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decreased intracranial pressure; intracranial hypotension
Etiology:
- ventriculostomy
- lumbar puncture
- trauma
- spontaneous (idiopathic)
- risk factors
- young age, female, low BMI
- use of larger gauge needles or conventional cutting
Pathology:
- CSF leakage
Clinical manifestations:
- postural headache worsening in upright position, improving in supine postition
- physical examination generally normal
- cranial nerve 6 palsy possible
Special laboratory:
- lumbar puncture with opening pressure & CSF analysis
Radiology:
- contrast-enhanced MRI of brain & spinal cord
- diffuse parenchymal enhancement in 80% [1]
- diffuse smooth dural thickening with contrast-enhancement (80%)*
- cerebellar tonsil descent*
- clinically insignificant subdural fluid collections*
- CT myelography if MRI does not reveal site of CSF leakage
* from case [1]
Management:
- bedrest, analgesia, clinical hydration
- if conservative measures fail, 10-15 mL of homologous blood can be injected into the epidural space (epidural blood patch)
- epidural blood patch associated with resolution of symptoms in 80-90% of patients
- alternative treatments:
- intravenous caffeine
- epidural saline
Related
cerebral perfusion pressure (CPP)
criteria for removal of intracranial pressure (ICP) monitor
increased intracranial pressure (ICP)
intracranial pressure (ICP)
General
sign/symptom
disease/disorder primarily affecting brain
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19.
American College of Physicians, Philadelphia 2015, 2018, 2021.
- Hoffmann J, Goadsby PJ
Update on intracranial hypertension and hypotension.
Curr Opin Neurol. 2013 Jun;26(3):240-7
PMID: 23594732