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Spontaneous Intracranial Hypotension: Case Series of Rare Clinical Presentations

Published online by Cambridge University Press:  02 December 2014

N. Chaudhary ,
P. Cooper ,
S.P. Lownie ,
W. Ng  and
N. Duggal
N. Chaudhary
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
P. Cooper
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Division of Neurology, London Health Sciences Center, London, Ontario, Canada
S.P. Lownie
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
W. Ng
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
N. Duggal*
Affiliation:
Division of Neurosurgery, London Health Sciences Center, London, Ontario, Canada Clinical Neurological Sciences, London Health Sciences Center, London, Ontario, Canada
*
Division of Neurosurgery, University Hospital, London Health Sciences Center, 339 Windermere Rd, London, Ontario, N6A 5A5, Canada
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Abstract:

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Background:

Spontaneous intracranial hypotension (SIH) is an increasingly described entity, with over 70 cases reported in the literature. The classic triad includes orthostatic headache, diffuse pachymeningeal enhancement on magnetic resonance imaging (MRI) with gadolinium, and low cerebrospinal fluid pressure (CSF) in the lateral decubitus (<60 mm H2O) and sitting positions.

Method:

We present four rare clinical presentations of SIH, two of which have not been previously described in the literature, to the best of our knowledge.

Results:

Patient 1 presented with dyspnea, dysphagia, bilateral ptosis, diplopia and seizures. Patient 2 presented with a paradoxical positional pattern of orthostatic hypotension. In Patient 3, bilateral subdural hematomas (SDH) were encountered; while in Patient 4, a recurrent unilateral SDH requiring multiple surgical interventions was demonstrated.

Conclusion:

Although uncommon clinical presentations, all four cases of intracranial hypotension were spontaneous, demonstrated diagnostic MRI findings, and responded favorably to blood patches or saline injections.

Résumé:

Résumé:Contexte:

L'hypotension intracrânienne spontanée (HIS) est une entité décrite de plus en plus fréquemment dont il existe plus de 70 cas dans la littérature. La triade classique comprend la céphalée orthostatique, un rehaussement pachyméningé à l'imagerie par résonance magnétique (IRM) avec gadolinium et une pression du liquide céphalorachidien basse en décubitus latéral (< 60 mm H2O) et en position assise.

Méthode:

Nous présentons les observations de quatre patients atteints de HIS dont le mode de présentation est rare. À notre connaissance, deux de ces modes de présentation n'ont jamais été décrits dans la littérature.

Résultats:

Le premier patient a consulté pour dyspnée, dysphagie, ptose bilatérale, diplopie et convulsions. Le deuxième patient a consulté pour une hypotension orthostatique dont la modalité positionnelle était paradoxale. Le troisième patient était porteur d'hématomes sous-duraux (HSD) bilatéraux et le quatrième patient présentait un HSD unilatéral récurrent nécessitant plusieurs chirurgies.

Conclusion:

Bien que ces tableaux cliniques soient peu fréquents, ces quatre cas d'hypotension intracrânienne étaient spontanés, avaient des observations à l'IRM qui étaient diagnostiques et ont répondu favorablement à des “blood patches” ou à des injections de solution physiologique.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 54 - 58
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

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