Spontaneous Intracranial Hypotension

Cho,  Gyu Chong; Kim,  Won; Choi,  Ok Kyoung; Lim,  Kyoung Soo

J Korean Soc Emerg Med > Volume 10(4); 1999 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1999;10(4): 628-635.

Spontaneous Intracranial Hypotension

Gyu Chong Cho, Won Kim, Ok Kyoung Choi, Kyoung Soo Lim

ABSTRACT

BACKGROUNDS: Headache is one of the common symptoms complained by patients at the emergency department. Postural headache is the characteristic symptom that is aggravated at upright position and relieved at recumbent position. This postural headache is associated with low cerebrospinal fluid (CSF) pressure. Spontaneous intracranial hypotension(SIH) is an unusual syndrome of postural headache and low CSF pressure without a precipitating event. The diagnosis of SIH is confirmed by 60mmH2O or less CSF opening pressure on lumbar puncture. However, the cases of SIH with normal CSF opening pressure have been reported. so it is needed to complement the diagnostic criteria of SIH.
METHODS:
A retrospective descriptive study with reviewing medical records of 10 patients who had been admitted at Asan Medical Center from Apr. 1995 to Jul. 1999 was done. Analyses were done on 22 variables of age, sex, clinical symptoms, spinal analysis findings, radiologic findings and therapeutic modality. Fisher's exact test and Mann-Whitney test were applied for statistical analysis (p-value < 0.05).
RESULTS:
1. The male to female ratio was 3 : 7, and the mean age was 37.30+/-5.96 years. 2. Postural headache was characteristic symptom & complained by all patients. 3. The mean CSF pressure was 22.8+/-30.8 mmH2O. 4. Brain MRI demonstrated the pachymeningeal enhancement in all patients. 5. Radioisotope cisternography demonstrated slow ascent of tracer to the cerebral convexity in 88.9% patients, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer in 66.7% patients, respectively. 6. 90.0% of all patients were recovered with autologous epidural blood patches, and 10.0% were recovered with conservative management.
CONCLUSION:
The SIH is an unusual syndrome. but we can diagnose the SIH in the patient, complains of a postural headache, if any following two or more criteria are present. 1. 60mmH2O or less CSF opening pressure on lumbar puncture. 2. Brain MRI finding : the pachymeningeal enhancement. 3. Cisternography findings : slow ascent of tracer to the cerebral convexity, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer.