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Der Nervenarzt

, Volume 75, Issue 12, pp 1194–1199 | Cite as

Das so genannte spontane Liquorunterdrucksyndrom

Kasuistische Hinweise auf eine Störung der Liquor-/Blutvolumenregulation
  • A. StraubeEmail author
  • C. Neudert
  • M. Glas
  • R. Brüning
  • C. S. Padovan
Originalien

Zusammenfassung

In der neuen IHS-Klassifikation wird unter dem Punkt 7.2.3 der Kopfschmerz bei spontanem Liquorunterdruck definiert. Anhand von vier Patientinnen mit einem entsprechenden Kopfschmerz und den in der aktuellen Literatur mitgeteilten Befunden wird der vermutete pathophysiologische Mechanismus diskutiert. Wesentlich scheint weniger der relative Liquorunterdruck als vielmehr eine Weitstellung von intrakraniellen und epiduralen Venen zu sein, die sich auch radiologisch als leptomeningeale Kontrastmittelaufnahme und als erweiterte epidurale Venen darstellen lassen. Therapeutisch ist neben der Gabe von Koffein, Theophyllin oder Indometacin die epidurale Eigenblutinjektion Therapie der Wahl, wobei diese auch ohne Nachweis einer Liquorfistel wirkt.

Schlüsselwörter

Spontaner Liquorunterdruckkopfschmerz Orthostatischer Kopfschmerz Autonome Dysregulation Venöse Dilatation Epidurale Eigenbluteingabe 

Spontaneous low CSF pressure

Case results indicating a disturbance in relation of CSF to blood volume

Summary

The new IHS classification describes under the paragraph 7.2.3 the headache attributed to spontaneous low CSF pressure. We report on four patients with such a headache and discuss the probable pathophysiology, including results published in the literature. It seems that not the low CSF pressure itself is the cause for the headache but the unphysiological, increased vasodilatation of intracranial and epidural veins. This dilatation of veins also shows up in the typical radiological findings with meningeal contrast enhancement and enlarged epidural veins. A trial with caffeine, theophylline, or indomethacin is recommended; otherwise, the most effective treatment option is an epidural blood patch, which is effective also in the absence of a documented CSF leak.

Keywords

Sponatenous low CSF pressure Orthostatic headache Autonomic dysregulation Vasoconstriction Epidural blood patch 

Notes

Danksagung

Die Arbeit wurde zum Teil durch das BMBF (chronischer Kopfschmerz) unterstützt. Frau J. Benson und Frau V. de Winter danken wir für ihre Hilfe beim Erstellen des Manuskriptes.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • A. Straube
    • 1
    • 3
    Email author
  • C. Neudert
    • 1
  • M. Glas
    • 1
  • R. Brüning
    • 2
  • C. S. Padovan
    • 1
  1. 1.Neurologische KlinikUniversität MünchenGroßhadern
  2. 2.Institut für NeuroradiologieUniversität MünchenGroßhadern
  3. 3.Neurologische KlinikKlinikum GroßhadernMünchenDeutschland

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