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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 2018; 9:93-100. [PMID: 31041122 DOI: 10.1212/cpj.0000000000000550] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
ObjectiveTo review our experience with patients with spontaneous intracranial hypotension (SIH) and coma because, although disorders of consciousness may complicate SIH, no comprehensive study of such patients has been reported.MethodsUsing a prospectively maintained registry, we identified all patients with SIH in whom coma developed. Patients or their caregivers/families were contacted for follow-up. Patients were compared to a cohort of patients with SIH without coma.ResultsThe mean age of the 12 men and 3 women with SIH was 56.2 years (range 34–72 years) at the time of onset of coma. In one-third of patients, coma developed after craniotomy for subdural hematomas or for an unrelated intracranial pathology. Imaging showed brain sagging, including bilateral temporal lobe herniation, in all 15 patients and brainstem edema in 8 patients (53%). Overall, coma was reversible in 7 of 15 patients treated with epidural blood patches, in 2 of 4 treated with percutaneous glue injections, and in 6 of 6 treated surgically. Only 1 patient had residual neurologic deficit related to coma (Glasgow Outcome Scale score 4 [moderate disability]). Compared to patients with SIH without coma (n = 568), those with coma were older, more often were male, and more often underwent surgery.ConclusionsComa in SIH is rare, reversible, and invariably associated with brain sagging. Coma due to SIH may be refractory to the usual percutaneous procedures, and surgical closure of the CSF leak may be required to regain consciousness.
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Schievink WI, Maya MM, Barnard ZR, Moser FG, Jean-Pierre S, Waxman AD, Nuño M. Behavioral Variant Frontotemporal Dementia as a Serious Complication of Spontaneous Intracranial Hypotension. Oper Neurosurg (Hagerstown) 2018. [DOI: 10.1093/ons/opy029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
BACKGROUND
Behavioral variant frontotemporal dementia (bvFTD) is a devastating early onset dementia. Symptoms of bvFTD may be caused by spontaneous intracranial hypotension (SIH), a treatable disorder, but no comprehensive study of such patients has been reported.
OBJECTIVE
To describe detailed characteristics of a large cohort of patients with SIH and symptoms of bvFTD.
METHODS
We identified patients with SIH who met clinical criteria for bvFTD. Patients were compared to a cohort of SIH patients without bvFTD.
RESULTS
The mean age for the 21 men and 8 women was 52.9 yr (range, 37–65 yr). All 29 patients with bvFTD symptoms had hypersomnolence. Magnetic resonance imaging showed brain sagging in all patients, cerebrospinal fluid (CSF) opening pressure low in about half of patients, but a spinal CSF leak could not be detected in any patient. All patients underwent epidural blood patching, but 26 patients eventually underwent 1 or more surgical procedures. Overall, a good outcome was obtained in 21 patients (72%); 20 (91%) of 22 patients who had not undergone prior Chiari surgery compared to 1 (14%) of 7 patients who did undergo Chiari surgery (P < .003). Compared to SIH patients without symptoms of bvFTD (n = 547), those with bvFTD symptoms were older, more often male, less often demonstrated CSF leak on spinal imaging, and more often underwent surgery (P < .02).
CONCLUSION
bvFTD in SIH is rare and associated with brain sagging and hypersomnolence. Spinal CSF leaks are rarely detected. bvFTD symptoms are often refractory to the usual percutaneous procedures but most patients can be cured.
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Affiliation(s)
- Wouter I Schievink
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - M Marcel Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary R Barnard
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Franklin G Moser
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stacey Jean-Pierre
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alan D Waxman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Miriam Nuño
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
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Schievink WI, Maya MM, Jean-Pierre S, Nuño M, Prasad RS, Moser FG. A classification system of spontaneous spinal CSF leaks. Neurology 2016; 87:673-9. [DOI: 10.1212/wnl.0000000000002986] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/09/2016] [Indexed: 11/15/2022] Open
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