자발두개내압저하 환자에서 뇌자기공명영상 결과와 예후의 상관관계
Relationship Between Findings on Brain MRI and Prognosis Patients With Spontaneous Intracranial Hypotension
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Background: The outcome of spontaneous intracranial hypotension (SIH) is unpredictable and some patients havepersistent and often incapacitating symptoms. This study was aimed to investigate whether abnormalities on initialmagnetic 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. Treatmentconsisted of conservative treatment and/or high-volume epidural blood patching. Patients were divided into twogroups: favorable or non-favorable group. Favorable group was defined as clinical improvement by conservativetherapy 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 severalabnormal findings on brain MRI (16 cases vs. 5 cases in favorable group, p<0.003), including platybasia (1), skull basetumor (1), Chiari I malformation (1), diffuse mild thickening and enhancement of dural and epidural layer of thoracicspine (1), pituitary enlargement (3), sagging brain (3) and subdural hemorrhage (4). In the non-favorable group, 13 out of23 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. Pachymeningealenhancement in particular could suggest an unfortunate prognosis.
Abstract
Background: The outcome of spontaneous intracranial hypotension (SIH) is unpredictable and some patients havepersistent and often incapacitating symptoms. This study was aimed to investigate whether abnormalities on initialmagnetic 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. Treatmentconsisted of conservative treatment and/or high-volume epidural blood patching. Patients were divided into twogroups: favorable or non-favorable group. Favorable group was defined as clinical improvement by conservativetherapy 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 severalabnormal findings on brain MRI (16 cases vs. 5 cases in favorable group, p<0.003), including platybasia (1), skull basetumor (1), Chiari I malformation (1), diffuse mild thickening and enhancement of dural and epidural layer of thoracicspine (1), pituitary enlargement (3), sagging brain (3) and subdural hemorrhage (4). In the non-favorable group, 13 out of23 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. Pachymeningealenhancement in particular could suggest an unfortunate prognosis.
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