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Journal of Korean Neurosurgical Society 2002;31(6): 558-563. |
| Clinical Analysis of Spontaneous Intracranial Hypotension. |
| Dong Chan Lee, Sin Soo Jeun, Kyeong Sik Ryu, Tae Kyu Lee, Kwan Sung Lee, Byeong Cheol Son, Wong Kil Hong, Chun kun Park, Moon chan Kim, Joon Ki Kang |
| Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. |
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| ABSTRACT |
OBJECTIVE
Spontaneous intracranial hypotension(SIH) is a rare condition presented with cardinal postural headache and low CSF pressure. The authors describe the characteristic clinical features, imaging findings, and treatment methods in the patients with spontaneous intracranial hypotension.
METHODS
Between May 1994 and Aug. 2001, eight patients were diagnosed with spontaneous intracranial hypotension based on characteristic radiologic and clinical findings in our department. All cases were shown diffuse meningeal enhancement(DME) on magnetic resonance(MR) image. Two cases had subdural hematoma.
RESULTS
The most characteristic feature on Brain MR image is DME with/without subdural fluid collection. Radionuclide image reveals direct leaking point and rapid appearance of urinary bladder activity. Direct leaking points were detected in all four cases who performed radioisotope study.
Autologous epidural blood patches were applied to four cases, and all of them were improved without complication.
Among four patients treated with conservative method, three were improved, but one patient was died of spontaneous chronic subdural hematoma.
CONCLUSION
We suggest that 1) meticulous studies need to be performed aggressively if SIH is diagnosed clinically and radiologically, 2) the most effective study may be radioisotope study, and 3) if leaking point is found, aggressive management such as autologous epidural blood patches is recommended. |
| Key Words:
Spontaneous intracranial hypotension; Low pressure symptom; Diffuse meningeal en-hancement; Autologous epidural blood patch |
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