TY - JOUR
T1 - Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension
AU - Cheema, Sanjay
AU - Anderson, Jane
AU - Angus-Leppan, Heather
AU - Armstrong, Paul
AU - Butteriss, David
AU - Carlton Jones, Lalani
AU - Choi, David
AU - Chotai, Amar
AU - D'Antona, Linda
AU - Davagnanam, Indran
AU - Davies, Brendan
AU - Dorman, Paul J.
AU - Duncan, Callum
AU - Ellis, Simon
AU - Iodice, Valeria
AU - Joy, Clare
AU - Lagrata, Susie
AU - Mead, Sarah
AU - Morland, Danny
AU - Nissen, Justin
AU - Pople, Jenny
AU - Redfern, Nancy
AU - Sayal, Parag P.
AU - Scoffings, Daniel
AU - Secker, Russell
AU - Toma, Ahmed K.
AU - Trevarthen, Tamsin
AU - Walkden, James
AU - Beck, Jürgen
AU - Kranz, Peter George
AU - Schievink, Wouter
AU - Wang, Shuu Jiun
AU - Matharu, Manjit Singh
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Background We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG). Methods A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH. Results SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided. Conclusions This multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH.
AB - Background We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG). Methods A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH. Results SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided. Conclusions This multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH.
KW - CSF dynamics
KW - headache
KW - interventional
KW - neuroradiology
KW - neurosurgery
UR - http://www.scopus.com/inward/record.url?scp=85165046928&partnerID=8YFLogxK
U2 - 10.1136/jnnp-2023-331166
DO - 10.1136/jnnp-2023-331166
M3 - Article
C2 - 37147116
AN - SCOPUS:85165046928
SN - 0022-3050
VL - 94
SP - 835
EP - 843
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
IS - 10
ER -