{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:39:58Z","timestamp":1770352798456,"version":"3.49.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spontaneous intracranial hypotension (SIH) is a rare condition characterized by positional headache, for which contrast-enhanced magnetic resonance imaging (MRI) is the preferred diagnostic method. Although MRI reveals characteristic findings, head computed tomography (CT) is usually the first diagnostic step, but identifying features of SIH on CT is often difficult. This study was specifically designed to evaluate the utility of head CT in detecting upper cervical epidural venous engorgement as a sign of SIH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Of 24 patients with SIH diagnosed between March 2011 and May 2023, 10 did not undergo upper cervical CT. In the remaining 14 patients, engorgement of the upper cervical epidural venous plexus was observed. CT detection rates were consistent with MRI for spinal fluid accumulation or dural thickening. After treatment, in 92.9% of patients, the thickness of the epidural venous plexus decreased statistically significantly from 4.8 \u00b1 1.3 mm to 3.6 \u00b1 1.2 mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This study suggests that upper cervical spine CT focused on epidural venous engorgement may be helpful in the initial diagnosis of SIH and may complement conventional MRI evaluation. Extending CT imaging to the upper cervical spine will improve the diagnostic accuracy of patients with positional headaches suspected to be SIH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23702","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T18:58:43Z","timestamp":1708973923000},"source":"Crossref","is-referenced-by-count":1,"title":["Significance of upper cervical epidural venous engorgement on head computed tomography in the initial diagnosis of spontaneous intracranial hypotension: patient series"],"prefix":"10.3171","volume":"7","author":[{"given":"Toshihide","family":"Takahashi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyoyuki","family":"Yanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Aiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minami","family":"Saura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michihide","family":"Kajita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Japan"},{"name":"Department of Neurology, Tsukuba Memorial Hospital, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuyuki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tsukuba Memorial Hospital, Tsukuba, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuniyuki","family":"Onuma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiichi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"343","article-title":"Spontaneous intracranial hypotension: a review and introduction of an algorithm for management","volume":"101","author":"Davidson B","year":"2017","unstructured":"Davidson B, Nassiri F, Mansouri A,  Spontaneous intracranial hypotension: a review and introduction of an algorithm for management. 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J Headache Pain. 2007;8(6):325\u2013328."},{"key":"b4","series-title":"World Neurosurg","first-page":"133","article-title":"Spontaneous spinal cerebrospinal fluid leak: review and management algorithm","volume":"150","author":"Jones MR","year":"2021","unstructured":"Jones MR, Shlobin NA, Dahdaleh NS Spontaneous spinal cerebrospinal fluid leak: review and management algorithm. World Neurosurg. 2021;150:133\u2013139."},{"issue":"2","key":"b5","series-title":"Acta Neurol Belg","first-page":"119","article-title":"Spontaneous intracranial hypotension: diagnosis to management","volume":"116","author":"Limaye K","year":"2016","unstructured":"Limaye K, Samant R, Lee RW Spontaneous intracranial hypotension: diagnosis to management. Acta Neurol Belg. 2016;116(2):119\u2013125."},{"issue":"7","key":"b6","series-title":"Headache","first-page":"1034","article-title":"Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks","volume":"53","author":"Mokri B","year":"2013","unstructured":"Mokri B Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache. 2013;53(7):1034\u20131053."},{"issue":"4","key":"b7","series-title":"AJR Am J Roentgenol","first-page":"817","article-title":"Prominent inferior intercavernous sinus on sagittal T1-weighted images: a sign of intracranial hypotension","volume":"206","author":"Alcaide-Leon P","year":"2016","unstructured":"Alcaide-Leon P, L\u00f3pez-Rueda A, Coblentz A, Kucharczyk W, Bharatha A, de Tilly LN Prominent inferior intercavernous sinus on sagittal T1-weighted images: a sign of intracranial hypotension. 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J Neurosurg Spine. 2011;15(4):433\u2013440."},{"key":"b12","series-title":"Clin Neurol Neurosurg","first-page":"71","article-title":"A quantitative study of intracranial hypotensive syndrome by magnetic resonance","volume":"141","author":"Tian W","year":"2016","unstructured":"Tian W, Zhang J, Chen J, Liu Y, Chen X, Wang N A quantitative study of intracranial hypotensive syndrome by magnetic resonance. Clin Neurol Neurosurg. 2016;141:71\u201376."},{"issue":"1","key":"b13","series-title":"AJNR Am J Neuroradiol","first-page":"147","article-title":"Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome","volume":"30","author":"Watanabe A","year":"2009","unstructured":"Watanabe A, Horikoshi T, Uchida M, Koizumi H, Yagishita T, Kinouchi H Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome. 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Neurology. 2001;56(12):1746\u20131748."},{"issue":"4","key":"b20","series-title":"Cephalalgia","first-page":"410","article-title":"Transtentorial herniation with cerebral infarction and duret haemorrhage in a patient with spontaneous intracranial hypotension: authors\u2019 reply","volume":"28","author":"Fuh JL","year":"2008","unstructured":"Fuh JL, Wang SJ Transtentorial herniation with cerebral infarction and duret haemorrhage in a patient with spontaneous intracranial hypotension: authors\u2019 reply. Cephalalgia. 2008;28(4):410."},{"issue":"6","key":"b21","series-title":"AJR Am J Roentgenol","first-page":"1283","article-title":"Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension","volume":"207","author":"Kranz PG","year":"2016","unstructured":"Kranz PG, Amrhein TJ, Choudhury KR, Tanpitukpongse TP, Gray L Time-dependent changes in dural enhancement associated with spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016;207(6):1283\u20131287."},{"key":"b1","series-title":"World Neurosurg","first-page":"343","article-title":"Spontaneous intracranial hypotension: a review and introduction of an algorithm for management","volume":"101","author":"Davidson B","year":"2017","unstructured":"Davidson B, Nassiri F, Mansouri A,  Spontaneous intracranial hypotension: a review and introduction of an algorithm for management. World Neurosurg. 2017;101:343\u2013349."},{"issue":"1","key":"b2","series-title":"J Headache Pain","first-page":"4","article-title":"The status of diagnosis and treatment to intracranial hypotension, including SIH","volume":"18","author":"Lin JP","year":"2017","unstructured":"Lin JP, Zhang SD, He FF, Liu MJ, Ma XX The status of diagnosis and treatment to intracranial hypotension, including SIH. 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Headache. 2013;53(7):1034\u20131053."},{"issue":"4","key":"b7","series-title":"AJR Am J Roentgenol","first-page":"817","article-title":"Prominent inferior intercavernous sinus on sagittal T1-weighted images: a sign of intracranial hypotension","volume":"206","author":"Alcaide-Leon P","year":"2016","unstructured":"Alcaide-Leon P, L\u00f3pez-Rueda A, Coblentz A, Kucharczyk W, Bharatha A, de Tilly LN Prominent inferior intercavernous sinus on sagittal T1-weighted images: a sign of intracranial hypotension. AJR Am J Roentgenol. 2016;206(4):817\u2013822."},{"issue":"6","key":"b8","series-title":"J Neurosurg","first-page":"1380","article-title":"Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients","volume":"121","author":"Beck J","year":"2014","unstructured":"Beck J, Gralla J, Fung C,  Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients. J Neurosurg. 2014;121(6):1380\u20131387."},{"issue":"1","key":"b9","series-title":"J Korean Neurosurg Soc","first-page":"1","article-title":"Spontaneous intracranial hypotension: clinical presentation, imaging features and treatment","volume":"45","author":"Park ES","year":"2009","unstructured":"Park ES, Kim E Spontaneous intracranial hypotension: clinical presentation, imaging features and treatment. J Korean Neurosurg Soc. 2009;45(1):1\u20134."},{"issue":"Pt 7","key":"b10","series-title":"Brain","first-page":"1884","article-title":"Spontaneous intracranial hypotension with deep brain swelling","volume":"130","author":"Savoiardo M","year":"2007","unstructured":"Savoiardo M, Minati L, Farina L,  Spontaneous intracranial hypotension with deep brain swelling. Brain. 2007;130(Pt 7):1884\u20131893."},{"issue":"4","key":"b11","series-title":"J Neurosurg Spine","first-page":"433","article-title":"Chronic cerebellar hemorrhage in spontaneous intracranial hypotension: association with ventral spinal cerebrospinal fluid leaks: clinical article","volume":"15","author":"Schievink WI","year":"2011","unstructured":"Schievink WI, Maya MM, Nu\u00f1o M Chronic cerebellar hemorrhage in spontaneous intracranial hypotension: association with ventral spinal cerebrospinal fluid leaks: clinical article. J Neurosurg Spine. 2011;15(4):433\u2013440."},{"key":"b12","series-title":"Clin Neurol Neurosurg","first-page":"71","article-title":"A quantitative study of intracranial hypotensive syndrome by magnetic resonance","volume":"141","author":"Tian W","year":"2016","unstructured":"Tian W, Zhang J, Chen J, Liu Y, Chen X, Wang N A quantitative study of intracranial hypotensive syndrome by magnetic resonance. Clin Neurol Neurosurg. 2016;141:71\u201376."},{"issue":"1","key":"b13","series-title":"AJNR Am J Neuroradiol","first-page":"147","article-title":"Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome","volume":"30","author":"Watanabe A","year":"2009","unstructured":"Watanabe A, Horikoshi T, Uchida M, Koizumi H, Yagishita T, Kinouchi H Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome. AJNR Am J Neuroradiol. 2009;30(1):147\u2013151."},{"issue":"20","key":"b14","series-title":"Neurology","first-page":"1789","article-title":"Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak","volume":"81","author":"Starling A","year":"2013","unstructured":"Starling A, Hernandez F, Hoxworth JM,  Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak. 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