{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T10:12:43Z","timestamp":1698833563676},"reference-count":46,"publisher":"Akademiai Kiado Zrt.","issue":"7","license":[{"start":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T00:00:00Z","timestamp":1613260800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["OH"],"published-print":{"date-parts":[[2021,2,14]]},"abstract":"<jats:p><jats:bold>\u00d6sszefoglal\u00f3.<\/jats:bold> A klasszikus esetben ortosztatikus fejf\u00e1j\u00e1st okoz\u00f3,\n                    spont\u00e1n intracranialis hypotensi\u00f3t az esetek t\u00falnyom\u00f3 t\u00f6bbs\u00e9g\u00e9ben a\n                    gerinccsatorn\u00e1ban, annak nyaki-h\u00e1ti \u00e1tmenet\u00e9ben, illetve a h\u00e1ti szakasz\u00e1n\n                    tal\u00e1lhat\u00f3 liquorsziv\u00e1rg\u00e1s okozza. Megl\u00e9v\u0151 k\u00f6t\u0151sz\u00f6veti betegs\u00e9g, degenerat\u00edv\n                    gerincbetegs\u00e9gek, illetve kisebb traum\u00e1k szerepet j\u00e1tszhatnak a sziv\u00e1rg\u00e1s\n                    kialakul\u00e1s\u00e1ban. Az ortosztatikus fejf\u00e1j\u00e1s l\u00e9trej\u00f6tt\u00e9ben szerepet j\u00e1tszhat a\n                    meningealis szerkezetek, \u00e9rz\u0151idegek \u00e9s h\u00eddv\u00e9n\u00e1k vong\u00e1l\u00f3d\u00e1sa. A klasszikus\n                    pozicion\u00e1lis, ortosztatikus fejf\u00e1j\u00e1sban szenved\u0151 betegek k\u00f6r\u00e9ben gondolni kell a\n                    spont\u00e1n intracranialis hypotensio lehet\u0151s\u00e9g\u00e9re, \u00e9s az agykoponya, illetve a\n                    gerinc kontrasztanyaggal v\u00e9gzett m\u00e1gneses rezonanci\u00e1s vizsg\u00e1lata (MRI) javasolt.\n                    A kontrasztanyaggal v\u00e9gzett koponya-MRI-vel klasszikus esetben diff\u00faz, nem\n                    nodularis, intenz\u00edv, vaskos pachymeningealis kontrasztanyag-halmoz\u00e1s, kit\u00e1gult\n                    v\u00e9n\u00e1ssinus-rendszer, subduralis effusi\u00f3k \u00e9s az agyt\u00f6rzs caudalis diszlok\u00e1ci\u00f3ja\n                    (\u201eslumping\u201d) l\u00e1that\u00f3. Fontos azonban szem el\u0151tt tartani, hogy az esetek 20%-\u00e1ban\n                    ezen elt\u00e9r\u00e9sek nem detekt\u00e1lhat\u00f3k. J\u00f3 min\u0151s\u00e9g\u0171, randomiz\u00e1lt, kontroll\u00e1lt\n                    vizsg\u00e1latok nem t\u00f6rt\u00e9ntek, a kezel\u00e9s hagyom\u00e1nyokon alapul. Kezdetben \u00e1ltal\u00e1ban\n                    konzervat\u00edv ter\u00e1pi\u00e1t alkalmaznak (\u00e1gynyugalom, koffein- \u00e9s folyad\u00e9kbevitel),\n                    ennek hat\u00e1stalans\u00e1ga eset\u00e9n epiduralis saj\u00e1tv\u00e9r-injekci\u00f3, epiduralis\n                    fibrinragaszt\u00f3-injekt\u00e1l\u00e1s, illetve seb\u00e9szi ter\u00e1pia j\u00f6het sz\u00f3ba. Orv Hetil. 2021;\n                    162(7): 246\u2013251.<\/jats:p>\n                <jats:p><jats:bold>Summary.<\/jats:bold> Spontaneous intracranial hypotension, the classic feature\n                    of which is orthostatic headache, is most commonly caused by a cerebrospinal\n                    fluid leakage at the level of the spinal canal, in most cases at the thoracic\n                    level or cervicothoracic junction. Underlying connective tissue disorders, minor\n                    trauma, degenerative spinal diseases may play a role in the development of\n                    cerebrospinal fluid leaks. Traction on pain-sensitive intracranial and meningeal\n                    structures, particularly sensory nerves and bridging veins, may play a role in\n                    the development of orthostatic headache. In the case of patients with classic\n                    orthostatic headache, the possibility of spontaneous intracranial hypotension\n                    should be considered, and if suspected, brain magnetic resonance imaging (MRI)\n                    with gadolinium and additional spine MRI are recommended. Diffuse, non-nodular,\n                    intense, thick dural enhancement, subdural effusions, engorgement of cerebral\n                    venous sinuses, sagging of the brain are typical features on brain MRI, which,\n                    however, remain normal in up to 20 percent of patients with spontaneous\n                    intracranial hypotension. Unfortunately, no randomized clinical trials have\n                    evaluated the effectiveness of the various treatment strategies and no\n                    definitive treatment protocols have been established. In clinical practice, the\n                    first-line treatment of spontaneous intracranial hypotension is conservative\n                    (bed rest, caffeine and fluid intake). If conservative therapy is not effective,\n                    epidural blood patch, epidural fibrin glue, or surgical repair should be\n                    considered. 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