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KMID : 0359720140320010014
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Journal of the Korean Neurological Association
2014 Volume.32 No. 1 p.14 ~ p.18
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Relationship Between Findings on Brain MRI and Prognosis in Patients With Spontaneous Intracranial Hypotension
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Park Myung-Ho
Kim Byeong-Chae
Choi Seong-Min
Kim Dong-Eun
Choi Kang-Ho
Kim Joon-Tae
Yoon Woong
Nam Tai-Seung
Lee Seung-Han
Park Man-Seok
Kim Myeong-Kyu
Cho Ki-Hyun
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Abstract
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Background: The outcome of spontaneous intracranial hypotension (SIH) is unpredictable and some patients have persistent and often incapacitating symptoms. This study was aimed to investigate whether abnormalities on initial magnetic resonance imaging (MRI) can predict the outcome in patients with SIH.
Methods: We retrospectively included 44 patients with SIH. Brain MRI was available for all patients. Treatment consisted of conservative treatment and/or high-volume epidural blood patching. Patients were divided into two groups: favorable or non-favorable group. Favorable group was defined as clinical improvement by conservative therapy or one trial of autologous epidural blood patching; non-favorable group as more than two week of admission, two or more trials of autologous epidural blood patching, or relapse of orthostatic headache.
Results: Twenty-one (48%) of 44 patients were classified as the favorable group. The non-favorable group had several abnormal findings on brain MRI (16 cases vs. 5 cases in favorable group, p<0.003), including platybasia (1), skull base tumor (1), Chiari I malformation (1), diffuse mild thickening and enhancement of dural and epidural layer of thoracic spine (1), pituitary enlargement (3), sagging brain (3) and subdural hemorrhage (4). In the non-favorable group, 13 out of 23 patients (57%) showed pachymeningeal enhancement in brain MRI (2 patients in favorable group, p<0.001).
Conclusions: Brain MRI abnormalities were more frequently related with non-favorable outcomes in SIH. Pachymeningeal enhancement in particular could suggest an unfortunate prognosis.
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KEYWORD
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Spontaneous intracranial hypotension, Pachymeningeal enhancement, Epidural blood patch
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