Movement Disorders in Brain Sagging Syndrome Due To Spontaneous Intracranial Hypotension: A Review

Area of Science:

• Neurology
• Neurosurgery

Background:

• Spontaneous intracranial hypotension (SIH) is a treatable condition caused by cerebrospinal fluid leakage.
• It typically presents with orthostatic headache and other symptoms, but can also lead to movement abnormalities, particularly in cases of
• brain sagging syndrome.

Purpose of the Study:

• To review the literature on movement disorders associated with spontaneous intracranial hypotension and brain sagging syndrome.
• To inform movement disorder neurologists about the clinical features and diagnosis of SIH-related movement abnormalities.

Main Methods:

• A literature search was conducted in PubMed using specific keywords related to brain sagging, intracranial hypotension, and various movement disorders.
• Twenty-one case reports and series detailing movement disorders in SIH patients were analyzed.

Main Results:

• Gait unsteadiness was the most frequently reported movement disorder, sometimes presenting in isolation.
• Tremor (postural, kinetic, Holmes tremor) was the second most common, followed by parkinsonism, chorea, and dystonia.
• A unique phenomenology of compulsive repetitive flexion and breath-holding was noted in over a third of patients.

Conclusions:

• Brain sagging syndrome associated with SIH can manifest as a diverse range of movement disorders due to mechanical distortion of brain structures.
• SIH is a significant addition to the spectrum of treatable movement disorders.
• Neurologists specializing in movement disorders must be familiar with SIH for accurate diagnosis and management.