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Frequency of spontaneous intracranial hypotension in the emergency department

Wouter I Schievink1, M M Maya, Franklin Moser

  • 1Department of Neurosurgery, The Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA 90048, USA. schievinkw@cshs.org

The Journal of Headache and Pain
|December 12, 2007
PubMed

Insights

Spontaneous intracranial hypotension, a rare disorder, is more common in emergency departments than previously thought. Misdiagnosis is frequent, highlighting challenges in identifying this condition during initial patient evaluations.

Area of Science:

  • Neurology
  • Emergency Medicine

Background:

  • Spontaneous intracranial hypotension (SIH) is often considered a rare neurological disorder.
  • Accurate and timely diagnosis of SIH in the emergency department (ED) setting is challenging.

Purpose of the Study:

  • To determine the frequency of SIH presentations in an ED.
  • To compare SIH incidence with spontaneous subarachnoid hemorrhage (SAH).
  • To assess the diagnostic accuracy of SIH in the ED.

Main Methods:

  • Retrospective review of ED patient records from January 2003 to December 2006 at a large urban hospital.
  • Identification of patients diagnosed with SIH and spontaneous subarachnoid hemorrhage (SAH).

Main Results:

  • Eleven patients with previously undiagnosed SIH were identified over a four-year period.
  • All SIH patients presented with positional headaches, with symptom duration ranging from one day to three months.
  • None of the eleven SIH patients received a correct SIH diagnosis in the ED.
  • Twenty-three patients with aneurysmal SAH were evaluated during the same period.

Conclusions:

  • Spontaneous intracranial hypotension is likely more prevalent than previously appreciated.
  • The diagnosis of SIH in the emergency department setting remains problematic and requires improved awareness and diagnostic strategies.

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