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Spontaneous Intracranial Hypotension: Recommendations for Management

Published online by Cambridge University Press:  23 September 2014

Farnaz Amoozegar ,
Darryl Guglielmin ,
William Hu ,
Denise Chan  and
Werner J. Becker
Farnaz Amoozegar
Affiliation:
Department of Clinical Neurosciences, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
Darryl Guglielmin
Affiliation:
Department of Anesthesia, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
William Hu
Affiliation:
Department of Diagnostic Imaging, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
Denise Chan
Affiliation:
Department of Diagnostic Imaging, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
Werner J. Becker
Affiliation:
Department of Clinical Neurosciences, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
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Abstract

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A literature search found no clinical trials or guidelines addressing the management of spontaneous intracranial hypotension (SIH). Based on the available literature and expert opinion, we have developed recommendations for the diagnosis and management of SIH. For typical cases, we recommend brain magnetic resonance (MR) imaging with gadolinium to confirm the diagnosis, and conservative measures for up to two weeks. If the patient remains symptomatic, up to three non-directed lumbar epidural blood patches (EBPs) should be considered. If these are unsuccessful, non-invasive MR myelography, radionuclide cisternography, MR myelography with intrathecal gadolinium, or computed tomography with myelography should be used to localize the leak. If the leak is localized, directed EPBs should be considered, followed by fibrin sealant or neurosurgery if necessary. Clinically atypical cases with normal brain MR imaging should be investigated to localize the leak. Directed EBPs can be used if the leak is localized; non-directed EBPs should be used only if there are indirect signs of SIH.

Résumé

RÉSUMÉ

Nous n'avons trouvéucun essai clinique ou ligne directrice sur le traitement de l'hypotension intracrâenne spontané(HIS) lors d'une recherche de la littéture. Nous avons éborées recommandations sur le diagnostic et le traitement de l'HIS fondé sur la littéture disponible et l'avis d'experts. Chez les cas typiques, nous recommandons de procér àne IRM cébrale avec gadolinium pour confirmer le diagnostic et de prescrire un traitement conservateur pour une péode de temps allant jusqu'àeux semaines. Si le patient demeure symptomatique, on devrait envisager de faire jusqu'àrois blood patches édurales lombaires non dirigé. Si ce traitement ne donne pas de réltat, une myégraphie non effractive par rénance magnéque, une cisternographie isotopique, une myégraphie par rénance magnéque avec gadolinium intrathél ou une myégraphie par tomodensitoméie devrait êe effectuéafin de localiser la fuite. Si la fuite est localisé on devrait envisager de faire des blood patches dirigé suivies de l'administration d'un scellant de fibrine ou avoir recours àa neurochirurgie si néssaire. Chez les cas atypiques au point de vue clinique, qui ont une IRM cébrale normale, on devraient essayer de localiser la fuite. Des blood patches dirigé peuvent êe utilisési la fuite est localisé Des blood patches non dirigé ne devraient êe utilisé que s'il y a des signes indirects d'HIS.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue 2 , March 2013 , pp. 144 - 157
Copyright
Copyright © The Canadian Journal of Neurological 2013

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