Document Detail

Spontaneous intracranial hypotension: recommendations for management.
MedLine Citation:
PMID:  23419561     Owner:  NLM     Status:  In-Data-Review    
A literature search found no clinical trials or guidelines addressing the management of spontaneous intracranial hypotension (SIH). Based on the available literature and expert opinion, we have developed recommendations for the diagnosis and management of SIH. For typical cases, we recommend brain magnetic resonance (MR) imaging with gadolinium to confirm the diagnosis, and conservative measures for up to two weeks. If the patient remains symptomatic, up to three non-directed lumbar epidural blood patches (EBPs) should be considered. If these are unsuccessful, non-invasive MR myelography, radionuclide cisternography, MR myelography with intrathecal gadolinium, or computed tomography with myelography should be used to localize the leak. If the leak is localized, directed EPBs should be considered, followed by fibrin sealant or neurosurgery if necessary. Clinically atypical cases with normal brain MR imaging should be investigated to localize the leak. Directed EBPs can be used if the leak is localized; non-directed EBPs should be used only if there are indirect signs of SIH.
Farnaz Amoozegar; Darryl Guglielmin; William Hu; Denise Chan; Werner J Becker
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques     Volume:  40     ISSN:  0317-1671     ISO Abbreviation:  Can J Neurol Sci     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0415227     Medline TA:  Can J Neurol Sci     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  144-57     Citation Subset:  IM    
Department of Clinical Neurosciences, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada.
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