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Traumatic vs Spontaneous Cerebrospinal Fluid Hypotension Headache: Our experience in a series of 137 cases

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dc.contributor.author Villamil, Facundo
dc.contributor.author Ruella, Mauro
dc.contributor.author Pérez, Adriana
dc.contributor.author Millar Vernetti, Patricio
dc.contributor.author Paday Formenti, María Emilia
dc.contributor.author Acosta, Julián Nicolás
dc.contributor.author Goicochea, María Teresa
dc.date.accessioned 2021-05-17T12:33:14Z
dc.date.available 2021-05-17T12:33:14Z
dc.date.issued 2020-11
dc.identifier.citation Villamil, F., Ruella, M., Perez, A., Millar Vernetti, P., Paday Formenti, M.E., Acosta, J.N., Goicochea, M.T., 2020. Traumatic vs Spontaneous Cerebrospinal Fluid Hypotension Headache: Our experience in a series of 137 cases. Clin Neurol Neurosurg 198, 106140. https://doi.org/10.1016/j.clineuro.2020.106140. es_ES
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/483
dc.identifier.uri https://doi.org/10.1016/j.clineuro.2020.106140
dc.description.abstract Objectives: To analyze and compare differences between epidemiological and clinical aspects, as well as radiologic findings and treatment, in a series of adult patients with traumatic intracranial hypotension (TIH) and spontaneous intracranial hypotension (SIH) treated at our institution in order to identify predictors of recurrence. Background: Cerebrospinal fluid hypotension headache (CSF-HH) is often caused by orthostasis and relieved by recumbency. Etiology can be either traumatic or spontaneous. Indirect signs of CSF hypotension are often observed on brain MRI. The most common therapeutic approach is conservative management and, when necessary, the use of an epidural blood patch. Methods: Medical history and brain MRI of adult patients consulting our institution with a diagnosis of CSF-HH between January 2010 and March 2019, were retrospectively reviewed. Clinical criteria as per the International Classification of Headache Disorders, 3rd edition, were applied. Presence of typical MRI findings were assessed by two experienced neuroradiologists, previously informed of patients' clinical characteristics. Patients were divided into two different groups, namely: Group A: Spontaneous Intracranial Hypotension (SIH) and Group B: Traumatic Intracranial Hypotension (TIH). Recurrence was defined as return of symptoms after one month of remission. In order to find predictors of recurrent intracranial hypotension the patients were divided into three groups: Recurrent Orthostatic headache (ROH); (33 cases; 25%); Non-Recurrent Orthostatic headache (NROH) (84; 61%) and Patients missing follow-up (20; 15%). The latter were excluded from the regression analysis. Results: 137 patients with CSF-HH were identified: 80 traumatic (54 women, age 33.8 ± 10.4 years) and 57 spontaneous (31 women, age 43.9 ± 15.2 years). Median follow-up was 35 months (range: 8 months-9 years). Compared with TIH, patients with SIH showed lower frequency of orthostatic headache and higher frequency of aural fullness. Also, in patients with SIH, brain MRI showed a higher frequency of pachymeningeal enhancement, ventricular collapse, cisternal obliteration, posterior fossa crowding, brainstem distortion, and a more likely presence of subdural collections. Patients with SIH required an epidural blood patch treatment more often, showed higher recurrence rates, and were more prone to develop subdural hematomas. Recurrence: As more days elapsed between headache onset and clinical consultation, the presence of spontaneous intracranial hypotension, tinnitus, and thoraco-lumbo-sacral pain were all more common in patients with recurrence. Findings on brain MRI suggesting higher recurrence rates in patients included: ventricular collapse, brainstem distortion, and posterior fossa crowding. Patients treated with invasive therapy (epidural blood patch) presented a higher recurrence rate. In the multivariate regression analysis, the only independent predictor of recurrence after adjusting for age, sex and traumatic vs spontaneous cause of IH, was brainstem distortion diagnosed on MRI (OR 5.13, 95% CI: 1.2-21.7; p = 0.026). Conclusions: SIH and TIH can no longer be likened, since there is considerable variability in clinical presentation, imaging findings, response to treatment and recurrence rates. Anatomical abnormalities underlying SIH leaks are often complex and not simply a disruption of normal structures as encountered in TIH, which could explain why treatment success is poor and recurrence rates remain high. es_ES
dc.language.iso eng es_ES
dc.publisher Elsevier es_ES
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Headache Disorders
dc.subject Trastornos de Cefalalgia
dc.subject Cerebrospinal Fluid es_ES
dc.subject Líquido Cefalorraquíde es_ES
dc.subject Intracranial Hypotension es_ES
dc.subject Hipotensión Intracraneal es_ES
dc.title Traumatic vs Spontaneous Cerebrospinal Fluid Hypotension Headache: Our experience in a series of 137 cases es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Villamil, Facundo. Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Fil: Ruella, Mauro. Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Fil: Pérez, Adriana. Fleni. Servicio de Anestesiología; Argentina.
dc.description.fil Fil: Millar Vernetti, Patricio. Fleni. Departamento de Neurología. Servicio de Movimientos Anormales; Argentina.
dc.description.fil Fil: Paday Formenti, María Emilia. Fleni. Departamento de Diagnóstico por Imágenes; Argentina.
dc.description.fil Fil: Acosta, Julián Nicolás. Fleni. Departamento de Neurología; Argentina.
dc.relation.ispartofVOLUME 198
dc.relation.ispartofPAGINATION 106140
dc.relation.ispartofCOUNTRY Países Bajos
dc.relation.ispartofCITY Ámsterdam
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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