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Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation
Spontaneous intracranial hypotension (SIH) occurs due to a leakage of the cerebrospinal fluid (CSF) lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. As a result of less support provided by CSF pressure, intracranial structures are stretched downwa...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179697/ https://www.ncbi.nlm.nih.gov/pubmed/37176727 http://dx.doi.org/10.3390/jcm12093287 |
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author | Bin Wan Hassan, Wan Muhammad Nazief Mistretta, Francesco Molinaro, Stefano Russo, Riccardo Bosco, Giovanni Gambino, Andrea Bergui, Mauro |
author_facet | Bin Wan Hassan, Wan Muhammad Nazief Mistretta, Francesco Molinaro, Stefano Russo, Riccardo Bosco, Giovanni Gambino, Andrea Bergui, Mauro |
author_sort | Bin Wan Hassan, Wan Muhammad Nazief |
collection | PubMed |
description | Spontaneous intracranial hypotension (SIH) occurs due to a leakage of the cerebrospinal fluid (CSF) lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. As a result of less support provided by CSF pressure, intracranial structures are stretched downward, leading to a constellation of more or less typical MRI findings, including venous congestion, subdural effusions, brainstem sagging and low-lying cerebellar tonsils. Clinic examination and an MRI are usually enough to allow for the diagnosis; however, finding the location of the dural tear is challenging. SIH shares some MRI features with Chiari malformation type I (CM1), especially low-lying cerebellar tonsils. Since SIH is likely underdiagnosed, these findings could be interpreted as signs of CM1, leading to a misdiagnosis and an incorrect treatment pathway. Medical treatment, including steroids, bed rest, hydration caffeine, and a blind epidural blood patch, have been used in this condition with variable success rates. For some years, CSF venous fistulas have been described as the cause of SIH, and a specific diagnostic and therapeutic pathway have been proposed. The current literature on SIH with a focus on diagnosis, treatment, and differential diagnosis with CM1, is reviewed and discussed. |
format | Online Article Text |
id | pubmed-10179697 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-101796972023-05-13 Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation Bin Wan Hassan, Wan Muhammad Nazief Mistretta, Francesco Molinaro, Stefano Russo, Riccardo Bosco, Giovanni Gambino, Andrea Bergui, Mauro J Clin Med Review Spontaneous intracranial hypotension (SIH) occurs due to a leakage of the cerebrospinal fluid (CSF) lowering the pressure of subarachnoid space, mostly caused by a dural breach or discogenic microspur. As a result of less support provided by CSF pressure, intracranial structures are stretched downward, leading to a constellation of more or less typical MRI findings, including venous congestion, subdural effusions, brainstem sagging and low-lying cerebellar tonsils. Clinic examination and an MRI are usually enough to allow for the diagnosis; however, finding the location of the dural tear is challenging. SIH shares some MRI features with Chiari malformation type I (CM1), especially low-lying cerebellar tonsils. Since SIH is likely underdiagnosed, these findings could be interpreted as signs of CM1, leading to a misdiagnosis and an incorrect treatment pathway. Medical treatment, including steroids, bed rest, hydration caffeine, and a blind epidural blood patch, have been used in this condition with variable success rates. For some years, CSF venous fistulas have been described as the cause of SIH, and a specific diagnostic and therapeutic pathway have been proposed. The current literature on SIH with a focus on diagnosis, treatment, and differential diagnosis with CM1, is reviewed and discussed. MDPI 2023-05-05 /pmc/articles/PMC10179697/ /pubmed/37176727 http://dx.doi.org/10.3390/jcm12093287 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Bin Wan Hassan, Wan Muhammad Nazief Mistretta, Francesco Molinaro, Stefano Russo, Riccardo Bosco, Giovanni Gambino, Andrea Bergui, Mauro Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation |
title | Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation |
title_full | Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation |
title_fullStr | Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation |
title_full_unstemmed | Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation |
title_short | Overview of Spontaneous Intracranial Hypotension and Differential Diagnosis with Chiari I Malformation |
title_sort | overview of spontaneous intracranial hypotension and differential diagnosis with chiari i malformation |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179697/ https://www.ncbi.nlm.nih.gov/pubmed/37176727 http://dx.doi.org/10.3390/jcm12093287 |
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