title: Clinical experiences with spontaneous intracranial hypotension: a proposal of a diagnostic approach and treatment.
abstract: OBJECTIVE
  We analyzed our clinical experience with patients with intracranial hypotension and developed a strategic model for the diagnosis mainly using Radioisotope (RI) cisternography and treatment of spontaneous intracranial hypotension (SIH).
  
  
  METHODS
  We retrospectively analyzed our clinical experiences with 30 cases of SIH from January 2000 through December 2006. All patients had confirmed by magnetic resonance image (MRI). RI cisternography or computed-tomography (CT) myelography was done for disclosing a cerebrospinal fluid leakage point. Initially patients were treated with medication. When patients complained of persistent headache, we performed epidural blood patch (EBP) administration. We performed subdural hematoma evacuation when it grew or worsened neurological status.
  
  
  RESULTS
  Twenty-one women (70%) and 9 men (30%) were enrolled. The mean age was 40 years (range: 30-58 years). After initial diagnosis with MRI, RI cisternography and CT myelography were helpful in pinpointing the exact leakage site. Four patients were treated only with the medication and 24 patients were treated with the epidural blood patch (EBP). Half of them achieved dramatic relief of symptoms after the initial EBP. A blind EBP was performed in 15 patients. Six patients experienced recurrence of symptoms. Hematoma evacuation was performed in 8 patients. None of diagnostic tools or treatment methods showed distinct superiority in predicting a favorable clinical outcome.
  
  
  CONCLUSIONS
  Clinicians should be systematic in their approach to plan a treatment regimen for patients with SIH. We suggest the use of a flow diagram when determining how to best approach and treat patients with SIH.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Yoon
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
authors.forename: Byung-Woo
authors.initials: BW
authors.lastname: Yoon
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Sun-Ha
authors.initials: SH
authors.lastname: Paek
authors.forename: Dong-Gyu
authors.initials: DG
authors.lastname: Kim
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001510:Bed Rest; D017217:Blood Patch, Epidural; D003287:Contrast Media; D005260:Female; D005440:Fluid Therapy; D005682:Gadolinium; D006408:Hematoma, Subdural / Q000150:complications; D006801:Humans; D019585:Intracranial Hypotension / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009192:Myelography; D019635:Neurosurgical Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D003287:Contrast Media; D005682:Gadolinium