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Spontaneous Intracranial Hypotension
- Source :
- Dtsch Arztebl Int
- Publication Year :
- 2020
-
Abstract
- Background Spontaneous intracranial hypotension (SIH) is an underdiagnosed disease. Its incidence is estimated at 5 per 100 000 persons per year. Methods This review is based on a selective literature search in PubMed covering the years 2000-2019, as well as on the authors' personal experience. Results The diagnostic and therapeutic methods discussed here are supported by level 4 evidence. SIH is caused by spinal leakage of cerebrospinal fluid (CSF) out of ventral dural tears or nerve root diverticula, or, in 2-5% of cases, through a fistula leading directly into the periradicular veins (CSF-venous fistula). In half of all patients, no CSF leak is demonstrable. A low CSF opening pressure on lumbar puncture is present in only one-third of patients; imaging studies are thus needed to confirm and localize a spinal CSF leak. Half of all patients in whom myelographic computed tomography (CT) reveals contrast medium reaching the epidural space have ventral dural tears, which tend to be located at upper thoracic spinal levels. Epidural blood patches applied under fluoroscopic or CT guidance can seal the CSF leak in 30-70% of patients, but 90% of patients with ventral dural tears will need operative closure. Some patients who have no visible epidural contrast medium on CT presumably do not have SIH, while others do, in fact, have a CSF leak from a diverticulum or a CSF-venous fistula and will need to have the site of the leak demonstrated with the aid of further studies, such as dynamic (subtraction) myelography in the lateral decubitus position. Conclusion The management of patients with SIH calls for complementary imaging studies to demonstrate the causative spinal CSF leak. Often, successful treatment requires surgical closure of the leak. In view of the sparse evidence available to date, controlled studies should be performed.
- Subjects :
- medicine.medical_specialty
Leak
Fistula
Intracranial Hypotension
Contrast Media
Review Article
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Cerebrospinal fluid
medicine
Humans
Myelography
medicine.diagnostic_test
Cerebrospinal Fluid Leak
Lumbar puncture
business.industry
Magnetic resonance imaging
General Medicine
medicine.disease
Magnetic Resonance Imaging
Epidural space
Contrast medium
medicine.anatomical_structure
Radiology
business
Tomography, X-Ray Computed
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18660452
- Volume :
- 117
- Issue :
- 27-28
- Database :
- OpenAIRE
- Journal :
- Deutsches Arzteblatt international
- Accession number :
- edsair.doi.dedup.....19c619011012fd003850f6978c230eed