• The Korean Journal of Nuclear Medicine
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• v.33 no.2
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• pp.184-188
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• 1999

Although cerebrospinal fluid leakage is suggested as one of the causes of spontaneous intracranial hypotension, only a few cases with direct evidence of cerebrospinal fluid leakage on radionuclide cisternography have been reported in the literature. Indirect evidences of cerebrospinal fluid leakage such as early visualization of the soft tissue and bladder or delayed migration of radiotracer have been observed in most patients with spontaneous intracranial hypotension. We report a case of spontaneous intracranial hypotension in which cerebrospinal fluid leakage was directly demonstrated by early dynamic imaging of spine on radionuclide cisternography. We suggest that early dynamic imaging of spine is an important adjunctive procedure in detecting cerebrospinal fluid leakage in patients with spontaneous intracranial hypotension.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.59-61
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• 2013

Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed.

• The Korean Journal of Pain
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• v.23 no.1
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• pp.46-50
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• 2010

Spontaneous intracranial hypotension (SIH) is considered to be a very rare disorder. It is characterized by an orthostatic headache that is aggravated with the patient in the upright position and it is relieved by the patient assuming the supine position. SIH is caused by a spontaneous spinal cerebrospinal fluid leakage without the patient having undergone trauma, surgery or dural puncture or having any other significant medical history. An autologous epidural blood patch (EBP) is effective in relieving SIH. We report here on a case of SIH with cerebrospinal fluid leakage at the upper cervical vertebral level and the middle thoracic vertebral level. The points of leakage were identified by radionuclide cisternography, and this patient was successfully managed by injecting an EBP at each level of leakage.

• The Korean Journal of Nuclear Medicine
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• v.33 no.2
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• pp.178-183
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• 1999

We report four cases of spontaneous intracranial hypotension that were investigated by radionuclide cisternography. $^{99m}Tc$-diethylenetriamine pentaacetic acid radionuclide cisternography of all our patients showed direct sign of cerebrospinal fluid leakage as well as indirect signs of less activity than expected over the cerebral convexities and rapid appearance of bladder activity. The headache of all patients was eventually controlled with bed rest and hydration.

• Journal of the Korean Society of Radiology
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• v.85 no.1
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• pp.24-35
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• 2024

Spontaneous intracranial hypotension (SIH), which generally presents as orthostatic headache, is increasingly being identified due to improved imaging technologies and heightened awareness. Many prior studies have reported the characteristic brain MRI findings of SIH. However, recently, focus has shifted to spinal MRI, as SIH is believed to be caused by leakage of cerebrospinal fluid from the spinal dural sac. Advanced techniques such as ultrafast CT myelography and digital subtraction myelography have emerged as useful technique to identify the site of cerebrospinal fluid leakage. In this review, we discuss the diagnosis, spinal MRI findings, imaging techniques, and treatment of SIH.

• Journal of Korean Neurosurgical Society
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• v.39 no.1
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• pp.68-71
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• 2006

Spinal subdural hematoma[SSDH] is rare disease. Furthermore, it rarely occurs as a complication of intracranial surgery. There are few case reports which describing SSDH after craniotomy. Although the exact pathogenetic mechanism is obscure, some investigators propose that downward migration of intracranial hematoma by the effect of gravity is one of the cause of SSDH, and which is commonly suggested. But others propose that cerebrospinal fluid[CSF] hypotension is an another possible mechanism In this paper, we report two cases of SSDH after clipping of an aneurysmal neck.

• Journal of Korean Neurosurgical Society
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• v.47 no.1
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• pp.48-50
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• 2010

Spontaneous intracranial hypotension is often idiopathic. We report on a patient presenting with symptomatic intracranial hypotension and pain radiating to the right leg caused by a transdurallumbar disc herniation. Magnetic resonance (MR) imaging of the brain revealed classic signs of intracranial hypotension, and an additional spinal MR confirmed a lumbar transdural herniated disc as the cause. The patient was treated with a partial hemilaminectomy and discectomy. We were able to find the source of cerebrospinal fluid leak, and packed it with epidural glue and gelfoam. Postoperatively, the patient's headache and log radiating pain resolved and there-was no neurological deficit. Thus, in this case, lumbar disc herniation may have been a cause of spontaneous intracranial hypotension.

• The Korean Journal of Physiology
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• v.11 no.1
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• pp.21-26
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• 1977

Many cases have been reported that a post spinal headache can be relieved immediately by an epidural injection of saline; and autologous blood also has recently been used successfully instead of saline. The changes of the cerebrospinal fluid pressure in 40 cases were observed in the present study in support of the concept; that a continuous leakage in association with hypovolemia and hypotension of the cerebrospinal fluid is the primary cause of a post spinal headache. Subarachnoid pressure increased immediately with saline injection into the lumber epidural space. A spinal needle was inserted into the subarachnoid space at the level of $L2{\sim}3$ and opening pressure of the cerebrospinal fluid was read. An epidural Tuohy needle was insertad at the$L3{\sim}4$ and 25m1 of saline was injected into the epidural space and the cerebrospinal fluid pressure was read in the sitting position. $\underline{Sitting\;Position:}$ Mean pressure after injection $555{\pm}(110.9)mm\;H_2O$, Pressure rise rise (%) 51.3%, Mean opening pressure $366{\pm}(52.2)mm\;H_{2}O$, $\underline{Lateral\;position:}$ Mean pressure after injection $308{\pm}(70.8)mm\;H_{2}O$, Pressure(%) 86.7%, Mean opening pressure $165{\pm}(42.6)mm\;H_{2}O$. These pressure changes responded almost simultaneously as saline was injected. This pressure rise of 51.3% in the sitting position and 86.7% in the lateral position are clinically very significant. Therefore, it is most possible that the immediate relieve of post, spinal headache by injection of fluid into the epidural space is simultaneous with the increase of the cerebrospinal fluid pressure.

• Journal of Korean Neurosurgical Society
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• v.47 no.4
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• pp.316-318
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• 2010

We report a rare case of intracranial hypotension that was complicated by a subdural hematoma following spine surgery. Intraoperatively, we did not notice any breach of the dura. However, the patient continued to have fluid leakage from the inferior edge of the lumbar incision. During revision surgery, a small dural tear was identified and repaired. It is likely that a small dural tear was overlooked or the dura was weakened during the initial operation and caused a subdural hematoma associated with intracranial hypotension.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.254-256
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• 2012

Intracranial hypotension syndrome typically occurs spontaneously or iatrogenically. It can be associated with headache, drowsy mentality and intracranial heamorrhage, Iatrogenic intracranial hypotension can occur due to dural pucture, trauma and spine surgery. Treatment may include conservative therapy and operation. We report a case of a 54-year-old man who was successfully treated with epidural blood patches for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the lumbosacral area after spine surgery.