Neurológia pre prax 1/2011

Spontaneous intracranial hypotension

The syndrome of intracranial hypotension is a wellknown complication of lumbar puncture. Its spontaneous variant is not often considered, although well defined clinical diagnostic criteria were established for this entity and the treatment is usually succesful. The case report describes a patient hospitalised with severe headache associated with upright position and accompanied by meningeal symptoms. MRI of the brain was normal, MRI of spine showed ventrolisthesis of L4 vertebra, without extradural collection of CSF. During lumbar puncture low opening pressure CSF was noted. Therefore, CT-perimyelography was performed, which visualized a significant CSF leak at the level of spondylolisthesis. Following blood patch (15 ml of autologous blood injected into epidural compartement) all symptoms disapeared. The purpose this article was to call attention to this clinical unit.

Keywords: intracranial hypotension, cerebrospinal fluid pressure, blood patch, epidural.