MEDLINE search re tinnitus:
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("blood patch, epidural"[MeSH Terms] OR epidural blood patch[Text
Word]) AND ("tinnitus"[MeSH Terms] OR tinnitus[Text Word])
1: Reg Anesth Pain Med 2001 Nov-Dec;26(6):582-7 Related Articles,
Links
Epidemiology and outcome of postural headache management in
spontaneous intracranial hypotension.
Diaz JH.
Department of Public Health, Louisiana State University School of
Medicine in New Orleans, New Orleans, Louisiana 70112, USA.
jdiaz@lsuhsc.edu
BACKGROUND AND OBJECTIVES: Spontaneous intracranial hypotension is a
postural headache syndrome unrelated to dural puncture. Due to the
apparent failure of epidural blood patch to relieve headache in
spontaneous intracranial hypotension, we investigated the
epidemiologic features and treatment outcomes of this condition.
METHODS: The clinical findings and management of 22 cases (21
published + 1 reported) of spontaneous intracranial hypotension were
analyzed retrospectively. The study population was stratified by age
and sex; continuous variables were compared for differences by
t-tests; categorical variables were compared by Fisher exact tests.
Significant differences were identified by P values of.05 or less.
RESULTS: The mean age of the study population was 43 +/- 16 years,
with a female:male ratio of 3.4:1.0. Females with spontaneous
intracranial hypotension were younger (P =.050) than males. Men
presented with tinnitus (P =.021) and visual field defects (P =.009)
more often than women. Meningeal enhancement on contrast magnetic
resonance imaging was the most consistent radiographic finding.
Radionuclide cisternography showed thoracolumbar dural leaks in 7 of 9
patients. Cerebrospinal fluid opening pressure was low in all patients
(33.13 +/- 31.02 mm H(2)O). Epidural blood patch was performed in 8
patients, repeated in 3 patients, failed in 3 patients, and offered
only transient improvement in 5 patients. CONCLUSIONS: Spontaneous
intracranial hypotension was more common in women than men, was not
uniformly responsive to epidural blood patch, and had significant
comorbidities. The management of postural headache in spontaneous
intracranial hypotension by other techniques to restore cerebrospinal
fluid dynamics and prevent its leakage should be investigated.
PMID: 11707800 [PubMed - indexed for MEDLINE]
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2: Clin Nucl Med 2001 Feb;26(2):114-6 Related Articles, Links
Radionuclide cisternography in spontaneous intracranial hypotension
with simultaneous leaks at the cervicothoracic and lumbar levels.
Jeon TJ, Lee JD, Lee BI, Kim DI, Yoo HS.
Department of Diagnostic Radiology, Research Institute of Radiologic
Science, Yonsei University, College of Medicine, Seoul, Korea.
tjjeon@yumc.yonsei.ac.kr
This case report clearly illustrates defined simultaneous
cerebrospinal fluid leaks at the cervicothoracic and upper lumbar
areas. A 53-year-old woman without a remarkable medical history was
hospitalized for sudden onset of severe headache. The headache lasted
more than 1 week and standing or sitting positions exaggerated the
symptoms, although it was relieved when the patient was recumbent.
Radionuclide cisternography was performed using 150 MBq (4 mCi) Tc-99m
DTPA. It revealed two cerebrospinal fluid leaks from the
cervicothoracic junction bilaterally and the left side of the upper
lumbar area. Epidural blood patching was tried at the lumbar level
(L1-L2) and showed only a transient effect. A second trial of this
method at the level of C7-T1 performed 2 days later resulted in
immediate improvement of the symptoms without recurrence. The
simultaneous cerebrospinal fluid leaks were detected successfully with
radionuclide cisternography using Tc-99m DTPA, which provided a useful
guideline for treatment despite the limitations of delayed scanning.
PMID: 11201466 [PubMed - indexed for MEDLINE]
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3: Neurology 2000 Nov 14;55(9):1321-7 Related Articles, Links
Comment in:
Neurology. 2001 Jun 12;56(11):1607-8.
Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging
features and outcome.
Chung SJ, Kim JS, Lee MC.
Department of Neurology, University of Ulsan, Asan Medical Center,
Seoul, South Korea.
OBJECTIVE: To investigate clinical, MRI, and radioisotope findings and
therapeutic outcome of the syndrome of CSF hypovolemia. METHODS:
Retrospective review was performed of 30 consecutive patients (10 men,
20 women; mean age 37 years) with the syndrome of CSF hypovolemia.
RESULTS: All patients had an orthostatic headache, which was
alleviated to a variable extent on recumbency. Additional clinical
symptoms included nausea, dizziness, neck stiffness, blurring of
vision, tinnitus, plugged ear, hearing difficulties and radicular pain
of the arm. Eighty-two percent of the patients had CSF opening
pressure less than 60 mm H2O, 59% had CSF pleocytosis, and 95% had
increased CSF protein. Brain MRI showed diffuse pachymeningeal
gadolinium enhancement on T1-weighted image in 83%, which was seen as
hyperintense signals on T2-weighted imaging. Other features included
subdural hematoma/hygroma in 17% and descent of the brain in 48% of
the patients. Radioisotope cisternographic results identified CSF
leakage sites in 52%, most often at the lumbar region. Also observed
were limited ascent of the tracer to the cerebral convexity (91%),
early appearance of radioisotope in the bladder (65%), and early soft
tissue uptake of radioisotope (43%). Epidural blood patches were
performed in 23 patients, which produced complete resolution of
headaches in 70%. Two patients underwent drainage of subdural
hematoma. None died or were disabled during hospitalization.
CONCLUSIONS: Patients with CSF hypovolemia frequently have distinct
MRI and radioisotope cisternographic abnormalities and often respond
favorably to an epidural blood patch.
PMID: 11087775 [PubMed - indexed for MEDLINE]
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4: Anesth Analg 1996 Jun;82(6):1303 Related Articles, Links
Long-term postdural puncture auditory symptoms: effective relief after
epidural blood patch.
Narchi P, Veyrac P, Viale M, Benhamou D.
Publication Types:
Letter
PMID: 8638815 [PubMed - indexed for MEDLINE]
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5: Ann Otolaryngol Chir Cervicofac 1996;113(3):175-7 Related Articles,
Links
[Chronic tinnitus and hearing loss caused by cerebrospinal fluid leak
treated with success with peridural blood patch. Apropos of 2 cases]
[Article in French]
Viale M, Narchi P, Veyrac P, Benhamou D.
Chirurgie ORL, Clinique Sainte Croix, Le Mans.
Hearing loss and tinnitus are frequently encountered in ENT patients
and usually require complementary investigations such as audiogram,
auditive evoked potentials, CT scan, MRI... One recent etiology, that
is more and more discovered, is a decrease in spinal fluid pressure
secondary to a dural fluid leak that occurs after a diagnostic lumbar
puncture, a spinal anesthesia, an accidental dural puncture during an
epidural technique or a lumbar myelography. Postural headache which
are frequently present in such a setting, may mask these auditive
symptoms. Epidural injection of autologous blood (blood patch)
performed by anesthesiologists, which is usually indicated to treat
such postural headaches, is efficient in relieving other symptoms
related to spinal fluid leak after dural puncture. We report two cases
of isolated auditive complaints (hearing loss and tinnitus) which have
been dramatically improved after blood patch. In conclusion, ENT
surgeons should seek for a recent or even a past history of spinal
puncture whenever the etiology of auditive symptoms of their patient
remains unclear.
PMID: 9033682 [PubMed - indexed for MEDLINE]
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6: Anesth Analg 1975 Jul-Aug;54(4):459-63 Related Articles, Links
Long-term follow-up of epidural blood patch.
Abouleish E, Vega S, Blendinger I, Tio TO.
Epidural blood patch (EBP) was performed for the treatment of severe
postlumbar puncture cephalalgia in 118 young patients. Following the
first EBP, 105 patients had relief of headache. Eleven of the 13 in
whom it failed had a second EBP, with adequate relief in 10, giving an
overall success of 97.5 percent. Lumbar epidural, caudal, and spinal
procedures were successful in 3 patients 105 to 380 days after EBP.
Soon after EBP, one patient developed facial paralysis and one
complained of episodes of vertigo, dizziness, tinnitus, and ataxia
without headaches. Residual complications included backache and/or
back stiffness in 22 patients and paresthesia in two. Two-year
follow-up revealed 95 percent patient acceptance of the procedure. EBP
was found to be a safe, effective method for treating severe
postlumbar puncture cephalalgia, provided a proper diagnosis is made
and there is no contraindication.
PMID: 125053 [PubMed - indexed for MEDLINE]
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