Spontan İntrakranyal Hipotansiyon
Özet
Spontan intrakranyal hipotansiyon (SİH), beyin omurilik sıvısı (BOS) basıncının veya hacminin düşmesi sonucu ortaya çıkan ve genellikle ayağa kalkmakla artan ortostatik baş ağrısıyla karakterize nadir bir sendromdur. Etyolojisi dural yırtıklar, bağ dokusu hastalıkları veya BOS-venöz fistüller gibi faktörlere dayanır; tanı koymada kranyal ve spinal MR görüntüleme temel yöntemlerdir. Tedavi sürecinde yatak istirahati ve hidrasyon gibi konservatif yaklaşımlar ilk basamak olup, dirençli vakalarda epidural kan yaması veya cerrahi müdahale gerekmektedir. Klinik şüphe durumunda anamnez ve nörogörüntüleme yöntemlerinin birlikte kullanılması doğru tanı için kritiktir.
Spontaneous intracranial hypotension (SIH) is a rare syndrome characterized by decreased cerebrospinal fluid (CSF) pressure or volume, typically manifesting as orthostatic headaches that worsen when standing. Its etiology often involves dural tears, connective tissue disorders, or CSF-venous fistulas, with cranial and spinal MRI serving as the primary diagnostic tools. Treatment begins with conservative measures like bed rest and hydration, while resistant cases require interventions such as epidural blood patches or, in severe instances, surgery. Accurate diagnosis relies on a thorough clinical assessment combined with appropriate neuroimaging techniques.
Referanslar
Sun-Edelstein C, Lay CL. Spontaneous intracranial hypotension: Pathophysiology, clinical features and diagnosis. In, Swanson J (ed). Last updated in Apr 08, 2021.
Miyazawa K, Shiga Y, Hasegawa T, et al. CSF hypovolemia vs intracranial hypotension in "spontaneous intracranial hypotension syndrome". Neurology 2003; 60:941-7.
Horton JC, Fishman RA. Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak. Ophthalmology 1994; 101:244-51.
Schievink WI, Reimer R, Folger WN. Surgical treatment of spontaneous intracranial hypotension associated with a spinal arachnoid diverticulum. Case report. J Neurosurg 1994; 80:736-9.
Swanson JW, Dodick DW, Capobianco DJ. Headache and other craniofacial pain. In: Neurology in Clinical Practice, Bradley WG, Daroff RB, Fenichel GM, Marsden CD (Eds), Butterworth, Boston 2000. p.1832.
Marcelis J, Silberstein SD. Spontaneous low cerebrospinal fluid pressure headache. Headache 1990; 30:192-6.
Mokri B. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia--evolution of a concept. Mayo Clin Proc 1999; 74:1113-23.
Levine DN, Rapalino O. The pathophysiology of lumbar puncture headache. J Neurol Sci 2001; 192:1-8.
Ferrante E, Citterio A, Savino A, Santalucia P. Postural headache in a patient with Marfan's syndrome. Cephalalgia 2003; 23:552-5.
Kumar N, Diehn FE, Carr CM, et al. Spinal CSF venous fistula: A treatable etiology for CSF leaks in craniospinal hypovolemia. Neurology 2016; 86:2310-2.
Schievink WI, Moser FG, Maya MM. CSF-venous fistula in spontaneous intracranial hypotension. Neurology 2014; 83:472-3.
Franzini A, Messina G, Nazzi V, et al. Spontaneous intracranial hypotension syndrome: a novel speculative physiopathological hypothesis and a novel patch method in a series of 28 consecutive patients. J Neurosurg 2010; 112:300-6.
Schievink WI, Maya MM, Jean-Pierre S, et al. A classification system of spontaneous spinal CSF leaks. Neurology 2016; 87:673-9.
Schievink WI, Maya MM, Moser FG, Tourje J. Spectrum of subdural fluid collections in spontaneous intracranial hypotension. J Neurosurg. 2005;103:608-13.
Schievink WI, Morreale MV, Atkinson JLD, Meyer FB, Piepgras DG, Ebersold MJ. Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. J Neurosurg. 1998;88:243-46.
Mea E, Chiapparini L, Savoiardo M, et al. Headache attributed to spontaneous intracranial hypotension. Neurol Sci. 2008;29:164-165.
Schievink WI, Maya MM, Tourje J. False localizing sign of C1-2 cerebrospinal fluid leak in spontaneous intracranial hypotension. J Neurosurg 2004; 100:639-44.
Rando TA, Fishman RA. Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 1992; 42:481-7.
Amorim JA, Gomes de Barros MV, Valença MM. Post-dural (post-lumbar) puncture headache: Risk factors and clinical features. Cephalalgia. 2012;32:916-23.
Ozge A, Bolay H. Intracranial hypotension and hypertension in children and adolescents. Curr Pain Headache Rep. 2014 Jul;18(7):430.
Syed NA, Mirza FA, Pabaney AH, Rameez-ul-Hassan. Pathophysiology and management of spontaneous intracranial hypotension- a review. J Pak Med Assoc. 2012;62:51-5.
Good DC, Ghobrial M. Pathologic changes associated with intracranial hypotension and meningeal enhancement on MRI. Neurology 1988;43:2698-700.
Krans PG, Gray L, Amrhein TJ. Spontaneous intracranial hypotension: 10 myths and misperceptions. Headache. 2018;58:948-59.
Mokri B. Spontaneous intracranial hypotension. Continuum (Minneap Minn) 2015;21:1086-108.
Luetmer PH, Mokri B. Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks. AJNR Am J Neuroradiol. 2003;24:1711-4.
Wang YF, Lirng JF, Fuh JL, et al. Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension. Neurology 2009;73:1892-8.
D’Antona L, Jaime Merchan MA, Vassilou A, et al. Clinical presentation, investigation findings and treatment outcomes of spontaneous intracranial hypotension syndrome: A systematic review and meta-analysis. JAMA Neurol 2021:78:329-37.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38:1-211.
Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006 May 17;295(19):2286-96.
Lipman IJ. Primary intracranial hypotension:the syndrome of spontaneous low cerebrospinal fluid pressure with traction headache. Dis Nerv Syst. 1997;38:212-3.
Sun-Edelstein C, Lay CL. Spontaneous intracranial hypotension: Treatment and prognosis. In, Swanson JW (ed). Last updated in Jul 08, 2021.
Hoffmann J, Goadsby PJ. Update on intracranial hypertension and hypotension. Curr Opin Neurol 2013;26:240-7.
Amoozegar F, Guglielmin D, Hu W, et al. Spontaneous intracranial hypotension: recommendations for management. Can J Neurol Sci 2013;40:144-57.
Marcelis J, Silberstein SD. Spontaneous low cerebrospinal fluid pressure headache. Headache 2990;30:192-6.
Wilmott RW. Pediatric spontaneous intracranial hypotension. J Pediatrics. 2013;163:309-11.
Bateman BT, Cole N, Sun-Edelstein C, Lay CL. Post dural puncture headache. In, Hepner DL, Swanson JW (eds). UpToDate, last updated Feb 03, 2021.
Bakshi R, Mechtler LL, Kamran S, et al. MRI findings in lumbar puncture headache syndrome: abnormal dural-meningeal and dural venous sinüs enhancement. Clin Imaging. 1999;23:73-6.
Ljubisavljevic S, Trajkovic JZ, Ignjatovic A, Stojanov A. Parameters related to lumbar puncture do not affect occurrence of postdural puncture headache but might influence its clinical phenotype. World Neurosurg. 2020;133:e540.
Smith JH, Mac Grory B, Butterfield RJ, et al. CSF Pressure, Volume, and Post-Dural Puncture Headache: A Case-Control Study and Systematic Review. Headache. 2019; 59:1324-38.
Kokki H, Salonvaara M, Herrgård E, Onen P. Postdural puncture headache is not an age-related symptom in children: a prospective, open-randomized, parallel group study comparing a 22-gauge Quincke with a 22-gauge Whitacre needle. Paediatr Anaesth. 1999; 9:429-34.
Kokki H, Heikkinen M, Turunen M, et al. Needle design does not affect the success rate of spinal anaesthesia or the incidence of postpuncture complications in children. Acta Anaesthesiol Scand. 2000; 44:210-3.
Nath S, Koziarz A, Badhiwala JH, et al. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis. Lancet 2018;391:1197-204.
Strupp M, Brandt T, Müller A. Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients. J Neurol. 1998; 245:589-92.
