1Department of Anesthesiology, E-DA Hospital/ I-Shou University, Kaohsiung, Taiwan
2Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Patients with spontaneous intracranial hypotension (SIH) typically present with orthostatic headache that is temporarily relieved by lying down flat; and is exacerbated when sitting up or standing. SIH has varied symptoms and signs, which have been underestimated since they were first described by Schaltenbrand in 1938. However, these symptoms have been recognized more effectively in recent years. New diagnostic criteria were referred from The International Classification of Headache Disorders (ICHD), ICHD-3 beta edition. In this paper we review three cases from medical records and recent studies on the diagnosis and treatment of SIH. Epidural blood patch (EBP) is still the major first-line interventional treatment, and we suggest that EBP should be applied more aggressively for some SIH cases with normal initial brain magnetic resonance imaging findings or the cases complicated with bilateral subdural collection because of poor outcomes.
spontaneous intracranial hypotension, orthostatic headache, epidural blood patch