Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcome.

Abstract

OBJECTIVE:

To investigate clinical, MRI, and radioisotope findings and therapeutic outcome of the syndrome of CSF hypovolemia.

METHODS:

Retrospective review was performed of 30 consecutive patients (10 men, 20 women; mean age 37 years) with the syndrome of CSF hypovolemia.

RESULTS:

All patients had an orthostatic headache, which was alleviated to a variable extent on recumbency. Additional clinical symptoms included nausea, dizziness, neck stiffness, blurring of vision, tinnitus, plugged ear, hearing difficulties and radicular pain of the arm. Eighty-two percent of the patients had CSF opening pressure less than 60 mm H2O, 59% had CSF pleocytosis, and 95% had increased CSF protein. Brain MRI showed diffuse pachymeningeal gadolinium enhancement on T1-weighted image in 83%, which was seen as hyperintense signals on T2-weighted imaging. Other features included subdural hematoma/hygroma in 17% and descent of the brain in 48% of the patients. Radioisotope cisternographic results identified CSF leakage sites in 52%, most often at the lumbar region. Also observed were limited ascent of the tracer to the cerebral convexity (91%), early appearance of radioisotope in the bladder (65%), and early soft tissue uptake of radioisotope (43%). Epidural blood patches were performed in 23 patients, which produced complete resolution of headaches in 70%. Two patients underwent drainage of subdural hematoma. None died or were disabled during hospitalization.

CONCLUSIONS:

Patients with CSF hypovolemia frequently have distinct MRI and radioisotope cisternographic abnormalities and often respond favorably to an epidural blood patch.

• Authors: S J Chung, J S Kim, M C Lee
• Journal: Neurology (Neurology) Vol. 55 Issue 9 Pg. 1321-7 (Nov 14 2000) ISSN: 0028-3878 [Print] United States
• PMID: 11087775 (Publication Type: Journal Article)

Topics

• Adult
• Cerebrospinal Fluid Pressure
• Female
• Humans
• Hypovolemia (cerebrospinal fluid, pathology, physiopathology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Subdural Effusion (cerebrospinal fluid, pathology, physiopathology)
• Syndrome