Rebound intracranial hypertension after noninvasive treatment of intracranial hypotension: Case report and literature review

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Akkoc C. C. , Karti D. T. , Gökçay F. , Çelebisoy N.

NEUROLOGY ASIA, cilt.24, ss.271-275, 2019 (SCI İndekslerine Giren Dergi) identifier

  • Cilt numarası: 24
  • Basım Tarihi: 2019
  • Sayfa Sayıları: ss.271-275


Intracranial hypotension is a clinical syndrome characterized by orthostatic headache and low cerebrospinal fluid pressure. Noninvasive management is the usual first line treatment. Epidural blood patch is the treatment of choice if noninvasive treatments are ineffective. Cases with rebound intracranial hypertension after epidural blood patch treatment have been reported in the medical literature previously. We report here three patients with rebound intracranial hypertension who were treated noninvasively for intracranial hypotension. This phenomenon has not been reported previously. The underlying cause of intracranial hypotension was epidural anesthesia in the first, lumbar disc surgery in the second patient, and idiopathic in the third patient. They had been treated either with bed rest or with medical treatment not requiring epidural blood patch. After a short remission the patients were seen with a different headache pattern. They all had papilledema on examination. Automated perimetry revealed bilateral blind spot enlargement in Patient 1 and peripheral constriction in Patient 2. Cranial MRI and MRV in all three patients were normal. All the patients recovered very quickly with acetazolamide 1.5 or 2gm/day.