Guidelines for the Diagnosis and Treatment of Spontaneous Intracranial Hypotension

Authors

  • Maria João Pinto Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto; Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. https://orcid.org/0000-0001-9133-4441
  • Luís Braz Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto; Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. https://orcid.org/0000-0002-3312-4283
  • José Fonseca Serviço de Neurorradiologia. Centro Hospitalar Universitário de São João. Porto.
  • Paulo Pereira Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto; Serviço de Neurocirurgia. Centro Hospitalar Universitário de São João. Porto. https://orcid.org/0000-0001-6961-9213
  • Paula Trigo Barbosa Unidade de Dor Crónica. Serviço de Anestesiologia. Centro Hospitalar Universitário de São João. Porto. https://orcid.org/0000-0003-1956-3463
  • Armanda Gomes Unidade de Dor Crónica. Serviço de Anestesiologia. Centro Hospitalar Universitário de São João. Porto.
  • Joana Guimarães Serviço de Neurologia. Centro Hospitalar Universitário de São João. Porto; Departamento de Neurociências Clínicas e Saúde Mental. Faculdade de Medicina. Universidade do Porto. Porto. https://orcid.org/0000-0003-1540-1395

DOI:

https://doi.org/10.20344/amp.19432

Keywords:

Cerebrospinal Fluid Leak/diagnostic imaging, Intracranial Hypotension/diagnostic imaging, Intracranial Hypotension/therapy

Abstract

Spontaneous intracranial hypotension (SIH) is a syndrome characterized by disabling orthostatic headache, due to reduced cerebrospinal fluid (CSF) volume probably caused by a CSF fistula. It affects mostly women of working-age, although it is probably underdiagnosed. The aim of this article is to present a practical approach to the diagnosis and treatment of SIH. After a description of its symptoms and signs, we present a step-by-step approach to the confirmation of the diagnosis and treatment, considering different clinical scenarios. This is intended to guide clinical decision making, through a systematized and individualized management, aimed at the best interest of the patient.

Downloads

Download data is not yet available.

References

D’Antona L, Jaime Merchan MA, Vassiliou A, Watkins LD, Davagnanam I, Toma AK, et al. Clinical presentation, investigation findings, and treatment outcomes of spontaneous intracranial hypotension syndrome: a systematic review and meta-analysis. JAMA Neurol. 2021;78:329-37.

Schievink WI. Spontaneous intracranial hypotension. N Engl J Med. 2021;385:2173-8.

Kranz PG, Tanpitukpongse TP, Choudhury KR, Amrhein TJ, Gray L. How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension? Cephalalgia. 2015;36:1209-17.

Wang SJ. Spontaneous intracranial hypotension. Continuum. 2021;27:746-66.

Dobrocky T, Nicholson P, Häni L, Mordasini P, Krings T, Brinjikji W, et al. Spontaneous intracranial hypotension: searching for the CSF leak. Lancet Neurol. 2022;21:369-80.

Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. 3rd ed. Cephalalgia. 2018;38:1-211.

Sociedade Portuguesa de Neurologia. Tradução portuguesa da classificação internacional de cefaleias. 3.a ed. Sinapse. 2018;18:S1-174.

Luetzen N, Dovi-Akue P, Fung C, Beck J, Urbach H. Spontaneous intracranial hypotension: diagnostic and therapeutic workup. Neuroradiology. 2021;63:1765-72.

Dobrocky T, Grunder L, Breiding PS, Breiding PS, Branca M, Limacher A, et al. Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol. 2019;76:580-7.

Amoozegar F, Guglielmin D, Hu W, Chan D, Becker WJ. Spontaneous intracranial hypotension: recommendations for management. Can J Neurol Sci. 2013;40:144-57.

Nair AS, Rayani BK. Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy. Korean J Pain. 2017;30:93-7

Ferrante E, Trimboli M, Rubino F. Spontaneous intracranial hypotension: review and expert opinion. Acta Neurol Belg. 2020;120:9-18.

Beck J, Häni L, Ulrich CT, Beck J, Häni L, Ulrich CT, et al. Diagnostic challenges and therapeutic possibilities in spontaneous intracranial hypotension. Clin Transl Neurosci. 2018;2:2514183X18787371.

Lin JP, Zhang SD, He FF, Liu MJ, Ma XX. The status of diagnosis and treatment to intracranial hypotension, including SIH. J Headache Pain. 2017;18:4.

Shin HY. Recent update on epidural blood patch. Anesth Pain Med. 2022;17:12-23.

Downloads

Published

2023-05-02

How to Cite

1.
Pinto MJ, Braz L, Fonseca J, Pereira P, Trigo Barbosa P, Gomes A, Guimarães J. Guidelines for the Diagnosis and Treatment of Spontaneous Intracranial Hypotension. Acta Med Port [Internet]. 2023 May 2 [cited 2024 Nov. 22];36(5):363-7. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/19432

Issue

Vol. 36 No. 5 (2023): May

Section

Guidelines

License

Copyright (c) 2023 Acta Médica Portuguesa

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.

It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.

Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.

After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.

Crossref
Scopus
Google Scholar
Europe PMC