Abstract
Spontaneous intracranial hypotension (SIH) is a neurological condition characterized by orthostatic headache (OH), low cerebrospinal fluid (CSF) pressure and diffuse pachymeningeal enhancement on brain magnetic resonance imaging (MRI). Hearing changes (HC) are also a common clinical finding. At present, epidural blood patch (EBP) is the most recommended treatment. Our study aimed at describing clinical variability of SIH patients. We also aimed at measuring the EBP efficacy on OH and HC in patients affected by SIH, by asking them to rate their levels of discomfort on a VAS. 28 consecutive patients were recruited. All of them complained about OH, 16 of them also reported HC. They were all treated with EBP. Two clinical psychologists interviewed them before and after the procedure, asking to rate the intensity of their OH and HC on a VAS at different time points: the day before the procedure, between 24 and 48 h after it and 2 months after treatment. Before EBP, patients rated their OH as 5 (IQR 2–7) and their HC as 4 (IQR 2–5.75). 24/48 h after EBP, a significant improvement in OH (median 0, IQR 0–0; p < 0.001) and HC (median 1, IQR 0–2; p < 0.05) was found. At follow up assessments, all patients reported a complete relief from their OH and four out of 16 patients only still reported mild HC. Our data show for the first time the early and durable efficacy of EBP on OH and HC in patients affected by SIH.
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References
Berroir S, Loisel B, Ducros A, Boukobza M, Tzourio C, Valade D, Bousser MG (2004) Early epidural blood patch in spontaneous intracranial hypotension. Neurology 63(10):1950–1951
Ferrante E, Arpino I, Citterio A, Savino A (2009) Coma resulting from spontaneous intracranial hypotension treated with the epidural blood patch in Trendelemburg position pre-medicated with acetazolamide. ClinNeurol Neurosurg 111:699–702
Ferrante E, Arpino I, Citterio A, Wetzl R, Savino A (2010) Epidural blood patch in Trendelenburg position pre-medicated with acetazolamide to treat spontaneous intracranial hypotension. Eur J Neurol 17:715–719
Ferrante E, Savino A (2005) Thunderclap headache caused by spontaneous intracranial hypotension. NeurolSci 26:s155–s157
Headache Classification Committee of the International Headache Society (IHS) (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33:629–808
Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorder (2nd edition). Cephalalgia 24(Suppl1):1–160
Mokri B (2008) Familial occurrence of spontaneous spinal CSF leaks: Underlying connective tissue disorder. Headache 48:146–149
Mokri B (2013) Spontaneous low pressure, low CSF volume headaches: spontaneous CSF Leaks. Headache 53:1034–1053
Mokri B, Atkinson JL (2000) False pituitary tumor in CSF leaks. Neurology 55:573–575
Schievink WI (2006) Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 295:2286–2296
Sencakova D, Mokri B, McClelland RL (2001) The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 57:1921–1923
Acknowledgments
The authors are grateful for statistical support to Simone Ghinzani.
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Prior to commencing of the study, local ethical committee approval was obtained.
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Ferrante, E., Olgiati, E., Sangalli, V. et al. Early pain relief from orthostatic headache and hearing changes in spontaneous intracranial hypotension after epidural blood patch. Acta Neurol Belg 116, 503–508 (2016). https://doi.org/10.1007/s13760-016-0617-2
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DOI: https://doi.org/10.1007/s13760-016-0617-2