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Acta Neurochir (2010) 152:19971999 DOI 10.1007/s00701-010-0783-6
LETTER TO THE EDITOR
Intracranial spontaneous hypotension associated with CSF cervical leakage successfully treated by lumbar epidural blood patch
Angelo Franzini & Edvin Zekaj & Giuseppe Messina &
Eliana Mea & Giovanni Broggi
Received: 9 August 2010 /Accepted: 17 August 2010 /Published online: 26 August 2010 # Springer-Verlag 2010
Dear Editor,Intracranial hypotension syndrome (IHS) typically presents with postural headache, often associated with one or more of the following symptoms: nausea, vomiting, dizziness, diplopia, photophobia, hearing impairment, neck stiffness, and blurred vision [1].
This condition is secondary to reduction of cerebrospinal fluid (CSF) volume. Most patients with spontaneous IHS have a CSF leak in the spinal dural sac demonstrated by myelographic magnetic resonance (MR) or by isotopic myelography. Some authors have hypothesized that the main causative factor of IHS could be the unbalance between negative spinal epidural pressure and CSF pressure [2].
Magnetic resonance imaging (MRI) of the brain with contrast enhancement is the imaging study of choice for patients suspected of IHS [3]. Characteristic radiologic abnormalities include diffuse thickening of the pachymeninges, contrast enhancement of the pachymeninges, subdural fluid collections or subdural hematomas that are frequently bilateral, and downward displacement of the brainstem and cerebellar tonsils [3, 4]. Computed tomography myelography, spinal MRI, and radionuclide cisternography are the imaging studies used frequently for the localization of the CSF leak site [3, 5].
Treatment of spontaneous IHS begins with bed rest and intravenous fluid administration to restore the depleted CSF volume [3]. Pharmacological therapy includes intravenous or oral caffeine, theophylline, and steroids. In cases refractory to conservative therapy, epidural blood patch (EBP) and/or surgical repair are indicated [6, 7].
We report a patient affected by IHS...