In a comprehensive study, researchers identified clinical and radiological features of patients with spontaneous intracranial hypotension and coma.

Spontaneous intracranial hypotension (SIH), a condition in which the fluid pressure inside the skull is lower than normal, is commonly associated with presentation of orthostatic headache. However, other manifestations of SIH include disorders of consciousness, which may have delayed diagnosis and can lead to death, coma, and stroke if not identified in time, according to a new study published in the April 13 online issue of Neurology.

In the first comprehensive study of patients with SIH and disorders of consciousness, Wouter I. Schievink, MD, director of the microvascular neurosurgery program and professor of neurosurgery at Cedars-Sinai Medical Center in Los Angeles, and colleagues used prospective registry data to follow a group of 15 patients who experienced coma after SIH and compared them to 568 SIH patients without coma.

Clinical information on individuals with SIH and coma is limited to single case reports or small case series and long-term follow-up and effectiveness of treatment usually remain unreported. While it is clear from the literature that coma can occur in SIH, little is known about the frequency of the occurrence, correlation with other features of SIH, treatment options, outcomes, and the pathophysiological mechanism that may underlie the development of coma in SIH patients. We therefore investigated the clinical and radiological features of a large group of patients with SIH and coma.
Dr. Schievinks and colleagues wrote

The findings, though limited, were encouraging.

Coma due to SIH is generally reversible and the prognosis is good. But timely recognition is essential, and the index of suspicion needs to be high.
Dr. Schievink told Neurology Today


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