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Spontaneous intracranial hypotension: Two cases including one treated with epidural blood patch.
MedLine Citation:
PMID:  20174499     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), low cerebrospinal fluid (CSF) pressure, and diffuse pachymeningeal gadolinium enhancement (DPME). We present here the case studies of two patients. One patient demonstrated a CSF leak in the mid-thoracic region, and recovered completely with conservative treatment. The other patient in whom leak could not be demonstrated, developed dementia, rapidly worsening encephalopathy, and became comatose, necessitating urgent epidural blood patch (EBP) with 25 cc of autologous blood, after which immediate and complete symptomatic relief was obtained. A second EBP was required a few days later and also provided complete and sustained clinical benefit, without subsequent recurrence. Both patients had OH and showed bilateral subdural fluid collections, DPME and "sagging" of brain on MRI. A high index of suspicion, recognizing the orthostatic nature of headache, and typical findings on contrast enhanced MRI should point to the diagnosis of SIH. EBP can be effective treatment in patients unresponsive to conservative measures.
Authors:
Pankaj Agarwal; Suresh Menon; Rajan Shah; B S Singhal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of Indian Academy of Neurology     Volume:  12     ISSN:  1998-3549     ISO Abbreviation:  Ann Indian Acad Neurol     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2011-07-14     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101273955     Medline TA:  Ann Indian Acad Neurol     Country:  India    
Other Details:
Languages:  eng     Pagination:  179-82     Citation Subset:  -    
Affiliation:
Departments of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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