Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment
Abstract Background Spontaneous intracranial hypotension (SIH) is characterized by positional headache caused by low CSF pressure, without any major traumatic event. Optimal treatment is still debated; epidural blood patch (EBP) is usually used after unsuccessful conservative treatment with variable...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2021-07-01
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| Series: | Egyptian Journal of Neurosurgery |
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| Online Access: | https://doi.org/10.1186/s41984-021-00109-x |
| _version_ | 1830512421349883904 |
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| author | Efthalia Angelopoulou Eirini Pantou Georgios Zacharis Michail Rentzos Leonidas Stefanis Vasiliki Zouvelou |
| author_facet | Efthalia Angelopoulou Eirini Pantou Georgios Zacharis Michail Rentzos Leonidas Stefanis Vasiliki Zouvelou |
| author_sort | Efthalia Angelopoulou |
| collection | DOAJ |
| description | Abstract Background Spontaneous intracranial hypotension (SIH) is characterized by positional headache caused by low CSF pressure, without any major traumatic event. Optimal treatment is still debated; epidural blood patch (EBP) is usually used after unsuccessful conservative treatment with variable efficacy and potentially severe complications. Although steroids have been reported to be beneficial, their effectiveness is still controversial, and more clinical evidence is needed. Case presentation A 37-year-old woman was admitted to the neurology department due to severe orthostatic headache with nausea over the last 5 days. No trauma history or spinal manipulation were mentioned. On arrival, neurological examination, brain CT, and laboratory investigation were normal. Intracranial hypotension was clinically suspected, and lumbar puncture revealed low opening pressure. Brain MRI demonstrated pachymeningeal gadolinium enhancement and distended and rounded dural venous sinuses, while cervicothoracic spine MRI revealed thoracic CSF leakage, leading to SIH diagnosis. The patient was treated with high-dose intravenous methylprednisolone, with complete clinical resolution within 24 h. Conclusions Our case, combined with literature evidence, supports the high-dose intravenous corticosteroids as a reasonable treatment option in selected cases, before trying EBP or surgical repair. Randomized clinical trials are needed, in order to optimize SIH patients’ outcomes. |
| first_indexed | 2024-12-22T02:27:51Z |
| format | Article |
| id | doaj.art-d3fa0f0529734d0eb89b326b65cc3af7 |
| institution | Directory Open Access Journal |
| issn | 2520-8225 |
| language | English |
| last_indexed | 2024-12-22T02:27:51Z |
| publishDate | 2021-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Journal of Neurosurgery |
| spelling | doaj.art-d3fa0f0529734d0eb89b326b65cc3af72022-12-21T18:41:57ZengSpringerOpenEgyptian Journal of Neurosurgery2520-82252021-07-013611910.1186/s41984-021-00109-xCorticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatmentEfthalia Angelopoulou0Eirini Pantou1Georgios Zacharis2Michail Rentzos3Leonidas Stefanis4Vasiliki Zouvelou5Department of Neurology, National and Kapodistrian University of Athens, Eginition HospitalResearch Unit of Radiology, 2nd Department of Radiology, National and Kapodistrian University of Athens, Eginition HospitalDepartment of Neurology, National and Kapodistrian University of Athens, Eginition HospitalDepartment of Neurology, National and Kapodistrian University of Athens, Eginition HospitalDepartment of Neurology, National and Kapodistrian University of Athens, Eginition HospitalDepartment of Neurology, National and Kapodistrian University of Athens, Eginition HospitalAbstract Background Spontaneous intracranial hypotension (SIH) is characterized by positional headache caused by low CSF pressure, without any major traumatic event. Optimal treatment is still debated; epidural blood patch (EBP) is usually used after unsuccessful conservative treatment with variable efficacy and potentially severe complications. Although steroids have been reported to be beneficial, their effectiveness is still controversial, and more clinical evidence is needed. Case presentation A 37-year-old woman was admitted to the neurology department due to severe orthostatic headache with nausea over the last 5 days. No trauma history or spinal manipulation were mentioned. On arrival, neurological examination, brain CT, and laboratory investigation were normal. Intracranial hypotension was clinically suspected, and lumbar puncture revealed low opening pressure. Brain MRI demonstrated pachymeningeal gadolinium enhancement and distended and rounded dural venous sinuses, while cervicothoracic spine MRI revealed thoracic CSF leakage, leading to SIH diagnosis. The patient was treated with high-dose intravenous methylprednisolone, with complete clinical resolution within 24 h. Conclusions Our case, combined with literature evidence, supports the high-dose intravenous corticosteroids as a reasonable treatment option in selected cases, before trying EBP or surgical repair. Randomized clinical trials are needed, in order to optimize SIH patients’ outcomes.https://doi.org/10.1186/s41984-021-00109-xSIHCSF leakageEpidural blood patchCorticosteroidsHeadache |
| spellingShingle | Efthalia Angelopoulou Eirini Pantou Georgios Zacharis Michail Rentzos Leonidas Stefanis Vasiliki Zouvelou Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment Egyptian Journal of Neurosurgery SIH CSF leakage Epidural blood patch Corticosteroids Headache |
| title | Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment |
| title_full | Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment |
| title_fullStr | Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment |
| title_full_unstemmed | Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment |
| title_short | Corticosteroids for spontaneous intracranial hypotension: a case-report and critical review focusing on pathophysiology and treatment |
| title_sort | corticosteroids for spontaneous intracranial hypotension a case report and critical review focusing on pathophysiology and treatment |
| topic | SIH CSF leakage Epidural blood patch Corticosteroids Headache |
| url | https://doi.org/10.1186/s41984-021-00109-x |
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