Intra-cranial hyper-tension

Published by: anonym 2008-11-29

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I am looking for a clinic (world wide) which specializes in this medical condition. I have LOW PRESSURE of fluid in my brain sac because of a tear or leak in my spinal cord, which so far has not been located through MRI testing. Can you find any research which prescribes remedy for my condition? My condition is the opposite of HIGH PRESSURE Intra-cranial hyper-tension, but in the same family. This rare condition has disabled me in such a way that I am getting know physical exercise, and suffering from extreme head pressure and pain.

Below you will find information on four world-renowned physicians who have done extensive work related to intracranial hypotension and cerebrospinal fluid leakage. I have also selected excerpts from some medical articles that I believe will be of interest to you. ====================================================================== Dr. Wouter I. Schievink, of the Maxine Dunitz Neurosurgical Institute (part of the Cedars-Sinai Health System in Los Angeles): "Wouter I. Schievink, MD, is Co-Director of the Neurovascular Surgery Program at the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai. Dr. Schievink specializes in sophisticated neurovascular procedures and is an expert in the areas of familial aneurysms and strokes. Dr. Schievink's research has focused on the genetic, etiologic and epidemiologic aspects of intracranial aneurysms and cervicocephalic arterial dissections. He also has a special interest in cerebrospinal fluid leaks and intracranial hypotension." Cedars-Sinai Medical Center http://www.csmc.edu/2414.html "Misdiagnosis of Spontaneous Intracranial Hypotension Wouter I. Schievink, MD Spontaneous intracranial hypotension is an important cause of "new daily persistent headaches" but is not a well-recognized entity. The misdiagnosis of spontaneous intracranial hypotension can have serious consequences... The clinical course in 18 consecutive patients with spontaneous intracranial hypotension who were evaluated for definitive surgical treatment of the underlying spontaneous spinal cerebrospinal fluid leak from January 1, 2001, through June 30, 2002, was investigated by correspondence with the patients and physicians... Seventeen patients (94%) initially received an incorrect diagnosis, and the diagnostic delay ranged from 4 days to 13 years (median, 5 weeks; mean, 13 months). Migraine, meningitis, and psychogenic disorder were the most commonly entertained diagnoses. Diagnostic or therapeutic procedures for disorders that mimicked spontaneous intracranial hypotension included cerebral arteriography in 2 patients, craniotomies for Chiari malformation in 2 patients, craniotomy for evacuation of subdural hematomas in 1 patient, and brain biopsy in 1 patient. ...Patients with spontaneous intracranial hypotension are commonly misdiagnosed, causing a significant delay in the initiation of effective treatments and exposing patients to the risks associated with treatment for disorders that mimic intracranial hypotension. Increasing the awareness of this spontaneous type of intracranial hypotension is required to decrease the high rate of misdiagnosis." Archives of Neurology http://archneur.ama-assn.org/cgi/content/abstract/60/12/1713 "Spontaneous intracranial hypotension has become a well-recognized clinical entity, but it remains an uncommonly, and probably underdiagnosed, cause of headache; its estimated prevalence is only one in 50,000 individuals. The clinical spectrum of spontaneous intracranial hypotension is quite variable and includes headache, neck stiffness, cranial nerve dysfunction, radicular arm pain, and symptoms of diencephalic or hindbrain herniation. Leakage of the spinal cerebrospinal fluid (CSF) is the most common cause of spontaneous intracranial hypotension. A combination of an underlying weakness of the spinal meninges and a more or less trivial traumatic event is often found to cause this event in these patients. ...The initial treatment of choice is a lumbar epidural blood patch, regardless of the location of the CSF leak. If the epidural blood patch fails, the blood patch procedure can be repeated at the lumbar level, or a blood patch can be directed at the exact site of the leak. Surgical repair of the CSF leak is safe and generally successful, although a distinct structural cause of the leak often is not found." Neurosurgery On-Call http://www.neurosurgery.org/focus/july00/9-1-8.pdf Dr Schevink is associated with the Maxine Dunitz Neurosurgical Institute, which offers a service called the Scan Review Program, which enables your physician to submit your MRI scans for review by the experts at the Institute: "The Maxine Dunitz Neurosurgical Institute's Scan Review Program is a consultation service offered to your primary care physician in order to help guide your treatment. The program is designed to give a basic review of your scans, and offer information and resources on the newest methods of treatment for brain, pediatric, blood vessel and spinal abnormalities... Maxine Dunitz Neurosurgical Institute 8631 W. Third St., Suite 800E Los Angeles, CA 90048 Phone: (310) 423-7900 Fax: (310) 423-0777 Cedars-Sinai Medical Center http://www.csmc.edu/2233.html ====================================================================== Dr. Bahram Mokri, of the Department of Neurology at the Mayo Clinic: "Bahram Mokri MD Department of Neurology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA Spontaneous intracranial hypotension (SIH) is typically manifested by orthostatic headaches that may be associated with one or more of several other symptoms, including pain or stiffness of the neck, nausea, emesis, horizontal diplopia, dizziness, change in hearing, visual blurring or visual field cuts, photophobia, interscapular pain, and occasionally face numbness or weakness or radicular upper-limb symptoms. Cerebrospinal fluid (CSF) pressures, by definition, are quite low. SIH almost invariably results from a spontaneous CSF leak... Although various treatment modalities have been implemented, epidural blood patch is probably the treatment of choice in patients who have failed an initial trial of conservative management. When adequate trials of epidural blood patches fail, surgery can offer encouraging results in selected cases in which the site of the leak has been identified. Some of the spontaneous CSF leaks are related to weakness of the meningeal sac, likely in connection with a connective tissue abnormality." BioMed Central http://www.biomedcentral.com/1528-4042/1/109/abstract More on Dr. Mokri: Mayo Clinic College of Medicine http://mayoresearch.mayo.edu/mayo/research/staff/mokri_b.cfm "Phone: Appointment Information Desk: (507) 284-2111 TDD service for the hearing impaired: (507) 281-9786 Between 8 a.m. and 5 p.m. Central time, Monday through Friday. Write to: Mayo Clinic Appointment Information 200 First Street SW Rochester, MN 55905" Mayo Clinic http://www.mayoclinic.org/becomingpat-rst/appointments.html ====================================================================== Dr. Jerome Posner, of Sloan-Kettering Institute: "SC Pannullo, JB Reich, G Krol, MD Deck and JB Posner Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY. We report seven patients with the syndrome of intracranial hypotension who were referred to Memorial Sloan-Kettering, primarily because of suspicion of meningeal tumor or infection raised by the finding of meningeal enhancement on MRI. In three patients, symptoms occurred after lumbar puncture; in four, there was no clear precipitating event. Lumbar puncture after MRI in six patients revealed low CSF pressure (six patients) and pleocytosis or high protein, or both (four patients). Three patients had subdural effusions. Six patients had measurable descent of the brain on midsagittal images. Postural headache resolved in all seven patients, six of whom had follow-up MRIs. Meningeal enhancement resolved or diminished in all six. Subdural effusions resolved spontaneously in two and were evacuated (but were not under pressure) in one. Downward brain displacement improved or resolved in all patients. The clinical syndrome and MRI abnormalities generally resolve on their own. An extensive workup is not helpful and may be misleading. Patients should be treated symptomatically." American Academy of Neurology http://www.neurology.org/cgi/content/abstract/43/5/919 "Jerome Posner George C. Cotzias Laboratory of Neuro-Oncology Office Phone : (212) 639-7047 Office Email : posnerj@mskcc.org" Memorial Sloan-Kettering Cancer Center http://www.mskcc.org/mskcc/html/11404.cfm ====================================================================== Dr. Juli n Benito Le n, of the Servicio de Neurolog a at the Hospital General de M stoles in Madrid, Spain: Diario Medico http://www.diariomedico.com/neurologia/n271200.html "Dr. Juli n Benito-Le n, Avda de la Constituci n 73, portal 3, 7 Izquierda, E-28820 Coslada, Madrid, Spain; e-mail: jbenitol@meditex.es The authors analyzed whether the pituitary gland enlarges in intracranial hypotension syndrome by studying 11 consecutive patients. Initial MRI scans showed pituitary gland enlargement with a convex superior margin. Follow-up MRI studies revealed that the size of the gland invariably diminished in all patients. The authors hypothesize that pituitary gland enlargement in intracranial hypotension syndrome is due to hyperemia of dural and epidural venous sinuses." American Academy of Neurology http://www.neurology.org/cgi/content/abstract/55/12/1895 ====================================================================== More info on intracranial hypotension: "Abstract: Background: Spontaneous intracranial hypotension (SIH) is a neurologic syndrome of unknown etiology, characterized by features of low cerebral spinal fluid (CSF) pressure, postural headache and magnetic resonance imaging (MRI) abnormalities. Methods: Four symptomatic cases of SIH presented to our institution over a six-month period. Magnetic resonance imaging studies were performed in all four cases. Diagnostic lumbar puncture was done in all except one case. Results: All of the patients on whom lumbar punctures were performed demonstrated low CSF pressure and CSF protein elevation with negative cultures and cytology. Three out of the four patients exhibited MRI findings of diffuse spinal and intracranial pachymeningeal gadolinium enhancement and extradural or subdural fluid collections. One patient had no MRI abnormalities despite prominent postural headache and reduced CSF pressure at lumbar puncture. All patients recovered with intravenous fluids and conservative treatment. Conclusions: Magnetic resonance imaging abnormalities are found in most, but not all patients, with SIH. Cerebral spinal fluid abnormalities can be detected even in patients with normal MRI studies. It is important to recognize the variability of imaging results in this usually benign disorder." Canadian Journal of Neurological Sciences http://www.cjns.org/29augtoc/spontaneous.html http://pub.ucsf.edu/newsservices/releases/2004010945/ "Spontaneous intracranial hypotension is a syndrome due to a Cerebrospinal Fluid CSF leak followed by decreased CSF volume and hydrostatic CSF pressure changes. Clinical-radiological presentation are characterised by orthostatic headaches related with low CSF pressure and diffuse dural-meningeal (pachymeningeal) contrast enhancement on magnetic resonance imaging with or without subdural fluid collections or imaging evidence of descent of the brain. MRI may shows abnormal dural venous sinus enhancement. Nausea and abducens palsy may represent additional symptoms. Therapy includes: increased fluid intake, steroids or epidural blood patch, continuous epidural saline infusion (CESI) and bed rest. Spontaneous intracranial hypotension is due to a CSF leak and hydrostatic CSF pressure changes associated with decreased CSF volume. Spontaneous intracranial hypotension should be considered in the differential diagnosis of chronic postural headache." European Congress of Radiology http://www.ecr.org/T/ECR01/sciprg/abs/pc0597.htm ====================================================================== "Headaches that may at first seem to be caused by a brain tumor can actually stem from a leak of spinal cord fluid, according to a study in the December 25 issue of Neurology, the scientific journal of the American Academy of Neurology... 'This is a disorder that was recently believed to be rare. New imaging technology has told us quite the opposite,' said Jerome Posner, MD, Memorial Sloan-Kettering Cancer Center neurologist and co-author of an editorial accompanying the study. Primarily diagnosed by a low spinal cord fluid pressure reading, the intracranial hypotension experienced by study participants had varied causes including spontaneous occurrence, unexplained fluid loss, lumbar puncture (spinal tap) and cervical spine surgery. Neck pain, nausea, hearing and vision problems and facial numbness accompanied the headaches... Many patients respond to conventional treatments such as bed rest, hydration, caffeine and corticosteroids. Surgical repair of the leak is performed in only the most severe cases." Eurekalert http://www.eurekalert.org/pub_releases/2000-12/AAoN-Nabt-2512100.php "Spontaneous Intracranial Hypotension - Spontaneous intracranial hypotension may present quite suddenly or more gradually. - Headache may involve the whole head, or be frontal or occipital. - It worsens in the erect position with improvement on lying down. - It is worsened by jugular venous compression or the Valsava manoeuvre. Other features include: - Neck stiffness - tinnitus - faintness - photophobia - nausea and vomiting Causes The cause is often unclear, although cases have been attributed to tears in nerve root sleeves resulting from a sneeze or strain. A similar headache may occur after lumbar puncture Diagnosis Lumbar puncture should be performed. The pressure is usually less than 60 mm of CSF. The protein may be elevated, and red cells or xanthochromia may be present. Isotope cisternography shows a rapid decrease of activity in the subarachnoid space, and a specific site of CSF leak may be demonstrated. Treatment - bed rest - epidural blood patch - intrathecal saline infusion - oral caffeine - surgical repair of any meningeal defect that is found." The Resident Medical Officer's Online Handbook http://mentor.wnmeds.ac.nz/groups/rmo/headache/headache16.html "The syndrome of spontaneous intracranial hypotension is being seen "...with increasing frequency in clinical practice," Drs. C. Philip O'Carroll and M Brant-Zawadzki of Newport Beach, California, note in the March issue of Cephalalgia... Drs. O'Carroll and Brant-Zawadzki have seen four patients with spontaneous intracranial hypotension during a three year period. All presented with orthostatic headache. ...The Newport Beach clinicians say a high index of suspicion is required for prompt and early diagnosis... A lumbar epidural patch is a 'reasonable approach' in confirmed cases of spontaneous intracranial hypotension, Drs. O'Carroll and Brant-Zawadzki say. If this fails, radioisotope cisternography or computed tomography myelography may yield useful information. Prognosis is generally 'excellent." Brain.com http://www.brain.com/Merchant2/merchant.mv?Screen=PROD&Store_Code=W&Product_Code=body_14833&Product_Count=0&Category_Code=headache "Q: I need information about spontaneous intercranial hypotension... A: The condition you mention is quite rare. It relates to reduced spinal fluid pressure and generally causes headaches when the person is upright; the headache clears rapidly upon lying down, in the absence of preceding trauma or lumbar puncture (spinal tap). Diagnosis is usually made by a combination of tests that may include lumbar puncture (spinal tap) to measure the pressure, MRI scanning, and RISSA scanning (isotope scan of spinal fluid flow). Treatment depends upon the cause and can include bed rest, intravenous caffeine, abdominal binder, steroids, continuous epidural saline infusion, and epidural blood patch. You should discuss any concern about this diagnosis with a neurologist." PeaceHealth http://www.peacehealth.org/apps/Expert/qa.asp?SubjectID=50 ====================================================================== Google search strategy: Google Web Search: "intracranial hypotension" + "research" ://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=%22intracranial+hypotension%22+research Google Web Search: "csf leak OR leakage" + "research" ://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=%22csf+leak+OR+leakage%22+research ====================================================================== I hope this helps. Please keep in mind that Google Answers is not a source of authoritative medical advice; the material presented above is for informational purposes, and should not be taken as a diagnosis nor as a substitute for the services of a qualified medical professional. Best regards, pinkfreud

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