Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak.
BACKGROUND
Spontaneous intracranial hypotension has been considered a rare clinical entity, with less than 75 cases reported in the medical literature. With the advent of magnetic resonance imaging (MRI), spontaneous intracranial hypotension currently is being recognized more frequently. The authors report the neurovisual manifestations of this disorder in a consecutive series of three patients.


METHODS
Each patient underwent clinical examination, computerized visual field testing, and MRI. After treatment, each patient was re-examined, and MRI was repeated.


RESULTS
Two patients had transient visual obscurations and unusual binasal visual field defects on automated perimetry. A third patient had diplopia from an abducens nerve paresis. After treatment of spontaneous intracranial hypotension, these findings improved or resolved.


CONCLUSIONS
This case series, and a review of previously reported cases, indicates that neurovisual problems are common in patients with spontaneous intracranial hypotension. Findings may include diplopia from sixth nerve paresis, transient visual obscurations, blurred vision, visual field defects, photophobia, and nystagmus.
Horton
J C
JC
Department of Ophthalmology, University of California, San Francisco 94143-0730.
Fishman
R A
RA
D000328:Adult; D001921:Brain / Q000473:pathology; D002555:Cerebrospinal Fluid; D015170:Cerebrospinal Fluid Pressure; D004388:Dura Mater; D005128:Eye Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005682:Gadolinium; D006801:Humans; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008588:Meningocele / Q000150:complications*; D009192:Myelography; D013577:Syndrome; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
D005682:Gadolinium