Abstract

Background
To investigate clinical, MRI and radioisotope findings and therapeutic outcome of the syndrome of CSF hypovolemia. Methods: We retrospectively reviewed 30 consecutive patients with syndrome of CSF hypovolemia admitted to Asan Medical Center. Results: There were 10 men and 20 women with the mean age of 37 years. All patients had an orthostatic headache, which was alleviated to a variable extent upon recumbency. Additional clinical symptoms included nausea, dizziness, neck stiffness, blurring of vision, tinnitus, plugged ear, hearing difficulties and radicular pain of the arm. 82% of the patients had CSF opening pressure <60 mmH2O, 59% had CSF pleocytosis, and 95% had increa- sed CSF protein. Brain MRI showed diffuse pachymeningeal gadolinium enhancement on T1-weighted image in 83%, which was seen as hyperintense signals on T2-weighted imaging. Other features included subdural hematoma/hygroma in 17%, and descent of the brain in 48% of the patients. Radioisotope cisternographic results identified CSF leakage sites in 52%, most often at the lumbar region. Also obser- ved were limited ascent of the tracer to the cerebral convexity(91%), early appearance of radioisotope in the bladder(65%) and early soft tissue uptake of radioisotope(43%). Epidural blood patches were performed in 23 patients, which produced complete resolution of headaches in 70%. Two patients under- went drainage of subdural hematoma. None died or were disabled during hospitalization. Conclusions: The patients with CSF hypovolemia frequently have distinct MRI and radioisotope cisternographic abnormalities and respond favorably by an epidural blood patch. The prognosis is good if appropriately diagnosed and treated. Korean Journal of Headache 1(1):74-85, 2000