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Intracranial hypotension: mechanisms, diagnosis, treatment – M. Gallucci, Italy
Orthostatic hypotension is typical(15 min efter stående läge)
nausea, dizziness, tinnitus, headache(91%) and rigidity can be present
Diplopia, trigeminal paresthesia
In young and middle aged affected
Easy to miss
Therapy can be possible if diagnosis is correct (##)
Etiologies:
Lumbar puncture
Overdraining ventricular shunts
Spine surgery
Rhinorrhea, otorrhea
Post traumatic
Sports - microtrauma?
Structural weakness
Collagenopathies (marphan, Ehler-Danlos..)
NF-1
Tarlov and peridural arachnoid cysts
Spontaneous - in most cases no evident etiology.
Low pressure: below 6 cm H20 in sitting, sometimes even negative
(shown in both lying down(norm 8-18) and sitting(normal 18-37))
Contrast administered at the same time.
Findings:
Descent of optic chiasm and midbrain(sagging)
Crowding of posterior fossa, prepontine, prechiasmatic cisterns
Possible subdural collections
Decreased ventricular size
Pituary enlargement >90%
Engorged venous sinuses >90%
Bilateral IAC enhancement >90%
Spinal pachmeningeal enhancement
Spinal diverticula/leakage - Myelo MR/CT - normally in the thoracic spine
OBS kan ha svullnad i basala ganglia thalamus! (inte från lektionen) http://www.ajnr.org/content/31/1/100.full
Treatment- blood patch if unresponsive to 3 weeks of conservative treatment (unless very severe)
Engorged sinuses
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