1.Rebound intracranial hypertension after noninvasive treatment of intracranial hypotension: Case report and literature review
Ceren Cetin Akkoc ; Dilek Top Karti ; Figen Gokcay ; Nese Celebisoy
Neurology Asia 2019;24(3):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. In conclusion, rebound intracranial hypertension should be kept in mind in patients with intracranial hypotension who developed changes in the headache pattern, had new symptoms of nausea, vomiting, blurred or double vision during follow-up. Rebound intracranial hypertension can develop after conservative treatment of intracranial hypotension.