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Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension
BACKGROUND: We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist i...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511987/ https://www.ncbi.nlm.nih.gov/pubmed/37147116 http://dx.doi.org/10.1136/jnnp-2023-331166 |
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author | Cheema, Sanjay Anderson, Jane Angus-Leppan, Heather Armstrong, Paul Butteriss, David Carlton Jones, Lalani Choi, David Chotai, Amar D'Antona, Linda Davagnanam, Indran Davies, Brendan Dorman, Paul J Duncan, Callum Ellis, Simon Iodice, Valeria Joy, Clare Lagrata, Susie Mead, Sarah Morland, Danny Nissen, Justin Pople, Jenny Redfern, Nancy Sayal, Parag P Scoffings, Daniel Secker, Russell Toma, Ahmed K Trevarthen, Tamsin Walkden, James Beck, Jürgen Kranz, Peter George Schievink, Wouter Wang, Shuu-Jiun Matharu, Manjit Singh |
author_facet | Cheema, Sanjay Anderson, Jane Angus-Leppan, Heather Armstrong, Paul Butteriss, David Carlton Jones, Lalani Choi, David Chotai, Amar D'Antona, Linda Davagnanam, Indran Davies, Brendan Dorman, Paul J Duncan, Callum Ellis, Simon Iodice, Valeria Joy, Clare Lagrata, Susie Mead, Sarah Morland, Danny Nissen, Justin Pople, Jenny Redfern, Nancy Sayal, Parag P Scoffings, Daniel Secker, Russell Toma, Ahmed K Trevarthen, Tamsin Walkden, James Beck, Jürgen Kranz, Peter George Schievink, Wouter Wang, Shuu-Jiun Matharu, Manjit Singh |
author_sort | Cheema, Sanjay |
collection | PubMed |
description | BACKGROUND: We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG). METHODS: A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH. RESULTS: SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided. CONCLUSIONS: This multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH. |
format | Online Article Text |
id | pubmed-10511987 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-105119872023-09-22 Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension Cheema, Sanjay Anderson, Jane Angus-Leppan, Heather Armstrong, Paul Butteriss, David Carlton Jones, Lalani Choi, David Chotai, Amar D'Antona, Linda Davagnanam, Indran Davies, Brendan Dorman, Paul J Duncan, Callum Ellis, Simon Iodice, Valeria Joy, Clare Lagrata, Susie Mead, Sarah Morland, Danny Nissen, Justin Pople, Jenny Redfern, Nancy Sayal, Parag P Scoffings, Daniel Secker, Russell Toma, Ahmed K Trevarthen, Tamsin Walkden, James Beck, Jürgen Kranz, Peter George Schievink, Wouter Wang, Shuu-Jiun Matharu, Manjit Singh J Neurol Neurosurg Psychiatry General Neurology BACKGROUND: We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG). METHODS: A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH. RESULTS: SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided. CONCLUSIONS: This multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH. BMJ Publishing Group 2023-10 2023-05-05 /pmc/articles/PMC10511987/ /pubmed/37147116 http://dx.doi.org/10.1136/jnnp-2023-331166 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | General Neurology Cheema, Sanjay Anderson, Jane Angus-Leppan, Heather Armstrong, Paul Butteriss, David Carlton Jones, Lalani Choi, David Chotai, Amar D'Antona, Linda Davagnanam, Indran Davies, Brendan Dorman, Paul J Duncan, Callum Ellis, Simon Iodice, Valeria Joy, Clare Lagrata, Susie Mead, Sarah Morland, Danny Nissen, Justin Pople, Jenny Redfern, Nancy Sayal, Parag P Scoffings, Daniel Secker, Russell Toma, Ahmed K Trevarthen, Tamsin Walkden, James Beck, Jürgen Kranz, Peter George Schievink, Wouter Wang, Shuu-Jiun Matharu, Manjit Singh Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension |
title | Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension |
title_full | Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension |
title_fullStr | Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension |
title_full_unstemmed | Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension |
title_short | Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension |
title_sort | multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension |
topic | General Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10511987/ https://www.ncbi.nlm.nih.gov/pubmed/37147116 http://dx.doi.org/10.1136/jnnp-2023-331166 |
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