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Spontaneous low cerebrospinal fluid pressure headache: an emergency medicine perspective

Published online by Cambridge University Press:  04 March 2015

Justin S. Ahn
Affiliation:
Division of Emergency Medicine, Department of Medicine
Cigdem Akincioglu
Affiliation:
Division of Nuclear Medicine, Department of Medical Imaging
Irene Gulka
Affiliation:
Division of Radiology, Department of Medical Imaging, Western University, London, ON
Grant Coome*
Affiliation:
Division of Emergency Medicine, Department of Medicine
*
800 Commissioners Road,E1-102, London, ON N6A 5W9; [email protected]

Abstract:

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Spontaneous low cerebrospinal fluid pressure headaches are a rare but treatable cause of debilitating headaches. The condition is characterized by a postural headache in the absence of any recent spinal procedures and is exacerbated when upright and relieved when supine. Diagnosis and treatment are often delayed, however, due to a lack of recognition and awareness, as illustrated by this case report of a patient who had multiple emergency department visits before further investigations were sought.

Type
Case Report • Rapport de cas
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1.Ramirez-Lassepas, M, Espinosa, CE, Cicero, JJ, et al. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol 1997;54:1506–9, doi:10.1001/archneur.1997.00550240058013.CrossRefGoogle ScholarPubMed
2.Manzoni, GC, Torelli, P. Epidemiological classification and social impact of chronic headache. Intern Emerg Med 2010;5Suppl 1:S1-5, doi:10.1007/s11739-010-0444-z.CrossRefGoogle ScholarPubMed
3.Schievink, WI, Maya, MM, Moser, F, et al. Frequency of spontaneous intracranial hypotension in the emergency department. J Headache Pain 2007;8:325–8, doi:10.1007/s10194-007-0421-8.Google Scholar
4.Rando, TA, Fishman, RA. Spontaneous intracranial hypotension: a report of two cases and review of the literature. Neurology 1992;42:481–7, doi:10.1212/WNL.42.3.481.Google Scholar
5.Schievink, WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006;295:2286–96, doi:10.1001/jama.295.19.2286.Google Scholar
6.Mokri, B, Maher, CO, Sencakova, D. Spontaneous CSF leaks: underlying disorder of connective tissue. Neurology 2002;58:814–6, doi:10.1212/WNL.58.5.814.Google Scholar
7.Ferrante, E, Citterio, A, Savino, A, et al. Postural headache in a patient with Marfan’s syndrome. Cephalalgia 2003;23:552–5, doi:10.1046/j.1468-2982.2003.00587.x.CrossRefGoogle Scholar
8.Suh, SI, Koh, SB, Choi, EJ, et al. Intracranial hypotension induced by cervical spine chiropractice manipulation. Spine 2005;30:E340-2, doi:10.1097/01.brs.0000166511.59868.b7.Google Scholar
9.Beck, J, Raabe, A, Seifer, V, et al. Intracranial hypotension after chiropractic manipulation of the cervical spine. J Neurol Neurosurg Psychiatry 2003;74:821–2, doi:10.1136/jnnp.74.6.821.Google Scholar
10.Grimaldi, D, Mea, E, Chiapparini, L, et al. Spontaneous low cerebrospinal pressure: a mini review. Neurol Sci 2004;25Suppl 3:S135-7, doi:10.1007/s10072-004-0272-x.Google Scholar
11.Mokri, B, Aksamit, AJ, Atkinson, JL. Paradoxical postural headaches in cerebrospinal fluid leaks. Cephalalgia 2004;24:883–7, doi:10.1111/j.1468-2982.2004.00763.x.Google Scholar
12.Liu, H, Kaye, A, Comarda, N, et al. Paradoxical postural cerebrospinal fluid leak-induced headache: report of two cases. J Clin Anesth 2008;20:383–5, doi:10.1016/j.jclinane.2008.01.011.Google Scholar
13.Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalagia 2004;24 Suppl 1:9160.Google Scholar
14.Mea, E, Chiapparini, L, Savoiardo, M, et al. Application of IHS criteria to headache attributed to spontaneous intracranial hypotension in a large population. Cephalalgia 2008;29:418–22, doi:10.1111/j.1468-2982.2008.01747.x.Google Scholar
15.Shievink, WI, Maya, MM, Louy, C, et al. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol 2008;29:853–6, doi:10.3174/ajnr.A0956.Google Scholar
16.Shievink, WI, Dodick, DW, Mokri, B, et al. Diagnostic criteria for headache due to spontaneous intracranial hypotension: a perspective. Headache 2011;51:1442–4, doi:10.1111/j.1526-4610.2011.01911.x.Google Scholar
17.Euerle, BD. Spinal puncture and cerebrospinal fluid examination. In: Roberts, JR, Hedges, JR, Custalow, CB, et al, editors. Clinical procedures in emergency medicine. 5th ed. Philadelphia: Saunders; 2010. p. 1111–2.Google Scholar
18.Schievink, WI. Spontaneous spinal cerebrospinal fluid leaks: a review. Neurosurg Focus 2000;9:19, doi:10.3171/foc.2000.9.1.8.CrossRefGoogle ScholarPubMed
19.Schievink, WI, Maya, MM, Riedinger, M. Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study. J Neurosurg 2003;99:840–2, doi:10.3171/jns.2003.99.5.0840.Google Scholar
20.Malone, RE, Love, JN. Spontaneous intracranial hypotension: case report and relevant review of the literature. J Emerg Med 2007;32:371–4, doi:10.1016/j.jemermed.2006.08.016.Google Scholar
21.Schievink, WI, Maya, MM. Quadriplegia and cerebellar hemorrhage in spontaneous intracranial hypotension. Neurology 2006;66:1777–8, doi:10.1212/01.wnl.0000218210.83855.40.Google Scholar
22.Pakiam, AS, Lee, C, Lang, AE. Intracranial hypotension with parkinsonism, ataxia, and bulbar weakness. Arch Neurol 1999; 56:869–72, doi:10.1001/archneur.56.7.869.CrossRefGoogle ScholarPubMed
23.Mokri, B, Ahlskog, JE, Luetmer, PH. Chorea as a manifestation of spontaneous CSF leak. Neurology 2006;67:1490–1, doi:10.1212/01.wnl.0000240059.96502.bf.Google Scholar
24.Pleasure, SJ, Abosch, A, Friedman, J, et al. Spontaneous intracranial hypotension resulting in stupor caused by diencephalic compression. Neurology 1998;50:1854–7, doi:10.1212/WNL.50.6.1854.Google Scholar
25.Kashmere, JL, Jacka, MJ, Emery, D, et al. Reversible coma: a rare presentation of spontaneous intracranial hypotension. Can J Neurol Sci 2004;31:565–8.Google Scholar
26.Mokri, B.Headaches caused by decreased intracranial pressure: diagnosis and management. Curr Opin Neurol 2003;16:319–26, doi:10.1097/00019052-200306000-00011.Google Scholar
27.Basurto Ona, X, Martinez Garcia, L, Sola, I, et al. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev 2011;(8):CD007887.Google Scholar
28.Gentile, S, Giudice, RL, Martino, PD, et al. Headache attributed to spontaneous low CSF pressure: report of three cases responsive to corticosteroids. Eur J Neurol 2004;11: 849–51, doi:10.1111/j.1468-1331.2004.00898.x.Google Scholar
29.Bel, I, Moreno, LA, Gomar, C. Epidural dextran-40 and paramethasone injection for treatment of spontaneous intracranial hypotension. Can J Anesth 2006;53:591–4, doi:10.1007/BF03021850.Google Scholar
30.Bintler, DK, Billon, WP, Fishman, RA. Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report. Neurosurgery 2002;51:830–7.Google Scholar
31.Marcelis, J, Silberstein, SD. Spontaneous low cerebrospinal fluid pressure headache. Headache 1990;30:192–6, doi:10.1111/j.1526-4610.1990.hed3004192.x.Google Scholar
32.Berroir, S, Loisel, B, Ducros, A, et al. Early epidural blood patch in spontaneous intracranial hypotension. Neurology 2004;63:1950–1, doi:10.1212/01.WNL.0000144339.34733.E9.Google Scholar
33.Cho, KI, Moon, HS, Jeon, HJ, et al. Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch. Neurology 2011;76:1129–44, doi:10.1212/WNL.0b013e318212ab43.Google Scholar
34.Schievink, WI, Maya, MM, Moser, FM. Treatment of spontaneous intracranial hypotension with percutaneous placement of a fibrin sealant. Report of four cases. J Neurosurg 2004;100:1098–100, doi:10.3171/jns.2004.100.6.1098.Google Scholar
35.Schievink, WI, Morreale, VM, Atkinson, JL, et al. Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg 1998;88:243–6, doi:10.3171/jns.1998.88.2.0243.Google Scholar
36.Shievink, WI, Maya, M, Louy, C. CranialMRI predicts outcome of spontaneous intracranial hypotension. Neurology 2005;64:1282–4, doi:10.1212/01.WNL.0000156906.84165.C0.Google Scholar
37.Kong, DS, Park, K, Nam, DH, et al. Clinical features and long-term results of spontaneous intracranial hypotension. Neurosurgery 2005;57:91–6, doi:10.1227/01.NEU.0000163093.38616.35.Google Scholar