Abstract
Spontaneous intracranial hypotension (SIH) is a rare disabling condition whose main clinical manifestation is orthostatic headache. We analysed clinical characteristics in relation to time to resolution in 90 consecutive patients diagnosed with SIH at our centre between 1993 and 2006. After excluding 7 patients lost to follow-up, the remaining 83 cases were divided into four groups: Group A (53 cases) with progressively worsening orthostatic headache; Group B (3 cases) with severe acute-onset orthostatic headache; Group C (9 cases) with fluctuating non-continuous headache, of mild severity, that, in 33% of cases, did not worsen on standing; Group D (18 cases), 5 with a previous history of headache, 14 with orthostatic headache, and 10 with altered neurological examination. Complete symptoms and neuroradiological resolution occurred during follow-up in Groups A, B and D, but was longer in Group D probably in relation to more severe clinical picture with altered neurological examination. However, after a mean of 52 months (range 24–108), none of the nine Group C patients had MRI indicating complete resolution. The main characteristic of Group C related to incomplete resolution was delayed diagnosis. These preliminary findings suggest that early diagnosis of SIH correlates with better outcome, further suggesting that patients with a new headache that may worsen on standing or sitting should undergo MRI with contrast to expedite a possible SIH diagnosis, even if the pain is relatively mild.
Similar content being viewed by others
References
Schievink WI (2006) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295:2286–2296
Mokri B (2003) Headaches caused by decreased intracranial pressure: diagnosis and management. Curr Opin Neurol 16:319–326
Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edn. Cephalalgia 24(Suppl 1):1–160
Mokri B (2004) Spontaneous low cerebrospinal pressure/volume headaches. Curr Neurol Neurosci Rep 4:117–124
Schwedt TJ, Dodick DW (2007) Spontaneous intracranial hypotension. Curr Pain Headache Rep 11:56–61
Mea E, Savoiardo M, Chiapparini L, Casucci G, Bonavita V, Bussone G, Leone M (2007) Headache and spontaneous low cerebrospinal fluid pressure syndrome. Neurol Sci 28:S232–S234
Savoiardo M, Minati L, Farina L, De Simone T, Aquino D, Mea E et al (2007) Spontaneous intracranial hypotension with deep brain swelling. Brain 130:1884–1893
Chiapparini L, Ciceri E, Nappini S, Castellani MR, Mea E, Bussone G et al (2004) Headache and intracranial hypotension: neuroradiological findings. Neurol Sci 25:S138–S141
Mea E, Chiapparini L, Savoiardo M, Franzini A, Grimaldi D, Bussone G, Leone M (2009) Application of IHS criteria to headache attributed to spontaneous intracranial hypotension in a large population. Cephalalgia (in press)
Conflict of interest statement
The authors declare that they have no conflict of interest related to the publication of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mea, E., Chiapparini, L., Savoiardo, M. et al. Clinical features and outcomes in spontaneous intracranial hypotension: a survey of 90 consecutive patients. Neurol Sci 30 (Suppl 1), 11–13 (2009). https://doi.org/10.1007/s10072-009-0060-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-009-0060-8