Document Detail

Atypical spontaneous intracranial hypotension (SIH) with nonorthostatic headache.
MedLine Citation:
PMID:  17300359     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Some patients with spontaneous intracranial hypotension (SIH) often do not demonstrate typical orthostatic headache, which is contrary to the typical SIH syndrome. They usually have an obscure and intermittent headache, regardless of their positional change. OBJECT: The objective of this study is to investigate the clinical course of atypical SIH that manifests with diffuse pachymeningeal enhancement, but no orthostatic headaches. METHODS: Between January 1997 and December 2005, we observed a total of 6 patients who revealed atypical presentations including nonpostural headaches and normal cerebrospinal fluid (CSF) pressure, despite the diffuse pachymeningeal enhancement seen on their MR images. For a comparison of the clinical features and the disease course, 13 other SIH patients with typical clinical manifestations were selected as a control group. RESULTS: Cerebrospinal fluid leakage sites were confirmed in only one patient through a variety of diagnostic tools; in contrast, definite focal CSF leakage sites were found in 12 of 13 patients with typical SIH. The 6 atypical SIH patients were treated with conservative treatment, including strict bed rest and intravenous hydration for 2 to 3 weeks. After a mean follow-up of 12 months, their headaches were gradually relieved after 2 to 3 weeks of conservative treatment only. CONCLUSIONS: All SIHs do not necessarily show the typical clinical manifestations. The atypical finding of SIH such as nonorthostatic headache or normal CSF pressure may be the result of a normal physiologic response to the typical SIH as a compensatory reaction. Therefore, when faced with patients showing findings compatible with SIH on the brain MR images, regardless of nonpostural headache, atypical SIH should be suspected.
Doo-Sik Kong; Kwan Park; Do-Hyun Nam; Jung-Il Lee; Eun-Sang Kim; Jong Soo Kim; Seung-Chyul Hong; Hyung Jin Shin; Whan Eoh; Jong Hyun Kim
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Headache     Volume:  47     ISSN:  0017-8748     ISO Abbreviation:  Headache     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-15     Completed Date:  2007-04-17     Revised Date:  2009-02-02    
Medline Journal Info:
Nlm Unique ID:  2985091R     Medline TA:  Headache     Country:  United States    
Other Details:
Languages:  eng     Pagination:  199-203     Citation Subset:  IM    
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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MeSH Terms
Brain / pathology
Case-Control Studies
Cerebrospinal Fluid Pressure / physiology
Headache / etiology*,  physiopathology
Intracranial Hypotension / complications*,  diagnosis*
Magnetic Resonance Imaging
Middle Aged
Posture / physiology
Retrospective Studies
Subdural Effusion / etiology
Comment In:
Headache. 2008 Apr;48(4):641-2   [PMID:  18377390 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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