein, we report an interesting case of traumatic CSF leakage in a patient who underwent acute-stage direct closure for a dural laceration similar to a stab at the C1/2 level. Because a 41-year-old man strongly twisted his neck, he had a typical orthostatic headache. Whole-spine T2 fat-saturated magnetic resonance imaging and computed tomographic myelography were examined, and fluid collection between the intrathecal site and epidural dorsal space, including soft tissue, was confirmed as a direct CSF leakage at the C1/2 level. Direct surgical closure was performed 13 days after the onset of symptoms, and dural laceration with sharp edges was detected on the right side at the C1/2 level. The laceration was sutured and coated with dural sealant. Finally, the patient's orthostatic headache was relieved completely after the operation.
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Affiliation(s)
- Tatsuya Ohtonari
- Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
| | - Shohei Noguchi
- Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan; Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Nobuharu Nishihara
- Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
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