Diagnoses and treatments of spontaneous intracranial hypotension: an analysis of 12 cases

Objective To explore the diagnoses of spontaneous intracranial hypotension, and discuss the therapeutic efficacy of epidural blood patch therapy in spontaneous intracranial hypotension patients. Methods The clinical data of 12 patients with spontaneous intracranial hypotension, admitted to our hospital from January 2013 to December 2018, were retrospectively analyzed. The lumbar puncture results, MR imaging features of the skull and spine, and CT myelography (CTM) features of these patients were analyzed. The treatment efficacies of epidural blood patch, which included blind epidural blood patch and targeted epidural blood patch, were compared. Results The cerebrospinal fluid pressure of 12 patients was ≤60 mmH2O. Ten patients (83.3%) showed subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain on brain MR imaging, and one of the patient showed pituitary hemorrhage. Seven patients (63.3%) showed spinal dural epithelial fluid accumulation and venous plexus expansion on spine MR imaging, and one of the patient showed dorsolateral dural discontinuous thickening of T6 and forward movement of the spinal cord caused by massive dorsal epidural effusion. Twelve patients in this group underwent CTM, and were found cerebrospinal fluid leakage. Twelve patients applied 14-times epidural blood tests; 4 responded well to one-time targeted epidural blood patch therapy, with success rate of 100%; 8 patients used blind epidural blood patch therapy, and 6 patients responded well to one-time therapy, with success rate of 75%, one patient improved with blind epidural blood stick twice, and one patient was ineffective twice. Conclusions Head MR imaging combined with spinal MR imaging is a non-invasive method to diagnose spontaneous intracranial hypotension. Myelogram can determine whether there is a leakage of spinal cerebrospinal fluid and accurately locate the leakage site. Epidural blood patch therapy is an effective method for treatment of patients with spontaneous intracranial hypotension. With the precise location of leak points by myelography, targeted epidural blood patch is more effective. Key words: Spontaneous intracranial hypotension; Cerebrospinal fluid leakage; Epidural blood patch; Myelography