Evaluation of spontaneous intracranial hypotension: assessment on ICP monitoring and radiological imaging.
We describe two recent cases of spontaneous intracranial hypotension. A 38-year-old woman developed a severe postural headache. Magnetic resonance imaging (MRI) showed marked dural enhancement. Histopathological findings of dural biopsy showed numerous dilated vessels in the dura, rather than hypertrophic change. Lumber CSF pressure was 5 cmH2O and RI cisternography suggested CSF leakage. A 58-year-old woman with postural headache and vertigo had bilateral subdural haematoma associated with diffuse dural enhancement on MRI. Lumber CSF monitoring confirmed persistent low pressure ranging from 0-5 cm H2O. MRI myelography revealed multiple CSF pouches along the whole spinal axis. CSF leakage was demonstrated on Radioisotope (RI) cisternography. Both cases described in this report were diagnosed as spontaneous intracranial hypotension caused by CSF leakage from spinal meningeal diverticula and were successfully treated by intravenous Factor XIII administration.
Ishihara
S
S
Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan 359-8513. shopar72@me.ndmc.ac.jp
Fukui
S
S
Otani
N
N
Miyazawa
T
T
Ohnuki
A
A
Kato
H
H
Tsuzuki
N
N
Nawashiro
H
H
Shima
K
K
D000328:Adult; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D004240:Diverticulum / Q000503:physiopathology*; D005176:Factor XIII / Q000627:therapeutic use; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008578:Meninges; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods
D005176:Factor XIII