title: Spontaneous Intracranial Hypotension: Characteristics of the Serious Form in a Series of 24 Patients.
abstract: BACKGROUND
  Recommended treatments for spontaneous intracranial hypotension (SIH) range from bed rest only to neurosurgery. However, the serious form of SIH is poorly defined. A better description of patient characteristics and their outcome may help define therapeutic options.
  
  
  METHODS
  We reviewed 24 cases of patients with SIH and separated them into 2 groups according to whether or not they presented with signs of severity at admission: disturbance of consciousness, subdural hematomas (SDHs), and cerebral venous thrombosis.
  
  
  RESULTS
  Nine patients (37%) were classified as having a serious form of SIH: six (25%) presented SDHs; three (12%) disturbance of consciousness; and one (4%) cerebral venous thrombosis. Bed rest and epidural blood patches (EBPs) were sufficient to treat all patients in the nonserious form group and 4 patients in the serious form group. Two patients (8%) had to undergo cerebrospinal fluid leak repair, and 3 others (12%) evacuation of SDHs. Outcome was good in both groups, with only one (4%) death due to extensive SDHs. Times to diagnosis in the serious form group (63 vs. 35 days, P = 0.052) and to recovery (9 months vs. 5 months, P = 0.088) tended to be higher without reaching difference.
  
  
  CONCLUSIONS
  The presence of SDHs, disturbance of consciousness, and a trend toward a longer time to diagnosis and recovery seem to define the serious form of SIH. These patients may require exploration and surgical repair of cerebrospinal fluid leak, only after failure of conservative measures--bed rest and time--and EBP, with good outcome.
authors.affiliation: Department of Neurology, University Hospital of Nancy, Cedex, France.
authors.forename: Aïcha Lyoubi
authors.initials: AL
authors.lastname: Idrissi
authors.affiliation: Department of Neurology, University Hospital of Nancy, Cedex, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lacour
authors.affiliation: Department of Neurosurgery, University Hospital of Nancy, Cedex, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Klein
authors.affiliation: Department of Neuroradiology, University Hospital of Nancy, Cedex, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Schmitt
authors.affiliation: Department of Neurology, University Hospital of Nancy, Cedex, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ducrocq
authors.affiliation: Department of Neurology, University Hospital of Nancy, Cedex, France. Electronic address: s.richard@chu-nancy.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Richard
mesh_terms: D000328:Adult; D000368:Aged; D017217:Blood Patch, Epidural; D065634:Cerebrospinal Fluid Leak / Q000150:complications* / Q000628:therapy; D003244:Consciousness Disorders / Q000209:etiology*; D005260:Female; D006261:Headache / Q000209:etiology; D006408:Hematoma, Subdural / Q000209:etiology*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020246:Venous Thrombosis / Q000209:etiology
keywords: Cerebrospinal fluid leak; Epidural blood patch; Orthostatic headache; Severity; Spontaneous intracranial hypotension; Subdural hematoma