title: Sex- and Age-Related Differences in the Clinical and Neuroimaging Characteristics of Patients With Spontaneous Intracranial Hypotension: A Records Review.
abstract: BACKGROUND
  The significance of sex- and age-related differences in the clinical course of spontaneous intracranial hypotension (SIH) was investigated.
  
  
  METHODS
  We retrospectively studied 40 consecutive patients (female:male = 28:12, median age 41.5 years) treated under clinical diagnoses of SIH satisfying the International Classification of Headache Disorders 3rd edition criteria, including 37 patients (92.5%) with diffuse pachymeningeal enhancement. The patients were divided into two groups by age and sex, and the clinical and neuroimaging findings in each group were investigated.
  
  
  RESULTS
  Acute onset (female:male = 82.1%:50.0%, P = .042), severe headache (75.0%:41.7%, P = .045) occurred with higher frequency in females than in males, and SDH occurred with lower frequency in females than in males (28.6%:75.0%, P = .006). Duration until the consultation (2:14 days, P = .022), SDH thickness (0:7.1 mm, P = .001), and iter displacement (1.6:7.1 mm, P = .004) was greater in males. Acute onset (Younger [≤40 years]: older [>40 years] = 94.1%:56.5%, P = .012), occurred with higher frequency in younger patients, and duration until the consultation (1:5 days, P = .001), frequency of SDH (17.7%:60.9%, P = .010), SDH thickness (0:5.9 mm, P = .003), in older patients. All nine patients with thunderclap headache were female, with median age of 37 years.
  
  
  CONCLUSIONS
  More severe clinical symptoms with acute onset were observed in females and younger patients of SIH. Comparatively rare subdural hygroma/hematoma on magnetic resonance imaging might result from the shorter duration to diagnosis in females and younger patients.
  
  
  BACKGROUND
  spontaneous intracranial hypotension, sex, age, magnetic resonance imaging, thunderclap headache.
authors.affiliation: Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. tnkyktk.gmed@gmail.com.
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tosaka
authors.affiliation: Department of Neurosurgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Fujimaki
authors.affiliation: Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Honda
authors.affiliation: Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yoshimoto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D019585:Intracranial Hypotension / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics; D012737:Sex Factors; D055815:Young Adult