SPONTAN İNTRAKRANİYAL HİPOTANSİYON

Abstract

Amaç: Spontan intrakraniyal hipotansiyon dural yırtığa bağlı ortaya çıkan beyin omurilik sıvısı kaçağının neden olduğu klinik tablodur. Bu çalışmada, spontan intrakraniyal hipotansiyonun epidemiyoloji, patofizyoloji, tanı, tedavi ve prognozuna ilişkin bilgilerin gözden geçirilmesi amaçlanmıştır.

Gereç ve Yöntem: Hastalığın tahmini insidansı 2-5/100.000 olup, dördüncü dekadda sıklık artmaktadır. Kadınlar erkeklerden daha çok etkilenir ve altta yatan konnektif doku hastalığına eşlik eden mekanik olaylar beyin omurilik sıvısı kaçağına yol açabilir.

Bulgular: Tipik klinik bulgusu postüral baş ağrısıdır. MRG'de pakimeningeal kontrast tutulumu, venöz yapılarda konjesyon, subdural effüzyon-kanama, hipofizde hiperemi, beyin dokusunun aşağı doğru yer değiştirmesi kardinal bulgulardır. Spinal göllenmenin lokalizasyonunu saptamada radyonüklid sisternografi, BT-miyelografi, MR-miyelografi kullanılır. Tedavi, sırasıyla konservatif yöntemler (mutlak yatak istirahatı), epidural kan yaması ve cerrahi yöntemlerden oluşmaktadır.

Sonuç: Spontan intrakraniyal hipotansiyon, son yıllarda giderek artan sayıda bildirilen, tanısı geciktiğinde ciddi nörolojik komplikasyonlara yol açan, erken tanı ve tedavi ile geri dönüşümlü olabilen bir klinik tablodur.

Keywords

• spontan intrakraniyal hipotansiyon
• Manyetik rezonans görüntüleme
• postüral baş ağrısı
• sisternografi
• myelografi

SPONTANEOUS INTRACRANIAL HYPOTENSION

Abstract

Objective: Spontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid leaks due to dural tear. In this study, epidemiology, pathophysiology, diagnosis, treatment and prognosis of spontaneous intracranial hypotension are summarized.

Matherials and Methods: The incidence has been estimated at 2-5/100.000 with a peak in fourth decade. Women are affected more commonly than men. Mechanical factors combined with an underlying connective tissue disorder cause cerebrospinal fluid leaks.

Results: The typical clinical finding is the postural headache. The cardinal findings of magnetic resonance imaging include enhancement of the pachymeninges, engorgement of venous structures, subdural effusion-hematome, pituitary hyperemia and sagging of the brain. Radionuclide systernography, CT myelography, MR-myelography are the studies to investigate the spinal cerebrospinal fluid leak. Treatments include conservative (total bed rest), epidural blood patching and surgical treatment of cerebrospinal fluid leak. The increasing number of patients are diagnosed with spontaneous intracranial hypotension recently which is reversible if treated early while delayed diagnosis may cause serious neurological complications.

Keywords

• spontaneous intracranial hypotension
• magnetic resonance imaging
• postural headache
• systernography
• myelography

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