Open AccessIntracranial Hypotension for Anesthesiologists: What We Should Know
Author(s) -
Maria Eugenia Calvo
Publication year - 2019
Publication title -
interventional pain management reports
Language(s) - English
Resource type - Journals
ISSN - 2575-9841
DOI - 10.36076/pmcr.2019/3/69
Subject(s) - medicine , intracranial hypotension , headaches , epidural blood patch , spontaneous intracranial hypotension , leak , anesthesia , cerebrospinal fluid leak , cerebral blood flow , cerebrospinal fluid , orthostatic vital signs , presentation (obstetrics) , surgery , radiology , blood pressure , environmental engineering , engineering
The common denominator of spontaneous intracranialhypotension (SIH), postsurgical cerebralspinal fluid (CSF) leaks, and postpuncture headache(PPH) is a decrease in CSF volume. Thetypical presentation is orthostatic headaches, butatypical headaches can be difficult to diagnoseand challenging to treat. Management is basedon clinical suspicion and characterization of theheadache, followed by imaging (noninvasive orinvasive). Treatment ranges from conservativeto different modalities of epidural blood patches,fibrin glue injections, or surgical exploration andrepair.We report 5 cases with great variation in clinicaland radiological presentations. Two cases ofSIH involved difficult diagnosis and treatment, 2others featured postsurgical high-flow CSF leaks,and one case presented with a low-flow CSFleak that needed closer evaluation in relation tohardware manipulation.In all cases, recommendations for diagnosis andmanagement of intracranial hypotension were followed,even though in 3 cases the mechanism oftrauma was not related to spontaneous hypotension.All cases of headache were resolved.The actual recommendations for SIH are veryeffective for PPH and postsurgical CSF leaks.With this case series, we illustrate how anatomicaland clinical considerations are paramount inchoosing appropriate imaging modalities andclinical management.Key words: CSF leak, epidural blood patch,intracranial hypotension, postural headaches,subdural hematomas