Clinical features and long-term results of spontaneous intracranial hypotension.
OBJECTIVE
Although spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome, the long-term outcomes have not been established. We conducted a long-term follow-up study to clarify the clinical features and long-term outcomes of patients with this disorder.


METHODS
We performed a retrospective study in 13 consecutive patients with SIH treated between 1998 and 2003. The diagnosis of intracranial hypotension was made on the basis of clinical symptoms, lumbar puncture, radiological studies (e.g. brain magnetic resonance imaging, spine magnetic resonance imaging, computed tomographic myelography) and radionuclide cisternography. We collected follow-up clinical information of the patients by telephone or by examination at an outpatient clinic.


RESULTS
All patients were treated by nonsurgical conservative treatments, such as absolute bed rest, intravenous hydration and repetitive epidural blood patch (5 patients). The mean duration of follow up was 51.4 months (range, 15-80 mo). Among 13 patients included in this study, only one patient (7.7%) developed recurrent SIH, and the other patients improved from orthostatic headache. Although 7 of 13 patients had complete resolution of headache at a minimum of 2 years follow-up, 4 patients had mild headache and 2 patients continued to have moderate headache at the final examination.


CONCLUSIONS
In this series, the outcome of SIH after conservative treatment was not as satisfactory as that reported in previous studies. We conclude that periodic follow-up examinations must be performed and a more effective treatment modality developed to achieve complete resolution of SIH.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Doo-Sik
DS
Kong
Kwan
K
Park
Do Hyun
DH
Nam
Jung-Il
JI
Lee
Jong Soo
JS
Kim
Whan
W
Eoh
Jong Hyun
JH
Kim
D000328:Adult; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies