Hulki FORTA, Münevver ÇELİK, Burcu İSMİHANOĞLU, Dilek NECİOĞLU, Gülay KENANGİL

Spontaneous intracranial hypotension

Spontan intrakraniyal hipotansiyon (SIH) herhangi bir ciddi travma veya lomber ponksiyon yapılma öyküsü olmayan vakalarda, ortostatik başağrısı ve düşük Beyin Omurilik Sıvısı (BOS) basıncı ile karakterize, nadir görülen bir tablodur. Tanı postural başağrısının tanınması ve tipik olarak MRG' de pakimeningial yaygın kontrast tutulumu, subdural sıvı birikimleri ve beynin aşağıya doğru yer değiştirmesi bulgularının izlenmesi ile konur. Vakaların çoğunda SIH nedeni BOS kaçışlarıdır. BOS kaçışının tam olarak nedeni bilinmemektedir. Ancak 2 faktör sorumlu tutulur. Birincisi küçük travmalar, ikincisi ise dural kesenin bölgesel güçsüzlüğüdür. Tedavide yatak istirahati çok önemlidir. Yanıtsız vakalarda epidural kan yamaları ya da nadiren cerrahi kullanılmaktadır.

Spontan intrakraniyal hipotansiyon

Spontaneous intracranial hypotension (SIH) is a rare syndrome characterized by an orthostatic headache with a cerebrospinal fluid (CSF) pressure of less than 40 mm Hg in patients without any history of severe trauma or lumbar puncture. Diagnosis is made by the definition of postural headache and with the typical cranial MRI signs like; pachymenengial diffuse gadolinium enhancement, subdural fluid collections and downward descent of the brain. SIH results from CSF leak in most cases. The exact cause of spontaneous CSF leak often remains unclear. However 2 factors are typically considered: 1-trivial traumas, 2- weakness of the dural sac. Bed rest is important for the treatment. Epidural blood patchs and rarely surgical repair are used for intractable cases.

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