Related Experiment Videos
[Benign intracranial hypo- and hypertension]
V Delvaux1, A Dioh, J Schoenen
1Université de Liège, Service de Neurologie, CHR de la Citadelle.
Insights
Diagnosing chronic headaches from intracranial pressure issues can be challenging. This review covers key features, causes, and treatments for intracranial hypotension and hypertension headaches.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Context:
- Chronic headaches associated with intracranial pressure variations (hypotension and hypertension) present diagnostic challenges.
- These conditions, including cerebrospinal fluid (CSF) leaks and benign intracranial hypertension, require careful clinical evaluation and advanced imaging.
- Understanding the nuances of these disorders is crucial for effective patient management.
Purpose:
- To review the principal clinical characteristics, etiologies, and therapies for chronic headaches related to intracranial hypotension and hypertension.
- To highlight diagnostic hallmarks such as postural headaches and MRI findings for hypotension, and visual disturbances for hypertension.
- To discuss differential diagnoses and therapeutic strategies for these complex headache disorders.
Summary:
- Intracranial hypotension, often linked to CSF leaks, is characterized by postural headaches confirmed by MRI leptomeningeal enhancement.
- Benign intracranial hypertension headaches may worsen when supine and are associated with visual symptoms and tinnitus; elevated CSF pressure confirms diagnosis.
- Excluding conditions like cerebral venous thrombosis through imaging is essential for accurate diagnosis and treatment planning.
Impact:
- Improved diagnostic accuracy for challenging chronic headache presentations.
- Enhanced understanding of the pathophysiology and clinical manifestations of intracranial pressure disorders.
- Guidance on selecting appropriate therapeutic strategies for patients suffering from intracranial hypo- or hypertension-related headaches.
Abstract:
Chronic headaches due to intracranial hypo- or hypertension (IHS codes 7.2 and 7.1) may be difficult to diagnose. In this article, we review their principal clinical characteristics, etiologies and therapies. Intracranial hypotension may be caused by CSF linkage, e.g. after lumbar puncture. It may also be "idiopathic" in which case a CSF leak, usually at the spinal level, may be difficult to demonstrate. Postural headache is the clinical hallmark of intracranial hypotension. The diagnosis is confirmed by leptomeningeal enhancement on MRI scans. The headache of benign intracranial hypertension may be aggravated by the supine position and accompanied by transient visual obscurations and tinnitus. Papillary edema supports the diagnosis but may be absent in some cases. Increased opening pressure of the CSF will confirm the diagnosis. Etiologies such as cerebral venous thrombosis, have to be excluded by adequate imaging methods. In both hypo- and hypertension syndromes, various therapeutic strategies have been proposed.