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- Title
Treatment Outcomes in Spontaneous Intracranial Hypotension: Do Epidural Blood Patches Stop the Leaks?
- Authors
Diaz, James H.
- Abstract
Spontaneous intracranial hypotension (SIH) is a postural headache syndrome unrelated to dural puncture. Because of the increasing failure of epidural blood patch (EBP) to relieve headache in SIH, we retrospectively investigated the epidemiological features and treatment outcomes in 55 cases of SIH. The study population was stratified by age and sex; continuous variables were compared for differences byt-tests; categorical variables were compared by Chi-squared analysis or Fisher exact tests. Significant differences were identified byPvalues of 0.05 or less. The mean age of the study population was 44 ± 12 years with a female to male ratio of 1.3:1.0. Men presented with subdural hematomas (P = 0.001) more often than women. Meningeal enhancement on contrast magnetic resonance imaging (MRI) was the most consistent radiographic finding. Radionuclide cisternography (RC) demonstrated thoracolumbar dural leaks in 16 of 22 patients. EBP failures were more common in patients aged 40 and younger than in older patients (P = 0.003). Postural headache from SIH was not uniformly responsive to EBP, and had significant comorbidities, especially in men. The management of postural headache in SIH by other techniques to restore brain position and cerebrospinal fluid dynamics should be investigated.
- Subjects
MIGRAINE; HEADACHE; PAIN; HYPOTENSION; PAIN management; THERAPEUTICS
- Publication
Pain Practice, 2004, Vol 4, Issue 4, p295
- ISSN
1530-7085
- Publication type
Article
- DOI
10.1111/j.1533-2500.2004.04405.x