Similar articles

Abstract: Objective: spontaneous intracranial hypotension (SIH) is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid (CSF) pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure (CSF OP) and explore the factors affecting CSF OP in SIH patients. Methods: We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables (including demographic data, body mass index (BMI), duration of symptoms, and brain imaging findings). Univariate and multivariate analyses were performed to identify the potential factors affecting CSF OP. Results: In a total of 114 (55.3%) cases the CSF OP was ≤60 mmH₂O (1 mmH₂O=9.806 65 Pa), in 90 (43.7%) cases it was between 60 and 200 mmH₂O, and in 2 (1.0%) cases it was >200 mmH₂O. Univariate analysis showed that the duration of symptoms (P<0.001), BMI (P<0.001), and age (P=0.024) were positively correlated with CSF OP. However, multivariate analysis suggested that only the duration of symptoms (P<0.001) and BMI (P<0.001) were strongly correlated with CSF OP. A relatively high R² of 0.681 was obtained for the multivariate model. Conclusions: Our study indicated that in patients without a low CSF OP, a diagnosis of SIH should not be excluded. BMI and the duration of symptoms can influence CSF OP in SIH patients, and other potential factors need further investigation.

影响自发性颅内低压患者的脑脊液开放压的潜在因素

[1]Berdahl, J.P., Fleischman, D., Zaydlarova, J., et al., 2012. Body mass index has a linear relationship with cerebrospinal fluid pressure. Invest. Ophthalmol. Vis. Sci., 53(3): 1422-1427.

[2]Bloomfield, G.L., Dalton, J.M., Sugerman, H.J., et al., 1995. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J. Trauma, 39(6):1168-1170.

[3]Bloomfield, G.L., Ridings, P.C., Blocher, C.R., et al., 1997. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit. Care Med., 25(3):496-503.

[4]Chung, S.J., Kim, J.S., Lee, M.C., 2000. Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcome. Neurology, 55(9):1321-1327.

[5]Chung, S.J., Lee, J.H., Kim, S.J., et al., 2006. Subdural hematoma in spontaneous CSF hypovolemia. Neurology, 67(6):1088-1089.

[6]Greer, M., 1962. Benign intracranial hypertension. I. Mastoiditis and lateral sinus obstruction. Neurology, 12:472-476

[7]Kranz, P.G., Tanpitukpongse, T.P., Choudhury, K.R., et al., 2015. How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension? Cephalalgia, 36(13):1209-1217.

[8]Kranz, P.G., Tanpitukpongse, T.P., Choudhury, K.R., et al., 2016. Imaging signs in spontaneous intracranial hypotension: prevalence and relationship to CSF pressure. Am. J. Neuroradiol., 37(7):1374-1378.

[9]Limaye, K., Samant, R., Lee, R.W., 2016. Spontaneous intracranial hypotension: diagnosis to management. Acta Neurol. Belg., 116(2):119-125.

[10]Luce, J.M., Huseby, J.S., Kirk, W., et al., 1982. Mechanism by which positive end-expiratory pressure increases cerebrospinal fluid pressure in dogs. J. Appl. Physiol. Respir. Environ. Exerc. Physiol., 52(1):231-235.

[11]Luetmer, P.H., Mokri, B., 2003. Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks. Am. J. Neuroradiol., 24(8):1711-1714.

[12]Luetmer, P.H., Schwartz, K.M., Eckel, L.J., et al., 2012. When should I do dynamic CT myelography? Predicting fast spinal CSF leaks in patients with spontaneous intracranial hypotension. Am. J. Neuroradiol., 33(4):690-694.

[13]Markey, K.A., Uldall, M., Botfield, H., et al., 2016. Idiopathic intracranial hypertension, hormones, and 11β-hydroxysteroid dehydrogenases. J. Pain Res., 9:223-232.

[14]Marmarou, A., Shulman, K., Rosende, R.M., 1978. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J. Neurosurg., 48(3):332-344.

[15]Miyazawa, K., Shiga, Y., Hasegawa, T., et al., 2003. CSF hypovolemia vs intracranial hypotension in “spontaneous intracranial hypotension syndrome”. Neurology, 60(6):941-947.

[16]Mokri, B., 1999. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia—evolution of a concept. Mayo Clin. Proc., 74(11):1113-1123.

[17]Mokri, B., 2001. The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology, 56(12):1746-1748.

[18]Mokri, B., 2004. Spontaneous low cerebrospinal pressure/volume headaches. Curr. Neurol. Neurosci. Rep., 4(2):117-124.

[19]Mokri, B., 2013. Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache, 53(7):1034-1053.

[20]Mokri, B., Hunter, S.F., Atkinson, J.L., et al., 1998. Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology, 51(3):786-790.

[21]Rando, T.A., Fishman, R.A., 1992. Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology, 42(3 Pt 1):481-487.

[22]Schievink, W.I., 2006. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA, 295(19):2286-2296.

[23]Schievink, W.I., 2008. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia, 28(12):1345-1356.

[24]Schievink, W.I., Maya, M.M., Louy, C., 2005. Cranial MRI predicts outcome of spontaneous intracranial hypotension. Neurology, 64(7):1282-1284.

[25]Schievink, W.I., Dodick, D.W., Mokri, B., et al., 2011. Diagnostic criteria for headache due to spontaneous intracranial hypotension: a perspective. Headache, 51(9):1442-1444.

[26]Schoffer, K.L., Benstead, T.J., Grant, I., 2002. Spontaneous intracranial hypotension in the absence of magnetic resonance imaging abnormalities. Can. J. Neurol. Sci., 29(3):253-257.

[27]Shin, H.S., Lee, S.H., Ko, H.C., et al., 2016. Extended pneumocephalus after drainage of chronic subdural hematoma associated with intracranial hypotension: case report with pathophysiologic consideration. J. Korean Neurosurg. Soc., 59(1):69-74.

[28]Spears, R.C., 2014. Low-pressure/spinal fluid leak headache. Curr. Pain Headache Rep., 18(6):425.

[29]Sugerman, H., DeMaria, E., Felton, W.R., et al., 1997. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology, 49(2):507-511.

[30]Takahashi, K., Mima, T., Akiba, Y., 2016. Chronic subdural hematoma associated with spontaneous intracranial hypotension: therapeutic strategies and outcomes of 55 cases. Neurol. Med. Chir. (Tokyo), 56(2):69-76.

[31]Wang, J., Zhang, D., Gong, X., et al., 2014. Rapid resolution of subdural hematoma after targeted epidural blood patch treatment in patients with spontaneous intracranial hypotension. Chin. Med. J. (Engl.), 127(11):2063-2066.

[32]Whiteley, W., Al-Shahi, R., Warlow, C.P., et al., 2006. CSF opening pressure: reference interval and the effect of body mass index. Neurology, 67(9):1690-1691.