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Don't delay, but don't despair: symptom duration, comorbidity and outcome after closure of spinal cerebrospinal fluid leaks. J Neurol 2024; 271:2776-2786. [PMID: 38409537 PMCID: PMC11055789 DOI: 10.1007/s00415-024-12242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Microsurgical sealing of spinal cerebrospinal fluid (CSF) leaks is a viable treatment option in spontaneous intracranial hypotension (SIH). Several factors may influence the outcome, with symptom duration probably the most modifiable variable. METHODS Patients with closure of spinal CSF leaks between September 2020 and March 2023 and a follow-up period of 6 months were included in this retrospective single-center study. Pre- and postoperative scores for impact of headaches (Headache Impact Test, HIT-6) and quality of life (QoL, EQ-5D-5L) were systematically collected. Multiple regression modelling and subgroup analyses for different symptom durations and comorbidities were performed for these outcomes. RESULTS One hundred patients (61% female, median age 43.5 years) were included. Six months postoperatively, there was significant improvement in headache impact (HIT-6: 66 (IQR 62-69) to 52 (IQR 40-61, p < 0.001) and QoL (EQ-5D-5L VAS: 40 (IQR 30-60) to 79 (IQR 60-90); EQ-5D-5L Index: 0.67 (IQR 0.35-0.8) to 0.91 (IQR 0.8-0.94, p < 0.001, respectively). Subgroup analysis for a symptom duration above (74%) and below 90 days (26%) and comorbidity, as well as multiple regression analysis, revealed a trend in favor of early treatment and lower comorbidity. However, even after a prolonged symptom duration, improvements were significant. CONCLUSION As patients with shorter symptom duration show a trend for a better outcome, our results promote a timely diagnosis and treatment in SIH patients. However, a significant postoperative improvement can still be expected even after a prolonged symptom duration.
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Pearls & Oy-sters: Bibrachial Amyotrophy From a Dural Tear. Neurology 2024; 102:e209256. [PMID: 38484224 DOI: 10.1212/wnl.0000000000209256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/10/2024] [Indexed: 03/19/2024] Open
Abstract
Bibrachial amyotrophy signifies a clinical phenotype characterized by weakness in both upper extremities with preserved strength in the face, neck, and lower extremities. The underlying causes of bibrachial amyotrophy are broad. We report a patient exhibiting bibrachial amyotrophy who initially received a diagnosis of amyotrophic lateral sclerosis (ALS); however, his clinical course and NCS/EMG were atypical for ALS. Further evaluation demonstrated dural tears with CSF leak, resulting in a compressive extradural fluid collection, ventral myelopathy, and intracranial hypotension. Dural tear and ALS have overlapping features, including the manifestation of the bibrachial amyotrophy phenotype and the presence of T2 hyperintensities in the anterior horn cells, recognized by an "owl's eye" appearance on spine MRI. Clinical and radiologic vigilance is required to identify rare cases of dural tear causing ventral myelopathy that manifest as bibrachial amyotrophy.
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Les convulsions post-partum, une complication de la ponction durale et de l’hypotension intracrânienne. CMAJ 2023; 195:E1283-E1286. [PMID: 37748785 PMCID: PMC10519169 DOI: 10.1503/cmaj.230063-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
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4
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Teaching Neuroimages: Dynamic Digital Subtraction Myelography Discloses a Ventral CSF Leak in a Patient with Upper Limb Amyotrophy. Clin Neuroradiol 2023; 33:245-246. [PMID: 36063168 PMCID: PMC10014673 DOI: 10.1007/s00062-022-01210-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/07/2022] [Indexed: 11/25/2022]
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5
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The "hyperdense basivertebral vein" sign: another marker of a CSF-venous fistula. Neuroradiology 2022; 64:627-630. [PMID: 35106631 PMCID: PMC8850216 DOI: 10.1007/s00234-022-02908-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
CSF-venous fistulas — initially described in 2014 — are a significant cause of spontaneous intracranial hypotension. Dynamic lateral decubitus digital subtraction and/or CT myelography typically show a hyperdense paraspinal vein. In case of a central drainage toward the internal vertebral venous plexus, it is the “hyperdense basivertebral vein” which should be searched for carefully.
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Sixth cranial nerve palsy secondary to spontaneous intracranial hypotension complicated by cerebral sinus venous thrombosis: Case report. J Fr Ophtalmol 2021; 45:e23-e24. [PMID: 34801274 DOI: 10.1016/j.jfo.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/07/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
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7
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Letter: Cerebrospinal Fluid-Venous Fistulas: A Systematic Review and Examination of Individual Patient Data. Neurosurgery 2021; 89:E138. [PMID: 33913490 DOI: 10.1093/neuros/nyab152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 11/14/2022] Open
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8
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[Lung cancer with intracranial hypotension: a case report]. ZHONGHUA ZHONG LIU ZA ZHI [CHINESE JOURNAL OF ONCOLOGY] 2020; 42:971-972. [PMID: 33256311 DOI: 10.3760/cma.j.cn112152-20190406-00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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9
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Lumbar drains: Practical understanding and application for the otolaryngologist. Am J Otolaryngol 2020; 41:102740. [PMID: 32979671 DOI: 10.1016/j.amjoto.2020.102740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Lumbar drains are frequently used in patients with otolaryngologic concerns. These can be used therapeutically or prophylactically with the primary purpose being to modulate CSF pressure. Within otolaryngology, lumbar drains are most frequently used for cerebrospinal fluid leaks - either due to cerebrospinal fluid fistulas or in skull base surgery as these allow for potential healing of the defect. While not typically placed by otolaryngologists, a basic understanding of lumbar drains is beneficial in the context of patient management. MANAGEMENT A lumbar drain is inserted into the intrathecal space in a patient's lumbar spine. Though considered to be a benign procedure, complications are relatively frequent, and adjustment or replacement of the drain may be required. Complications include infection, epidural bleeding, retained hardware, sequelae of relative immobility, or may relate to over-drainage, ranging from mild headache to cranial neuropathies, altered mental status, pneumocephalus, intracranial hemorrhage, and death. While in place, neurologic exams should be performed routinely and should include motor and sensory exams of the lower extremities. A patient should be monitored for fevers, nuchal rigidity, and other signs of infection or meningitis. The CSF fluid should be grossly examined to identify changes, but routine laboratory tests are not typically run on the fluid itself. Drainage rates will vary usually between 5 and 20 mL per hour and must be frequently reassessed and adjusted based upon signs of intracranial hypotension. Drains should be removed when appropriate and should not be left in more than 5 days due to the increased infectious risk. CONCLUSION Lumbar drains are important tools used in patients with otolaryngologic pathologies. Otolaryngologists and otolaryngology residents should be familiar with these catheters to determine if they are working correctly and to identify adverse effects as early as possible.
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In vivo detection of venous sinus distension due to intracranial hypotension in small animal using pulsed-laser-diode photoacoustic tomography. JOURNAL OF BIOPHOTONICS 2020; 13:e201960162. [PMID: 32030895 DOI: 10.1002/jbio.201960162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/18/2019] [Accepted: 02/01/2020] [Indexed: 05/24/2023]
Abstract
Intracranial hypotension (IH) is a pathophysiological condition of reduced intracranial pressure caused by low cerebrospinal fluid (CSF) volume due to dural injuries from lumbar puncture, surgery, or trauma. Understanding the prognosis of IH in small animal models is important to gain insights on the complications associated with it such as orthostatic headache, cerebral venous thrombosis, coma, and so forth. Photoacoustic tomography (PAT) offers a novel and cost-effective way to perceive and detect IH in small animal models. In this study, a pulsed laser diode (PLD)-based PAT imaging system was used to examine the changes in the venous sinuses of the rat brain due to IH, induced through CSF extraction. After the CSF extraction, an increase in the sagittal sinus area by ~30% and width by 40% ± 5% was observed. These results provide supportive evidence that the PLD-PAT can be employed for detecting changes in sagittal sinus due to IH in rat model.
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Ventral Displacement of Spinal Cord in Spontaneous Intracranial Hypotension: A Sign Easily Be Overlooked. ACTA NEUROLOGICA TAIWANICA 2020; 29(2):59-63. [PMID: 32436204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Spontaneous intracranial hypotension (SIH) is suspected in patients presenting orthostatic headache and needs excluding structural or iatrogenic causes. Image studies are required to confirm the diagnosis and define exact locations of cerebrospinal fluid leakage, but currently there is no single study sensitive enough to make identifications among patients with various symptoms. CASE REPORT We present a 24-year-old young woman having acute orthostatic headache. She denied having previous headache, head trauma, or neuraxial procedures like lumbar punctures. Brain magnetic resonance image (MRI) with gadolinium enhancement reported normal findings on arrival. She received conservative treatment including analgesics and aggressive intravenous hydration, but her headache improved little. Whole spine MRI with gadolinium enhancement revealed no obvious leakage of cerebrospinal fluid but typical dilated epidural veins with ventral displacement of her thoracic spinal cord. After autologous epidural blood patches therapy, her headache relieved completely. CONCLUSION We review the typical and uncommon findings of spinal MRI in SIH, which is more sensitive than brain MRI in acute stages. Spinal MRI offers the diagnostic value in SIH especially when cranial images do not respond in time.
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Regarding "the Interpeduncular Angle: A Practical and Objective Marker for the Detection and Diagnosis of Intracranial Hypotension on Brain MRI". AJNR Am J Neuroradiol 2020; 41:E2. [PMID: 31924608 DOI: 10.3174/ajnr.a6388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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13
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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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14
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[Spontaneous intracranial hypotension: 12 case reports and follow-up]. ZHONGHUA YI XUE ZA ZHI 2016; 96:2625-2628. [PMID: 27666881 DOI: 10.3760/cma.j.issn.0376-2491.2016.33.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective: To investigate the pathogenesis, clinical presentation, imaging features and prognosis of spontaneous intracranial hypotension. Methods: Clinical manifestation and imaging changes of 12 patients with spontaneous intracranial hypotension were reported. They were followed up regularly. The clinical and neuroimaging characteristics were summarized. Results: All the 12 cases were adults, presenting with orthostatic headache. They all recovered with conservative therapy. Head MRI demonstrated cerebral lobe hemorrhage, subdural hematoma, pituitary hyperemia, subarachnoid hemorrhage, enhancement of the pachymeninges, sagging of the brain, etc. Conclusions: Spontaneous intracranial hypotension is characterized by orthostatic headaches and is associated with compensatory changes following loss of CSF volume. The long-time prognosis is not bad.
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Successful steroid treatment of coma induced by severe spontaneous intracranial hypotension. NAGOYA JOURNAL OF MEDICAL SCIENCE 2016; 78:229-36. [PMID: 27303109 PMCID: PMC4885822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/24/2016] [Indexed: 11/21/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is a syndrome characterized by low cerebrospinal fluid (CSF) pressure and postural headaches. It is a rare condition which may sometimes present with severe symptoms such as stupor or coma. The standard treatment protocol includes conservative measures such as bed rest, hydration, and steroids. However, severe cases may require invasive measures such as epidural blood patch (EBP), continuous epidural saline infusion, epidural fibrin glue, or surgical repair of the dural defect. In this report, we describe a case of severe SIH resulting in coma that exhibited dramatic improvement on intravenous administration of steroids. This is the first report of severe SIH causing coma that was treated non-invasively by steroids only.
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Not everything that worsens on standing is intracranial hypotension! Acta Neurol Belg 2015; 115:481-3. [PMID: 25287820 DOI: 10.1007/s13760-014-0371-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
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17
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Treating dural metastases mimicking intracranial hypotension. THE JOURNAL OF SUPPORTIVE ONCOLOGY 2007; 5:423-424. [PMID: 18019849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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18
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Proceedings from the 12th International Symposium on Intracranial Pressure and Brain Monitoring, 16-21 August 2004, Hong Kong, China. ACTA NEUROCHIRURGICA. SUPPLEMENT 2005; 95:1-480. [PMID: 16514759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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19
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Abstract
Of 58 consecutive patients with spontaneous CSF leaks, nine exhibited features of connective tissue disorder. One had Marfan's syndrome. Five additional patients had hyperflexible joints, of whom four had arachnodactyly, four were tall and slender, two had hyperextensible skin, and one had a strong family history of abdominal aorta aneurysms. Retinal detachment at a young age was noted in two. One patient had bilateral carotid dissections. A dural weakness may predispose patients to spontaneous CSF leak.
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[A case of spontaneous intracranial hypotension with simultaneous CSF leaks at the upper and lower thoracic levels]. Rinsho Shinkeigaku 2001; 41:775-9. [PMID: 12080608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We presented a patient of spontaneous intracranial hypotension (SIH), in which radionuclide cisternography demonstrated multiple CSF leaks. A 51-year-old previously healthy woman awoke with a severe headache and nausea that were almost completely relieved by lying flat (day 1). The headache was not relieved by analgesics. On day 10, she visited our clinic. Neurological examination showed no abnormalities. A lumbar puncture revealed an opening pressure of 50 mmH2O, protein level of 64 mg/dl, 21 erythrocytes 21/microliter, and 4 lymphocytes/microliter. Cranial MRI on day 11 with gadolinium infusion demonstrated diffuse thickening and enhancement of the meninges. No signs of venous sinus thrombosis were identified. There was no downward displacement of the cerebellar tonsils. Indium-111 radionuclide cisternography demonstrated early accumulation of the tracer in the urinary bladder and CSF leakage at the upper thoracic level on the left side, at the lower thoracic level on both sides, and at the lumbar level. It is noteworthy that the scintigram taken 4 hours after tracer injection demonstrated CSF leakage at the injection site but not in the upper thoracic area. The patient kept sitting for about 20 minutes just before the images were obtained. Spinal MRI did not show meningeal diverticulum and epidural fluid collection. Ten days of bed-rest and transfusion failed to relieve the headache. Epidural patching with 7 ml of autologous blood performed at the Th2/3 interspace partially relieved the headache. Five days later, a second epidural patching was performed at Th11/12, which was slightly effective. A third epidural patching at L3/4 was ineffective. On day 32, a fourth epidural patching was performed at Th1/2 while the patient was lying down on her left side. The postural headache disappeared. Repeated cranial MRI with gadolinium infusion performed on day 47 showed resolution of the abnormal findings. To our knowledge, this is the second case report of SIH with double CSF leaks. To localize multiple leaks, radionuclide cisternography should be performed with a patient in various positions just before images are obtained.
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[On intracranial orthostatic hypotension]. RINSHO GANKA. JAPANESE JOURNAL OF CLINICAL OPHTHALMOLOGY 1961; 15:883-7. [PMID: 14474828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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23
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[Critique of heroic methods of inducing intracranial hypotension]. AGRESSOLOGIE: REVUE INTERNATIONALE DE PHYSIO-BIOLOGIE ET DE PHARMACOLOGIE APPLIQUEES AUX EFFETS DE L'AGRESSION 1960; 1:139-50. [PMID: 13807200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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24
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[Primary intracranial hypotension (Idiopathic hypoliquorrachia)]. Minerva Med 1960; 51:1091-6. [PMID: 13822535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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25
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[Significance of intracranial hypotension in general practice]. MEDICINSKI ARHIV 1959; 12:23-8. [PMID: 14411963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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26
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[Possibility of intracranial hypotension in the acute stage of closed cerebral trauma]. VOPROSY NEIROKHIRURGII 1956; 20:17-21. [PMID: 13325410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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27
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[ Intracranial hypotension after Torkildsen's operation]. REVISTA ESPANOLA DE OTO-NEURO-OFTALMOLOGIA Y NEUROCIRUGIA 1955; 14:287-9. [PMID: 13290244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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[ Intracranial hypotension and its treatment]. WIENER ZEITSCHRIFT FUR NERVENHEILKUNDE UND DEREN GRENZGEBIETE 1955; 12:171-9. [PMID: 13300111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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[Post-traumatic intracranial hypotension]. SISTEMA NERVOSO 1954; 6:384-95. [PMID: 14373071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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31
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[ Intracranial hypotension]. NEUROLOGIE A PSYCHIATRIE CESKOSLOVENSKA 1954; 17:257-64. [PMID: 14370357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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[Fat embolism of the brain and its possible effect on intracranial hypotension]. NEUROLOGIA, NEUROCHIRURGIA I PSYCHIATRIA POLSKA 1954; 4:501-10. [PMID: 14356317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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[So-called essential intracranial hypotension]. NEUROLOGIA, NEUROCHIRURGIA I PSYCHIATRIA POLSKA 1954; 4:173-9. [PMID: 13223926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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36
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37
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[ Intracranial hypotension and hypertension]. LA RIFORMA MEDICA 1952; 66:1057-8. [PMID: 13004760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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38
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[On subdural hematomas; intracranial hypotension]. HELVETICA CHIRURGICA ACTA 1951; 18:315-21. [PMID: 14897303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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39
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[ Intracranial hypotension, 23 case reports; on the pathogenesis of hypotensive states]. SCHWEIZERISCHE MEDIZINISCHE WOCHENSCHRIFT 1951; 81:326-30. [PMID: 14865974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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40
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[ Intracranial hypotension]. JOURNAL DES PRATICIENS; REVUE GENERALE DE CLINIQUE ET DE THERAPEUTIQUE 1950; 64:625-7. [PMID: 14825261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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41
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42
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[ Intracranial hypotension]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 1950; 94:1911-7. [PMID: 15439400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Discussion on intracranial hypotension. Proc R Soc Med 1948; 41:771-776. [PMID: 18105188 PMCID: PMC2184697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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