Abstract
Materials and methods From 1992 to 2015 we observed 326 patients (169 females and 157 males; age range 15-84; mean, 47 years) with OH from SIH according to the ICHD 2004 criteria. One hundred and sixteen performed a conservative treatment, while 210 underwent lumbar EBP with 15-50 ml (mean 28 ml) autologous blood. In 203 cases blood was mixed with contrast medium (1 ml of gadolinium [12 pts] and 5 ml of iopamidol [191 pts]), because about 30’ after EBP they underwent a spinal MRI or CT to document the blood spread into the epidural space. All patients were kept in a 30° Trendelenburg position for an hour before the procedure, during and for 24 h (52 pts) or 16 h (158 pts) after the procedure. Fifty-two patients were premedicated with acetazolamide (500 mg). The follow-up ranged from 6 months to 8 years.
Highlights
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), diffuse pachymeningeal enhancement on brain MRI and low CSF pressure
In 203 cases blood was mixed with contrast medium (1 ml of gadolinium [12 pts] and 5 ml of iopamidol [191 pts]), because about 30’ after epidural blood patch (EBP) they underwent a spinal MRI or CT to document the blood spread into the epidural space
Twelve patients had a recurrence of SIH, 6 after a short period of time (1-4 week) and 6 after a long period of time (1-4 years)
Summary
Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), diffuse pachymeningeal enhancement on brain MRI and low CSF pressure. But autologous epidural blood patch (EBP) has emerged as the most important non-surgical management
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