Spontaneous intracranial hypotension: from cerebral venous thrombosis to neurosurgical treatment: a case series experience from a Brazilian tertiary health care center

Abstract Background  Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complica...

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Veröffentlicht in:Arquivos de neuro-psiquiatria 2023-02, Vol.81 (2), p.128-133
Hauptverfasser: Moreira, Daniel Gabay, Félix, Evandro Penteado Villar, Onishi, Franz Jooji, Ferraz, Henrique Ballalai, Coradine, Tácio Luis Cavalcante, Braga, Vinícius Lopes, Oliveira, Enedina Maria Lobato de
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Sprache:eng
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Zusammenfassung:Abstract Background  Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective  To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods  Review of the medical files of three patients and description of clinical and surgical outcomes. Results  Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed tomography (CT) myelography could determine an identifiable cerebrospinal fluid (CSF) leak in only one patient. One patient received a conservative approach, and the other two were submitted to open surgery with laminoplasty. Both of them had uneventful recovery and remission in surgery follow-up. Conclusion  The diagnosis and management of SIH are still a challenge in neurology practice. We highlight in the present study severe cases of incapacitating SIH, complication with CVT, and good outcomes with neurosurgical treatment.
ISSN:0004-282X
1678-4227
1678-4227
DOI:10.1055/s-0042-1758752