1. Spontaneous Intracranial Hypotension A discussion about this disorder, its features, causes, diagnosis and treatment.Category Health Conditions and Diseases intracranial hypotension......Spontaneous intracranial hypotension. Spontaneous intracranial hypotensionmay present quite suddenly or more gradually. Headache http://medmic02.wnmeds.ac.nz/groups/rmo/headache/headache16.html

Spontaneous intracranial hypotension Spontaneous intracranial hypotension may present quite suddenly or more gradually. Headache may involve the whole head, or be frontal or occipital. It worsens in the erect position with improvement on lying down. It is worsened by jugular venous compression or the Valsava manoeuvre. Other features include: Neck stiffness tinnitus faintness photophobia nausea and vomiting Causes The cause is often unclear, although cases have been attributed to tears in nerve root sleeves resulting from a sneeze or strain. A similar headache may occur after lumbar puncture Diagnosis Lumbar puncture should be performed. The pressure is usually less than 60 mm of CSF. The protein may be elevated, and red cells or xanthochromia may be present. Isotope cisternography shows a rapid decrease of activity in the subarachnoid space, and a specific site of CSF leak may be demonstrated. Treatment bed rest epidural blood patch intrathecal saline infusion oral caffeine surgical repair of any meningeal defect that is found. E-mail comments or criticisms to: Dr Graeme Hammond Tooke Last modified: 3 Jan 1999

2. Baylor Neurology Case Of The Month Department of Neurology. Diagnosis 1. Spontaneous intracranial hypotension2. Secondary ArnoldChiari Malformation Patient 28 is http://www.bcm.tmc.edu/neurol/challeng/pat28/summary.html

Patient #28 Summary and Discussion Jay Foreman, M.D., Ph.D. Resident, Department of Neurology Diagnosis: 1. Spontaneous intracranial hypotension 2. Secondary Arnold-Chiari Malformation The most worrisome and confusing aspects of this case, however, were the findings of CSF pleocytosis and diffuse meningeal enhancement on MRI ( see initial MRI ). In fact, the patient was referred to our service for a possible meningeal biopsy because of the unexplained nature of her problem and these MRI findings. The numerous possibilities of diffuse meningeal enhancement include inflammatory, infectious, and neoplastic processes. Meningeal enhancement is seen with meningeal carcinomatosis and lymphoma but the appearance is usually one of nodular enhancement, which may be focal or diffuse. Our patient had no evidence of blood cell dyscrasia on peripheral smear. Additionally this patient had no other symptoms or laboratory findings to suggest the presence of a malignancy. Neurosarcoidosis can give a similar appearance but it is usually associated with cranial neuropathy (53%), parenchymal disease (48%), aseptic meningitis (22%), peripheral neuropathy (17%), myopathy (15%) and/or hydrocephalus (7%). There is usually some evidence of systemic disease (97%) and elevation of serum angiotensin enzyme (ACE) levels. None of these were present in our patient. Lyme disease was considered. There is a triad of meningitis, radiculitis and neuritis without fever that is highly suggestive of this disease. Meningeal enhancement may or may not be seen, but is more often at nerve roots. Initially, patients have mild meningeal signs including headaches, myalgias, stiff neck and cranial nerve involvement. After several weeks patients may have cardiac conduction abnormalities, meningial signs, multiple cranial neuropathies, peripheral mononeuropathies and encephalopathy, as well as transitory erythematous blotchy rashes. The third stage typically involves development of a chronic arthritis. Our patient had none of these findings and her Lyme titers were negative.

3. Ae The dural findings seen with intracranial hypotension are due to congestive changes caused by chronically low http://www.med.uc.edu/neurorad/webpage/gba.html

Intracranial Hypotension Findings: Smooth, uniformly thickened and enhancing dura. Differential Diagnosis: intracranial hypotension, dural fibrosis, sarcoid, TB, mets Discussion: The dural findings seen with intracranial hypotension are due to congestive changes caused by chronically low intracranial pressure. The pressure differential may be maintained by an occult CSF leak, and many patients can give a history of previous lumbar puncture or trauma. Uniform thickening of the dura is a characteristic feature, and the lack of nodularity or a basilar distribution can help distinguish this process from metastatic disease or TB/sarcoid. The cerebellar tonsils may occasionally sink through the foramen magnum, leading to an acquired Chiari I malformation. BACK TO UNKNOWNS BACK TO CATEGORIES HOME NEXT CASE

4. CJNS - Spontaneous Intracranial Hypotension In The Absence Of Magnetic Resonance Abstract Background Spontaneous intracranial hypotension (SIH) is a neurologic syndrome of unknown etiology, http://www.canjneurolsci.org/29augtoc/spontaneous.html

Abstract Close Window Spontaneous Intracranial Hypotension in the Absence of Magnetic Resonance Imaging Abnormalities Kerrie L. Schoffer, Timothy J. Benstead, Ian Grant Abstract: Background: Spontaneous intracranial hypotension (SIH) is a neurologic syndrome of unknown etiology, characterized by features of low cerebral spinal fluid (CSF) pressure, postural headache and magnetic resonance imaging (MRI) abnormalities. Methods: Four symptomatic cases of SIH presented to our institution over a six-month period. Magnetic resonance imaging studies were performed in all four cases. Diagnostic lumbar puncture was done in all except one case. Results: All of the patients on whom lumbar punctures were performed demonstrated low CSF pressure and CSF protein elevation with negative cultures and cytology. Three out of the four patients exhibited MRI findings of diffuse spinal and intracranial pachymeningeal gadolinium enhancement and extradural or subdural fluid collections. One patient had no MRI abnormalities despite prominent postural headache and reduced CSF pressure at lumbar puncture. All patients recovered with intravenous fluids and conservative treatment. Conclusions: Magnetic resonance imaging abnormalities are found in most, but not all patients, with SIH. Cerebral spinal fluid abnormalities can be detected even in patients with normal MRI studies. It is important to recognize the variability of imaging results in this usually benign disorder.

5. The Patient With Acute Severe Headache Cerebral abscess; Cerebral tumour; Benign intracranial hypertension (pseudotumourcerebri); Temporal arteritis; Spontaneous intracranial hypotension. Author. http://medmic02.wnmeds.ac.nz/groups/rmo/headache/head_toc.html

The patient with acute severe headache Causes of acute severe headache Clinical pointers to the cause Important questions to ask Investigations Clinical features of specific causes of headache Subarachnoid haemorrhage Intracerebral haemorrhage Migraine Cluster headache ... Author E-mail comments or criticisms to: Dr Graeme Hammond Tooke Last modified: 3 Jan 1999

6. Patient 28 Selftest Patient 28 Spontaneous intracranial hypotension 1. Which of the followingare considered causes of orthostatic/postural headaches http://www.bcm.tmc.edu/neurol/challeng/pat28/selftest.html

Patient #28 Spontaneous Intracranial Hypotension 1. Which of the following are considered causes of orthostatic/postural headaches: A. spontaneous intracranial hypotension B. colloid cyst of the third ventricle C. post-lumbar puncture headache D. all of the above E. A and C 2. Typical findings suggestive of increased intracranial pressure include all of the following EXCEPT: A. early morning headaches B. papilledema C. nausea and vomiting D. scintillations E. worsening of headache on standing 3. Which of the following may cause diffuse meningeal enhancement on MRI? A. spontaneous intracranial hypotension B. CNS lymphoma C. neurosarcoidosis D. Lyme disease E. All of the above F. B, C, and D 4. All of the following are typically seen in patients with spontaneous intracranial hypotension EXCEPT: A. diffuse meningeal thickening and enhancement on MRI B. low CSF pressure C. papilledema D. mild CSF pleocytosis E. downward displacement of the cerebellar tonsils 5. All of the following are recognized causes of low CSF pressure headaches EXCEPT: A.

7. Arch Neurol -- Page Not Found Arch Neurol. 59;1027, June 2002, Spontaneous intracranial hypotension, GiridharP. Kalamangalam, DPhil, MRCP (UK); Nis Haq, FRCR; Simon J. Ellis, MD, FRCP. http://archneur.ama-assn.org/issues/v59n6/ffull/nim10017.html

Select Journal or Resource JAMA Archives of Dermatology Facial Plastic Surgery Family Medicine (1992-2000) General Psychiatry Internal Medicine Neurology Ophthalmology Surgery MSJAMA Science News Updates Meetings Peer Review Congress The page you requested was not found. The JAMA Archives Journals Web site has been redesigned to provide you with improved layout, features, and functionality. The location of the page you requested may have changed. To find the page you requested, click here HOME CURRENT ISSUE PAST ISSUES ... HELP Error 404 - "Not Found"

8. Arch Neurol -- Page Not Found intracranial hypotension With Parkinsonism, Ataxia, and Bulbar Weakness AuthorInformation Anthony SI Pakiam, MD; Christine Lee, MD; Anthony E. Lang, MD http://archneur.ama-assn.org/issues/v56n7/abs/nob7973.html

Select Journal or Resource JAMA Archives of Dermatology Facial Plastic Surgery Family Medicine (1992-2000) General Psychiatry Internal Medicine Neurology Ophthalmology Surgery MSJAMA Science News Updates Meetings Peer Review Congress The page you requested was not found. The JAMA Archives Journals Web site has been redesigned to provide you with improved layout, features, and functionality. The location of the page you requested may have changed. To find the page you requested, click here HOME CURRENT ISSUE PAST ISSUES ... HELP Error 404 - "Not Found"

9. Qango : Health: Diseases And Conditions: I: Intracranial Hypotension category Options Help. Home Health Diseases and Conditions I intracranial hypotension, Suggest a Site. Health, etc. If you would http://www.qango.com/dir/Health/Diseases_and_Conditions/I/Intracranial_Hypotensi

Chat Forums Free Email Personals Classifieds ... Help Qango Directory Intracranial Hypotension all of Qango only this category Options Help Home Health ... I > Intracranial Hypotension Suggest a Site Health, etc If you would like to suggest a site for this category please click here Home Health Diseases and Conditions ... I > Intracranial Hypotension Suggest a Site Home Suggest a Site Search ... Login

10. Spontaneous Intracranial Hypotension Professionals only. Spontaneous intracranial hypotension,, Print thisarticle, (SIH Spontaneous intracranial hypotension, Fig. 1 a, b http://www.amershamhealth.com/medcyclopaedia/Volume VI 1/SPONTANEOUS INTRACRANIA

Medcyclopaedia About Medcyclopaedia Amersham Health Search for: Type a word or a phrase. All forms of the word are searchable. Advanced search Browse entry words starting with: A B C D ... Other characters Try our Medcyclopaedia Premium Edition with added tools and functionality tailored to make your working day easier. The following tools are presently available: Expanded search *For Medical Professionals only, registration required Spontaneous intracranial hypotension, (SIH) a syndrome with reduced CSF pressure that occurs in the absence of dural puncture, surgery or trauma. The pathogenesis is usually considered to be an occult CSF leak through small defects in the meninges with a resultant decrease in CSF volume and pressure. The characteristic headache in SIH is similar to postlumbar puncture postural headache in that it is aggravated by sitting or standing and relieved by lying down. Other associated symptoms, seen less commonly, include stiff neck, nausea and vomiting, diplopia and cranial neuropathies, producing vertigo, tinnitus, photophobia and changes in hearing. CSF may be normal or reveal increased protein, xanthochromia or lymphocytic pleocytosis. By definition, the CSF pressure in SIH is low (less than 60 mm H O) and may be unobtainable via lumbar puncture, the so-called dry tap. Treatment options for intractable headache in SIH are similar to those for postdural puncture headache and include bed rest, analgesics, sedatives, oral caffeine, intravenous hydration, epidural blood patch and epidural saline infusion. The usual clinical course of SIH in most patients is spontaneous resolution over a period of weeks to months.

11. Hypotension, Intracranial, Spontaneous Hypotension, intracranial, spontaneous,, Print this article, see spontaneousintracranial hypotension GS The Encyclopaedia of Medical Imaging Volume VI1, http://www.amershamhealth.com/medcyclopaedia/Volume VI 1/HYPOTENSION INTRACRANIA

Medcyclopaedia About Medcyclopaedia Amersham Health Search for: Type a word or a phrase. All forms of the word are searchable. Advanced search Browse entry words starting with: A B C D ... Other characters Try our Medcyclopaedia Premium Edition with added tools and functionality tailored to make your working day easier. The following tools are presently available: Expanded search *For Medical Professionals only, registration required Hypotension, intracranial, spontaneous, see spontaneous intracranial hypotension GS The Encyclopaedia of Medical Imaging Volume VI:1 Welcome to Medcyclopaedia. This site is open to a public audience, still we want to know a little more about our visitors. Please tick off the boxes that match your profile. Do you live in Europe? Yes No Are you a medical professional? Yes No This frame will disappear when submitted Legal Contact us Making Waves

12. BioMed Central | Abstract | Spontaneous Intracranial Hypotension Report Spontaneous intracranial hypotension Bahram Mokri MD Department ofNeurology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA. http://www.biomedcentral.com/1528-4042/1/109/abstract

Welcome guest user home journals A-Z journals by subject advanced search ... Issue 2 Viewing options Abstract Full text PDF Other links: E-mail to a friend Download references Post a comment Search PubMed For Mokri B Report Spontaneous Intracranial Hypotension Bahram Mokri MD Department of Neurology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA. Current Neurology and Neuroscience Reports Abstract Terms and Conditions Privacy statement Information for advertisers Contact us

13. BioMed Central | Full Text | Spontaneous Intracranial Hypotension Welcome guest user, http://www.biomedcentral.com/1528-4042/1/109

Welcome guest user home journals A-Z journals by subject advanced search ... my BioMed Central Although all research articles in Current Neurology and Neuroscience Reports are available free, most other articles require a subscription Click here to view an abstract of this article Click here to login if you are already a subscriber to Current Neurology and Neuroscience Reports Subscribe to Current Neurology and Neuroscience Reports Register for a free online trial Ask your librarian to investigate institutional access Athens users please click here to gain access If you believe you are seeing this page in error, or cannot activate your subscription, e-mail us info@biomedcentral.com Terms and Conditions Privacy statement Information for advertisers ... Contact us

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16. Spontaneous Intracranial Hypotension Spontaneous intracranial hypotension was diagnosed. Symptoms gradually abatedover the following 68 weeks. Khurana RK. intracranial hypotension. http://home.earthlink.net/~radiologist/tf/022502.htm

O. The fluid was viscous and markedly xanthochromic, protein was 200 mg/cc. There was no bacterial, fungal or TB growth. A nuclear cisternogram failed to demonstrate a site of CSF leakage. Spontaneous intracranial hypotension was diagnosed. Symptoms gradually abated over the following 6-8 weeks. Khurana RK. Intracranial hypotension. Semin Neurol 1996 Mar;16(1):5-10 PMID:8879051 Mokri B. Spontaneous intracranial hypotension. Curr Pain Headache Rep 2001 Jun;5(3):284-91 PMID:11309218 Ly JN, DeSilva SJ, Brazier D. Spontaneous intracranial hypotension. Australas Radiol 1999 Nov;43(4):548-50 PMID:10901980 Tsui EY, Ng SH, Cheung YK, Fong D, Yuen MK. Spontaneous intracranial hypotension with diffuse dural enhancement of the spinal canal and transient enlargement of the pituitary gland. Eur J Radiol 2001 Apr;38(1):59-63 PMID:11287167 Huang C, Chuang Y, Lee C, Lee R, Lin T. Spontaneous spinal cerebrospinal fluid leak and intracranial hypotension. Clin Imaging 2000 Sep-Oct;24(5):270-2 PMID:11331153 Inenaga C, Tanaka T, Sakai N, Nishizawa S. Diagnostic and surgical strategies for intractable spontaneous intracranial hypotension. Case report. J Neurosurg 2001 Apr;94(4):642-5 PMID:11302668

17. References Miller GM, et al Acquired Chiari I malformation secondary to spontaneous spinalcerebrospinal fluid leakage and chronic intracranial hypotension syndrome in http://www.medscape.com/content/2000/00/40/56/405623/405623_ref.html

References for: Surgical Treatment of Spontaneous Spinal Cerebrospinal Fluid Leaks Atkinson JLD, Weinshenker BG, Miller GM, et al: Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg 88:237-242, 1998 Bell WE, Joynt RJ, Sahs AL: Low spinal fluid pressure syndromes. Neurology 10:512-521, 1960 Crul BJP, Gerritse BM, Van Dongen RTM, et al: Epidural fibrin glue injection stops persistent postdural puncture headache. Anesthesiology 91:576-577, 1999 Fishman A, Dillon WP: Dural enhancement and cerebral displacement secondary to intracranial hypotension. Neurology 43:609-611, 1993 Front D, Penning L: Subcutaneous extravasation of CSF demonstrated by scinticisternography. J Nucl Med 15:200-201, 1974 Gerriste BM, Van Dongen RTM, Crul BJP: Epidural fibrin glue injection stops persistent cerebrospinal fluid leak during long-term intrathecal catheteriztion. Anesth Analg 84:1140-1141, 1997 Gibson BE, Wedel DJ, Faust RJ, et al: Continuous epidural saline infusion for the treatment of low CSF pressure headache. Anesthesiology 68:789-791, 1988 Lasater GM: Primary intracranial hypotension. The low spinal fluid pressure syndrome. Headache 10:63-66, 1970

18. Member Sign In The clinical spectrum of spontaneous intracranial hypotension is variable and includesheadache, neck stiffness, and cranial nerve dysfunction. Focus On http://www.medscape.com/viewarticle/405624

If you are having trouble logging in: In order to use Medscape, your browser must be set to accept "cookies." To find out how to adjust your browser settings, please click here Log In Username Password Forgot your password? Not a Member? Register Now for free access to: MEDLINE (Optimized for Physicians) 200+ Free CME Courses 25 Medical Specialty Sites 100+ Medical Journals Conference Coverage Daily Medical News About Medscape Help WebMD Health

19. Not A Brain Tumor: Serious Headaches Explained An article entitled Not a brain tumor serious headaches explained.Category Health Conditions and Diseases intracranial hypotension...... Spanish researchers identified enlarged pituitary glands in the brains of 11 patientswith headache symptoms characterized as intracranial hypotension syndrome http://www.eurekalert.org/pub_releases/2000-12/AAoN-Nabt-2512100.php

Public release date: 25-Dec-2000 Contact: Cheryl Grogan cgrogan@aan.com American Academy of Neurology Not a brain tumor: serious headaches explained ST. PAUL, MN – Headaches that may at first seem to be caused by a brain tumor can actually stem from a leak of spinal cord fluid, according to a study in the December 25 issue of Neurology, the scientific journal of the American Academy of Neurology. Spanish researchers identified enlarged pituitary glands in the brains of 11 patients with headache symptoms characterized as intracranial hypotension syndrome. People suffering from this syndrome experience headaches that occur or worsen shortly after sitting up from a lying position. "This is a disorder that was recently believed to be rare. New imaging technology has told us quite the opposite," said Jerome Posner, MD, Memorial Sloan-Kettering Cancer Center neurologist and co-author of an editorial accompanying the study. "The incapacitating headaches experienced by sufferers of this disorder can now be explained and treated, and not confused for a brain tumor." Primarily diagnosed by a low spinal cord fluid pressure reading, the intracranial hypotension experienced by study participants had varied causes including spontaneous occurrence, unexplained fluid loss, lumbar puncture (spinal tap) and cervical spine surgery. Neck pain, nausea, hearing and vision problems and facial numbness accompanied the headaches.

20. ECR 2001 - Presentation C-0597 Spontaneous intracranial hypotension MR findings. In this work we also reviewrecent scientific literature about spontaneous intracranial hypotension. http://www.ecr.org/T/ECR01/sciprg/abs/pc0597.htm

C-0597 G. Zuccoli , M.L. Motti, G. Giaroli, A. Troiso, N. Marcello; Reggio Emilia/IT Spontaneous intracranial hypotension: MR findings [ presentation ] [ index ]

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