Symptom Relief and Quality of Life in Patients Managed for Spontaneous Intracranial Hypotension

Background: Spontaneous intracranial hypotension (SIH) results from cerebrospinal fluid loss, mostly due to a spinal dural tear. Patients with SIH are treated with an autologous epidural blood patch (EBP) if conservative treatment fails. There is a paucity of studies from India regarding the symptom relief and long-term outcomes of patients with SIH. In this study, we present our institutional experience regarding the clinical-epidemiological profile, imaging findings, and long-term outcomes of patients after treatment of SIH who have presented to our hospital since 2012. Methods: We retrospectively examined the medical records of all patients with a diagnosis of SIH from 2012 to date. We collected data regarding the clinical presentation, imaging findings, and treatment received. Subsequently, we performed telephonic follow-ups to enquire about their headache severity at 3 months and 6 months (using a numeric rating scale) after treatment, current quality of life by using the EuroQOL-5D questionnaire, and sleep quality. Results: Since 2012, 37 SIH patients have been treated at our institution. The predominant symptom was headache (97%), and 86% had postural headache. Pachymeningeal enhancement, engorged venous sinuses, subdural collection, and spinal longitudinal epidural collection were the most common findings on magnetic resonance imaging (MRI), with a median Bern score of 9. Twenty-five (68%) patients received EBP, most commonly at the C6-C7 level, mostly with fluoroscopic assistance. About 71% of patients achieved complete symptom relief. Post-EBP MRI (n = 12) showed partial resolution of SIH features. On telephonic follow-up, the median headache score at 3 and 6 months was 3. The median QOL scores were 1 for mobility, self-care, usual activity, pain, and anxiety/depression, implying no problems in these dimensions. The median sleep score was 100, indicating excellent sleep. Conclusion: Patients have good symptom relief following treatment of SIH, leading to a good quality of life, even years after the initial presentation.