Relationship Between Findings on Brain MRI and Prognosis in Patients With Spontaneous Intracranial Hypotension

BACKGROUND: The outcome of spontaneous intracranial hypotension (SIH) is unpredictable and some patients have persistent and often incapacitating symptoms. This study was aimed to investigate whether abnormalities on initial magnetic resonance imaging (MRI) can predict the outcome in patients with SIH. METHODS: We retrospectively included 44 patients with SIH. Brain MRI was available for all patients. Treatment consisted of conservative treatment and/or high-volume epidural blood patching. Patients were divided into two groups: favorable or non-favorable group. Favorable group was defined as clinical improvement by conservative therapy or one trial of autologous epidural blood patching; non-favorable group as more than two week of admission, two or more trials of autologous epidural blood patching, or relapse of orthostatic headache. RESULTS: Twenty-one (48%) of 44 patients were classified as the favorable group. The non-favorable group had several abnormal findings on brain MRI (16 cases vs. 5 cases in favorable group, p<0.003), including platybasia (1), skull base tumor (1), Chiari I malformation (1), diffuse mild thickening and enhancement of dural and epidural layer of thoracic spine (1), pituitary enlargement (3), sagging brain (3) and subdural hemorrhage (4). In the non-favorable group, 13 out of 23 patients (57%) showed pachymeningeal enhancement in brain MRI (2 patients in favorable group, p<0.001). CONCLUSIONS: Brain MRI abnormalities were more frequently related with non-favorable outcomes in SIH. Pachymeningeal enhancement in particular could suggest an unfortunate prognosis.

Alopecia After Occipital Nerve Blockade

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.

Alopecia After Occipital Nerve Blockade

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.

Reproducibility of Optic Nerve Head Topographic Measurements with the Heidelberg Retina Tomograph

Laser scanning tomography is an accurate method for the three-dimentional assessment of the optic nerve head. But its topographic measurement should be highly reproducible for early diagnosis and follow-up of patients with glaucoma. The authors evaluated the reproducibility of optic nerve head topographic measurements by the Heidelberg retina tomograph(HRT). The mean standard deviation of height measurements and the mean coefficient of variation of each parameters were calculated on the 10 independent measurements in five normal eyes. The results showed that the mean standard deviation of height measurements was 29.19 microgram. The mean coefficient of variation of the cup area, rim area, rim volume, mean cup depth and the mean retinal nerve fiber layer thickness was under 10%. Optic nerve head topographic measurement by the HRT is highly reprooucible, which may help follow-up of glaucoma patients.