The Clinical And Imaging Characteristics Of Spontaneous Intracranial Hypotension

Objective: To retrospectively investigate the clinical presentations andneuroimaging findings in patients with spontaneous intracranial hypotension(SIH), and to summarize the diagnosis and treatment strategy.Methods: A retrospective review of36patients with SIH was carriedout. We analyzed their clinical and neuroimaging presentations, results ofcerebral spinal fluid (CSF), and summarize the diagnosis and treatmentstrategy based on literatures review. The relation between MRI abnormalityand course of SIH patients is unclear. According to whether has evidence oflow CSF pressure on brain MRI, patients were divided into two groups. Weexplored whether the time of performed MRI determine the presence of MRIabnormality. IBM SPSS Statistics19.0for Windows was used for statisticalanalysis. Means were compared using t-test.Results: Twenty-four females and twelve males were enrolled, theratio of male/female (M/F) was1:2, and the mean age was39±12.8y (Range:14-68years). Typical postural headache was found in all the36patients, itcould happen on frontal, temporal, top and occipital regions, the characterwas almost bursting pain. Concomitant symptoms included nausea， vomiting，dizziness，interscapular pain and neck pain/stiffness, tinnitus，blurred vision, diplopia，eye strain, consciousness disturbance and so on.Signs:17patients with Neck resistance,1patient with abducens palsy.33patients had low CSF pressure，which was below60mmH2O or CSF drop<25droplets/min, among who CSF pressure could not be detected in15cases. High CSF protein was in13patients，11had increased CSF white cellsand4red cells.25patients were performed by brain MRI, abnormalitiessuch as enhancement of meninges, subdural fluid collection, ventriclenarrowed and brain displacement, were discovered in9patients. The presentstudy had shown that patients with brain MRI abnormality had a longer timeinterval from headache onset to MRI examination compared with patientswithout（26.2±19.8vs.11.9±10.5, P<0.025）. Spinal MRI documentedepidural fluid collection in3patients. After conservative treatment, exceptautologous epidural blood patching was performed in3patients and surgicalevacuation of the subdural hematoma in2cases. All patients experiencedrelief of symptoms. In predicting clinical outcome, none of diagnostic toolsor treatment methods displayed obvious superiority.Conclusions: SIH is often caused by Cerebrospinal fluid leaks. Clinicalpresentations in SIH are variable with the typical symptom being orthostaticheadache, CSF pressure <60mmH2O, the characteristic presention of brainMRI are SEEPS: subdural fluid collection, enhancement of meninges,engorgement of venous structures，pituitary hyperemia and sagging of brain. Spinal MRI is useful for diagnosis of SIH. Autologous epidural bloodpatching is considered to be the best choice for patients with SIH. Cliniciansshould be systematic in planning a diagnosis and treatment method forpatients with SIH, and make early diagnosis and treatment.