SPONTAN İNTRAKRANİYAL HİPOTANSİYON

Abstract

Spontan intrakraniyal hipotansiyon (SIH) herhangi bir ciddi travma veya lomber ponksiyon yapılma öyküsü olmayan vakalarda, ortostatik başağrısı ve düşük Beyin Omurilik Sıvısı (BOS) basıncı ile karakterize, nadir görülen bir tablodur. Tanı postural başağrısının tanınması ve tipik olarak MRG' de pakimeningial yaygın kontrast tutulumu, subdural sıvı birikimleri ve beynin aşağıya doğru yer değiştirmesi bulgularının izlenmesi ile konur. Vakaların çoğunda SIH nedeni BOS kaçışlarıdır. BOS kaçışının tam olarak nedeni bilinmemektedir. Ancak 2 faktör sorumlu tutulur. Birincisi küçük travmalar, ikincisi ise dural kesenin bölgesel güçsüzlüğüdür. Tedavide yatak istirahati çok önemlidir. Yanıtsız vakalarda epidural kan yamaları ya da nadiren cerrahi kullanılmaktadır

Keywords

• ortostatik başağrısı, intrakraniyal hipotansiyon

References

1. Aoki N, Sakai T, Oikawa A. Spontaneous intracranial hypoten- sion associated with subdural hematoma : diagnostic usefullness of percutaneous subdural tapping and magnetic resonance ima- ging. Acta Neurol Chir 1998; 140: 47-49.
2. Chung SJ, Kim JS, Lee MC. Syndrome of cerebral spinal fluid hypovolemia. Neurology 2000; 55: 1321-1328.
3. Ferrante E, Citterio A, Savino A, Santalucia P. Postural headac- he in a patient with Marfan Syndrome. Cephalagia 2003; 23: 552-555.
4. Ferrante E, Savino A, Sances G, Nappi G. Spontaneous intracra- nial hypotension syndrome: a report of twelve cases. Headache 2004; 44: 615-622.
5. Frank LR, Paxson A, Brake J. Spontaneous intracranial hypoten- sion. J Emerg Med 2005; 28: 427-430.
6. Guigon B, Tailla H, de la Marniere E, Macarez R, Bazin S, Mad- zou M. Abducens nevre palsy in spontaneous intracranial hypo- tension. J Fr Ophtalmol. 2004; 27: 392-396.
7. Hannerz J, Dahlgren G, Irestedt L, Meyerson B, Ericson K. Tre- atment of idiopathic intracranial hypotension: Cervicothoracic and lumbar blood patch and peroral steroid treatment. Headache 2006; 46: 508-511.
8. Hochman MS, Naidich TP, Kobetz SA, Fernandez-Maitin A. Spontaneous intracranial hypotension with pachymenegial enha- cement on MRI. Neurology 1992; 42: 1628-1630.

9. Kashmere JL, Jacka MJ, Emery D, Gross DW. Reversible coma: a rare presentation of spontaneous intracranial hypotension.Can J Neurol Sci 2004; 31:565-568.
10. Kong DS, Park K, Nam do H, Lee JI, Kim JS, Eoh W, Kim JH. Clinical features and long–term results of spontaneous intracra- nial hypotension. Neurosurgery 2005; 57: 91-96.
11. Marcelis J, Silberstein SD. Spontaneous low cerebrospinal fluid pressure headache. Headache 1990; 30: 192-196.
12. Milledge JT, Ades LC, Cooper MG, Jaumees A, Onikul E. Se- vere spontaneous intracranial hypotension and Marfan syndro- me in an adolescent. J Paediatr Child Health 2005; 41: 68-71.
13. Miyazawa K, Shiga Y, Hasegawa T, Endoh M, Okita N, Higano S, Takahashi S, Itoyama Y. CSF hypovolemia vs intracranial hypotension in "spontaneous intracranial hypotension syndro- me". Neurology 2003; 60: 941-947.
14. Mokri B, Krueger BR, Miller GM, Peipgras DG. Meningeal ga- dolinium enhacement in low pressure headaches. (Abstract) Ann Neurol 1991; 30: 294-295.
15. Mokri B, Peipgras DG, Miller GM. Syndrome of Orthostatic Headaches and Diffuse Pachymeningeal Gadolinium Enhace- ment. Mayo Clinic Proc 1997; 72: 400-413.
16. Mokri B, Hunter SF, Atkinson JLD, Piepgras DG. Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology 1998; 51: 786-790.
17. Mokri B. The Monro-Kellie hypothesis: applications in CSF vo- lume depletion. Neurology 2001; 56: 1746-1748.
18. Mokri B. Headaches caused by decreased intracranial pressure: diagnosis and management. Current Opinion in Neurology 2003; 16; 319-326.
19. Nakajima M, Hirano T, Sasamoto N, Uyama E, Mita S, Uchino M. A case of spontaneous intracranial hypotension without any history of positional headache. No to Shinkei (Abstract) 2002; 54: 991-995.
20. Pannullo SC, Reich JB, Krol G, Deck MD, Posner JB. MRI changes in intracranial hypotension. Neurology 1993; 43: 919- 926.
21. Peng PW. Intracranial hypotension with severe neurological symptomes resolved by epidural blood patch. Can J Neurol Sci 2004; 31:569-71.
22. Pleasure SJ, Abosch A, Friedman J, Ko NU, Barbaro N, Dillon W, Fishman RA, Poncelet AN. Spontaneous intracranial hypo- tension resulting in stupor caused by diencephalic compression. Neurology 1998; 50: 1854-1857.
23. Rai A, Rosen C, Carpenter J, Miele V. Epidural blood patch at C2:diagnosis and treatment of spontaneous intracranial hypoten- sion. AJNR 2005; 26: 2663-2666.
24. Rando TA, Fishman RA. Spontaneous intracranial hypotension: Report of two cases and review of the literature. Neurology 1992; 42: 481-547.
25. Rosser T, Finkel J, Vezina G, Majd M. Postural headache in a child with Marfan syndrome:case report and review of the lite- rature. J Child Neurol 2005; 20: 153-155.
26. Sable SG, Ramadan NM. Meningeal enhacement and low CSF pressure headache : an MRI study. Cephalalgia 1991; 11: 275- 276.
27. Schaltenbrand G. Neuere Anschauungen zur Pathophysiologie der Liquorzirkulation. Zentralbl Neurochir 1938; 3: 290-300.
28. Schaltenbrand G. Die akute Aliquorrhoe. Verh Dtsch Ges Inn Med 1940; 52: 473-481.
29. Schievink WI. Misdiagnosis of Spontaneous Intracranial Hypo- tension. Arch Neurol 2003; 60: 1713-1718.
30. Schievink WI, Gordon OK, Tourje J. Connective tissue disorders with spontaneous spinal cerebrospinal fluid leaks and intracrani- al hypotension: a prospective study. Neurosurgery 2004; 54: 65- 70.
31. Schievink WI, Maya MM, Louy C. Cranial MRI predicts outco- me of spontaneous intracranial hypotension. Neurology 2005; 64: 1282-1284.
32. Seleker FK, Öztürk F, Kenangil G, Çelik M, Forta H. Ehler Dan- los Sendromlu hastada gelişen spontan intrakraniyal hipotansi- yon. Şişli Etfal Hastanesi Tıp Bülteni 2001; 35: 46-49.
33. Trappolini M, Clarice A, Scorza A, Angrisani L, Trappolini F, Rochietti March M, Proietta M. A case of spontaneous intracra- nial hypotension with typical magnetic resonance images. J He- adache Pain 2006; 7: 44-46
34. Vilming ST, Campbell JK. Low cerebrospinal fluid pressure. In: Jes Olesen, Peer Tfelt-Hansen, K.Michael A.Welch (ed). He- adaches. Lippincott Williams and Wilkins, Philedelphia, USA 2000; pp.836-838.
35. Zaatreh M, Finkel A. Spontaneous Intracranial Hypotension. So- uth Med J. 2002; 95: 1342-1345.