Abstract
BackgroundSpontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment.MethodsWe retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus).ResultsA total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02).ConclusionsPatients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.
Highlights
Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses
To help physicians plan the appropriate treatment approach depending on the disease, we investigated the differences in clinical characteristics, neuroimaging data, and responses to epidural blood patch (EBP) between Spontaneous intracranial hypotension (SIH) and postdural puncture headache (PDPH) patients
Patients were screened based on the diagnosis code at discharge. The inclusion criteria for SIH were as follows [1]; orthostatic headache that worsens within 15 min after sitting or standing and improves < 30 min after recumbent positioning, [2] absence of a procedure or trauma known to be able to cause cerebrospinal fluid (CSF) leakage and [3] the presence of at least one of the following three criteria: low opening CSF pressure (< 60 mm H2O in the sitting position), sustained improvement of symptoms after EBP or evidence of CSF leakage on imaging
Summary
Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment. Spontaneous intracranial hypotension (SIH) and postdural puncture headache (PDPH) are both caused by a loss of cerebrospinal fluid (CSF) but have different pathogeneses. Few reports have described the brain MRI findings for PDPH because this condition is mainly diagnosed based on procedure history and clinical features [7]. The imaging findings of SIH and PDPH have rarely been compared
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