title: Intraspinal hemorrhage in spontaneous intracranial hypotension: link to superficial siderosis? Report of 2 cases.
abstract: Spontaneous intracranial hypotension due to a spinal CSF leak has become a well-recognized cause of headaches, but such spinal CSF leaks also are found in approximately half of patients with superficial siderosis of the CNS. It has been hypothesized that friable vessels at the site of the spinal CSF leak are the likely source of chronic bleeding in these patients, but such an intraspinal hemorrhage has never been visualized. The authors report on 2 patients with spontaneous intracranial hypotension and intraspinal hemorrhage, offering support for this hypothesis. A 33-year-old man and a 62-year-old woman with spontaneous intracranial hypotension were found to have a hemorrhage within the ventral spinal CSF collection and within the thecal sac, respectively. Treatment consisted of microsurgical repair of a ventral dural tear in the first patient and epidural blood patching in the second patient. The authors suggest that spontaneous intracranial hypotension should be included in the differential diagnosis of spontaneous intraspinal hemorrhage, and that the intraspinal hemorrhage can account for the finding of superficial siderosis when the CSF leak remains untreated.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Wouter I
authors.initials: WI
authors.lastname: Schievink
authors.affiliation: Palo Alto Medical Foundation, Palo Alto, California.
authors.forename: Philip
authors.initials: P
authors.lastname: Wasserstein
authors.affiliation: Radiology, Cedars-Sinai Medical Center, Los Angeles; and.
authors.forename: M Marcel
authors.initials: MM
authors.lastname: Maya
mesh_terms: D000328:Adult; D017217:Blood Patch, Epidural; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D019585:Intracranial Hypotension / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009192:Myelography; D012806:Siderosis / Q000150:complications*
keywords: spinal hemorrhage; spontaneous intracranial hypotension; superficial siderosis