Clinical Association Between Brain MRI Findings With Epidural Blood Patch in Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension (SIH) is characterized by spontaneous postural headache with neck stiffness, nausea, vomiting, tinnitus, and vertigo in patients with low cerebrospinal fluid pressure. Epidural blood patch (EBP) can be a treatment of choice in patients nonresponsive to the initial noninvasive treatments. We compared brain magnetic resonance imaging (MRI) findings and clinical variables between patients with conservative management only and patients with added EBP, to help physicians plan the management modalities for SIH patients. In addition, clinical factors associated with MRI abnormalities in SIH, and the response to EBP between elderly and young patients were assessed.

We retrospectively reviewed the medical records of patients fulfilling the symptomatic diagnostic criteria for SIH between 2001 and 2014. The following data were collected and analyzed by reviewing electronic medical records: demographic variables, initial clinical symptoms (nausea and vomiting, neck stiffness, vertigo, and tinnitus), initial pain score, reports of brain MRI, identified leakage site by cisternography or myelography, finding(s) of spine MRI, and duration of hospital stay. The response to EBP between elderly and young patients based on the age of 45 years, that is, the mean age of EBP in the study, were also compared.

The incidence of abnormalities of brain MRI findings did not show significant differences between conservative treatment and EBP. However, the proportion of patients with severe pain was higher in patients who underwent EBP. In multivariate regression analysis, the incidence of positive brain MRI finding(s) for SIH increased in patients with older age, higher weight, and an absence in nausea/vomiting. EBP procedure was effective in both younger and elderly patients.

The results of our study indicated no difference between MRI findings in both conservative treatment and EBP modalities; however, there were differences in initial pain score. Therefore, clinical presentation of SIH patients may be critical and help physicians make a decision of EBP procedure.