SİBEL GÜLER, Bekir ÇAĞLI, Ufuk UTKU, Ercüment ÜNLÜ, YAHYA HIŞMAN ÇELİK

Intracranial hypotension is a rare cause of orthostatic headache: a review of the etiology, treatment and prognosis of 13 cases

Amaç: Ortostatik başağrısının nadir bir deneni olan spontan intrakraniyal hipotansiyonun nedenleri, kliniği, tedavi ve prognozunu kliniğimizde izlenen olgular eşliğinde gözden geçirmek. Gereç ve Yöntem: Ocak 2009-30 Ekim 2011 tarihleri arasında kliniğimizde tanı alan 5 erkek ve 8 kadın olmak üzere 13 tane spon- tan intrakraniyal hipotansiyon olgusu çalışmaya dahil edildi. Hastalar geliş semtomları, uygulanan tedavi, kraniyal MRG bulguları, uygun hastalarda yapınla BOS basınç değerleri ve klinik iyileşme süreleri değerlendirilerek incelendi. Bulgular: Ortostatik baş ağrısının ve eşlik eden bulguların yatak istirahati, oral sıvı alımının artırılması, intravenöz hidrasyon ve kafein tedavisi uygulanan iki hastada (%15.3) 10 günde iki hastada (%15.3) 15 günde bir hastada (%7.6) 21 günde tamamen düzeldiği görüldü. Benzer tedavi uygulanan dört (%37.6) olguda başağrısı ve diğer klinik özelliklerinin 30 gün içerisinde belirgin olarak gerilediği ancak periyodik takiplerinde hafif şiddette baş ağrılarının aralıklı olarak devam ettiği gözlendi. 30 gün sonrasında ortostatik baş ağrısı gerilemeyen olgulara uygulanan epidural kan yaması sonrasında 10-15 gün içerisinde kliniklerinin tamamen düzeldiği görüldü. Sonuç: Postural baş ağrısı tarifleyen olgularda öncelikle spontan intrakraniyal hipotansiyondan (SIH) mutlaka şüphe edilmeli ve kontrastlı kraniyal görüntüleme yapılmalıdır. Kraniyal sinir paralizileri ve piramidal traktus bulguları olabileceği unutulmamalıdır. Epidural kan yamaları konservatif tedavinin yetersiz kaldığı olgulara uygulanmalıdır.

Ortostatik baş ağrısının çok nadir bir nedeni: İntrakranial hipotansiyonlu 13 olgunun etyoloji, tedavi ve prognozlarının gözden geçirilmesi

Objectives: The aim of this investigation is to examine the causes, clinical picture, treatment, and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, among the cases presenting in our clinic. Methods: Thirteen cases (5 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in this study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, cerebrospinal fluid pressure measured at lumbar puncture (in available patients), and the healing period of the patients were recorded. Results: Five patients with orthostatic headache and accompanying symptoms were treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, and experienced 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 in these individuals. As the headache had not resolved after 30 days, an epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days. Conclusion: Spontaneous intracranial hypotension should primarily be suspected in cases complaining about postural head- ache and contrast-enhanced cranial imaging should be performed. The presence of cranial nerve paralysis and pyramidal tract signs should b considered. Conservative treatments should be considered initially, however if conservative treatments fail, epidural blood patches must be applied.

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