Intracranial Hypotension: A Rare Cause of Orthostatic Headache: A Review of the Etiology, Treatment and Prognosis of 13 Cases

Abstract

To view the causes, clinical picture, treatment and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, along with the cases followed in our clinic.
Method: Thirteen cases (6 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in the study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, the pressure of cerebrospinal fluid taken at lumbar puncture (in available patients), and healing period of the patients were recorded.
Results: Five patients with orthostatic headache and accompanying symptoms, treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, had a complete recovery. Complete recovery was observed in two patients (15.3%) within 10 days, in another two (15.3%) within 15 days and in one patient (7.6%) within 21 days. Headache and other clinical symptoms significantly regressed within 30 days in four patients (37.6%) who received similar treatment, but a mild headache persisted intermittently during follow-up. As the headache had not resolved after 30 days, epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days.
Spontaneous intracranial hypotension should primarily be suspected and contrast-enhanced cranial imaging should be performed in cases complaining about postural headache. It should be kept in mind that there might be cranial nerve paralysis and pyramidal tract signs. At first, conservative treatments should be considered, however if conservative treatments fail, epidural blood patches must be applied.