October 2013

Introduction

Intracranial Hypotension: Diagnosis and Treatment

Jeffrey Ross

Jeffrey Ross

The Agony of Aliquorrhea

Intracranial hypotension can occur in a variety of clinical settings and can be grouped by primary or secondary etiologies. We are generally quite familiar with the secondary type of intracranial hypotension, related to prior cranial or spinal surgery, trauma, or prior lumbar puncture, as a cause of postural headache. The primary form (aka spontaneous intracranial hypotension) has now received … more »

Spine

Gadolinium-Enhanced MR Cisternography to Evaluate Dural Leaks in Intracranial Hypotension Syndrome

Sait Albayram

Sait Albayram

I first met one of the patients with intracranial hypotension syndrome at Johns Hopkins Hospital during my neuroradiology research fellowship in 2000. Later on, in 2002, this case was published in AJNR.1

After finishing my research fellowship, in my clinical practice, I realized that intracranial hypotension is not a rare syndrome. There were only 40 papers in the literature in 2000, but … more »

Spine

CT Myelography for the Planning and Guidance of Targeted Epidural Blood Patches in Patients with Persistent Spinal CSF Leakage

Christina Wendl

Christina Wendl

Intracranial hypotension is a rare cause of persistent headache originating mostly from a dural CSF leak. Conservative treatment serves as first-line therapy, but if it fails, a minimally invasive epidural blood patch (EBP) can lead to successful sealing of such a leak. The usual treatment is a blind EBP at the lumbar level.

MRI of the brain is used routinely to diagnose … more »

Head & Neck

Diagnostic Criteria for Spontaneous Spinal CSF Leaks and Intracranial Hypotension

Wouter I. Schievink

Wouter I. Schievink

I saw my first patient with spontaneous intracranial hypotension in 1991 when I was a neurosurgery resident: A 22-year-old exotic dancer had been suffering with headaches for 6 weeks after a minor brawl, and she had seen a multitude of physicians. However, her head CT was normal, and no cause for the headaches was established until she saw Dr. … more »

Spine

Diagnostic Value of Spinal MR Imaging in Spontaneous Intracranial Hypotension Syndrome

Arata Watanabe

Arata Watanabe

When we did our research, the findings of brain MRI had already been accumulated. However, we believed that the findings of spinal MRI should be more direct. Spontaneous intracranial hypotension (SIH) is a disease caused by CSF leakage from the spinal dural sac. When diagnosing SIH, combining spinal and brain MRI is more precise than brain MRI alone, and some patients … more »

Spine

CT-Guided Epidural Blood Patching of Directly Observed or Potential Leak Sites for the Targeted Treatment of Spontaneous Intracranial Hypotension

Peter G. Kranz

Peter G. Kranz

Try to imagine how your life would be impacted if you were suddenly completely unable to sit up or stand at all without suffering a crushing, debilitating headache. This is the reality for many patients who suffer from spontaneous intracranial hypotension (SIH). SIH is a disease that has become much more widely recognized over the past decade, and substantial … more »

Spine

When Should I Do Dynamic CT Myelography? Predicting Fast Spinal CSF Leaks in Patients with Spontaneous Intracranial Hypotension

Patrick H. Luetmer

Patrick H. Luetmer

My initial interest in spontaneous intracranial hypotension (SIH) and localization of CSF leaks began over 10 years ago. The early work of my colleagues Drs. Gary Miller, Bahram Mokri, and David Piepgras served to increase clinical awareness and MRI recognition of SIH. We began to accrue a cohort of patients who had chronic debilitating symptoms of SIH, were unresponsive to … more »

Brain

The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the Brain

Richard I. Farb

Richard I. Farb

Gadolinium-enhanced MR venography has provided neuroradiologists with the ability to visualize the effect that altered intracranial pressure (ICP) has on the appearance of the dural venous sinuses. Specifically, the dural sinuses appear mildly compressed when ICP is elevated and will distend when ICP is abnormally low. This changing contour of the dural sinuses has been shown to be a … more »