TY - JOUR
T1 - Treatment of spontaneous intracranial hypotension
T2 - Evolution of the therapeutic and diagnostic modalities
AU - Franzini, Angelo
AU - Messina, G.
AU - Chiapparini, L.
AU - Bussone, G.
PY - 2013
Y1 - 2013
N2 - Magnetic resonance imaging in patients affected by orthostatic headache often allows the diagnosis of spontaneous intracranial hypotension (SIH). Nevertheless, in the last 5 years, the diagnostic and therapeutic strategy for spontaneous intracranial hypotension (SIH) has been significantly modified. Specifically, all invasive techniques aimed at localization and demonstration of "spontaneous" spinal fistulas (myelography, isotopic cisternography, and so on) have been progressively abandoned. Also myelo-MR, although not an invasive exam, is no longer considered necessary to establish the most appropriate treatment. This change is due to the development and demonstration of a pathogenetic theory which considers the cerebrospinal fistula not as the primary cause of intracranial hypotension, but as the consequence of an imbalance between epidural and cerebrospinal fluid (CSF) pressures. In a consecutive series of 80 patients, we performed a standardized epidural lumbar injection of a dense compound aimed to raise the epidural pressure irrespective of the presence and site of CSF leaks. The technique used, the long-term results of this treatment and the diagnostic pathways will be discussed.
AB - Magnetic resonance imaging in patients affected by orthostatic headache often allows the diagnosis of spontaneous intracranial hypotension (SIH). Nevertheless, in the last 5 years, the diagnostic and therapeutic strategy for spontaneous intracranial hypotension (SIH) has been significantly modified. Specifically, all invasive techniques aimed at localization and demonstration of "spontaneous" spinal fistulas (myelography, isotopic cisternography, and so on) have been progressively abandoned. Also myelo-MR, although not an invasive exam, is no longer considered necessary to establish the most appropriate treatment. This change is due to the development and demonstration of a pathogenetic theory which considers the cerebrospinal fistula not as the primary cause of intracranial hypotension, but as the consequence of an imbalance between epidural and cerebrospinal fluid (CSF) pressures. In a consecutive series of 80 patients, we performed a standardized epidural lumbar injection of a dense compound aimed to raise the epidural pressure irrespective of the presence and site of CSF leaks. The technique used, the long-term results of this treatment and the diagnostic pathways will be discussed.
KW - Blood patch
KW - Orthostatic headache
KW - SIH
KW - Spontaneous intracranial hypotension
UR - http://www.scopus.com/inward/record.url?scp=84892490054&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892490054&partnerID=8YFLogxK
U2 - 10.1007/s10072-013-1364-2
DO - 10.1007/s10072-013-1364-2
M3 - Article
C2 - 23695068
AN - SCOPUS:84892490054
VL - 34
JO - Neurological Sciences
JF - Neurological Sciences
SN - 1590-1874
IS - SUPPL. 1
ER -