• The Korean Journal of Nuclear Medicine
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• v.33 no.2
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• pp.184-188
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• 1999

Although cerebrospinal fluid leakage is suggested as one of the causes of spontaneous intracranial hypotension, only a few cases with direct evidence of cerebrospinal fluid leakage on radionuclide cisternography have been reported in the literature. Indirect evidences of cerebrospinal fluid leakage such as early visualization of the soft tissue and bladder or delayed migration of radiotracer have been observed in most patients with spontaneous intracranial hypotension. We report a case of spontaneous intracranial hypotension in which cerebrospinal fluid leakage was directly demonstrated by early dynamic imaging of spine on radionuclide cisternography. We suggest that early dynamic imaging of spine is an important adjunctive procedure in detecting cerebrospinal fluid leakage in patients with spontaneous intracranial hypotension.

• Journal of Korean Neurosurgical Society
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• v.47 no.1
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• pp.48-50
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• 2010

Spontaneous intracranial hypotension is often idiopathic. We report on a patient presenting with symptomatic intracranial hypotension and pain radiating to the right leg caused by a transdurallumbar disc herniation. Magnetic resonance (MR) imaging of the brain revealed classic signs of intracranial hypotension, and an additional spinal MR confirmed a lumbar transdural herniated disc as the cause. The patient was treated with a partial hemilaminectomy and discectomy. We were able to find the source of cerebrospinal fluid leak, and packed it with epidural glue and gelfoam. Postoperatively, the patient's headache and log radiating pain resolved and there-was no neurological deficit. Thus, in this case, lumbar disc herniation may have been a cause of spontaneous intracranial hypotension.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.104-108
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• 1997

Spontaneous intracranial hypotension, a syndrome of low CSF pressure, occurs without preceding events such as lumbar puncture, back trauma, operative procedure or medical illness. The most characteristic symptom is an occipital or frontal headache which is aggrevated in the erect position and relieved in the supine position. This syndrome usually resolves spontaneously or with strict bed rest. When the headach persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of spontaneous intracranial hypotension. Epidural blood produces an organized clot which effectively tamponade any dural CSF leak. The rapid relief of headache immediately after the infusion of blood occur by some other mechanism, such as an increase in subarachnoid pressure that is known to occur with infusion of fluid into the lumbar epidural space. We report three cases of spontaneous intracranial hypotension successfully treated with epidural blood patch.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.79-83
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• 2000

Background: Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The purpose of this study is to analyze the effect of epidural blood patch in spontaneous intracranial hypotension. Methods: The spontaneous intracranial hypotension patients treated with epidural blood patch were analyzed on the symptoms, radiologic images and methods of epidural blood patch retrospectively by the medical records. Results: Patients had postural headache (15 patients) including nausea/vomiting (10 patients), tinnitus (2 patients), neck stiffness (13 patients), vertigo (3 patients) and occular pain (1 patient). Brain CT and MRI showed diffuse enhancement of the pachymeninges (9 patients) and radionuclide cisternography demonstrated direct evidence of leakage (11 patients). With epidural blood patch, the symptoms were promptly relieved in 11 patients. Conclusions: We concluded that epidural blood patch is a good treatment of method in spontaneous intracranial hypotension patients.

• The Korean Journal of Pain
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• v.25 no.2
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• pp.112-115
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• 2012

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.157-161
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• 1999

We report a patient with spontaneous intracranial hypotension. In addition to the cardinal feature of a postural headache and a low CSF pressure, the patient also had subdural hematoma demonstrated by brain MRI. Radionuclide cisternography revealed a CSF leakage in the intracranium. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Methods of treatment are identical to those for post-dural puncture headaches. We experienced a patient with spontaneous intracranial hypotension developed in the intracranium who was successfully managed with a cervical blood patch.

• The Korean Journal of Pain
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• v.23 no.1
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• pp.46-50
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• 2010

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.109-112
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• 1997

Spontaneous intracranial hypotension(SIH) is a rare syndrome of spontaneously occurring postural headache associated with low CSF pressure. It usually occur without evidence of any preceeding events such as lumbar puncture, back trauma, operative procedure, or medical illness. This syndrome usually resolves spontaneously or with strict bed rest. When the headache persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of SIH. We experienced a case of SIH with downward displacement of brain in MRI and successfully treated with epidural blood patch.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.274-276
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• 2011

Spontaneous cerebrospinal fluid (CSF) leak is a recognized cause of spontaneous intracranial hypotension (SIH). Subdural hematoma (SDH) is a serious but rare complication of SIH. An autologous epidural blood patch at the CSF-leak site can effectively relieve SIH. We report a case of bilateral SDH with SIH caused by a CSF leak originating at the C1-2 level. A 55-year-old male complained of orthostatic headache without neurological signs. His symptoms did not respond to conservative treatments including bed rest, hydration and analgesics. Magnetic resonance imaging showed a subdural hematoma in the bilateral fronto-parietal region, and computed tomography (CT) myelography showed a CSF leak originating at the C1-2 level. The patient underwent successful treatment with a CT-guided epidural blood patch at the CSF-leak site after trephination for bilateral SDH.

• The Korean Journal of Nuclear Medicine
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• v.33 no.2
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• pp.178-183
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• 1999

We report four cases of spontaneous intracranial hypotension that were investigated by radionuclide cisternography. $^{99m}Tc$-diethylenetriamine pentaacetic acid radionuclide cisternography of all our patients showed direct sign of cerebrospinal fluid leakage as well as indirect signs of less activity than expected over the cerebral convexities and rapid appearance of bladder activity. The headache of all patients was eventually controlled with bed rest and hydration.