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Título

CLINICAL-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH SPONTANEOUS CEREBROSPINAL FLUID FISTULA ASSOCIATED WITH IDIOPATHIC INTRACRANIAL HYPERTENSION IN A UNIVERSITY HOSPITAL

Resumo

Introduction: This descriptive and retrospective study aims to describe the analysis of medical records of patients enrolled in a university hospital diagnosed with cerebrospinal fluid (CSF) fistula resulting from intracranial hypertension (ICH).
Methods: Data from patients treated at Hospital Universitário Walter Cantídio at Ceará state, Brazil were collected. This study descriptively evidenced the clinical and epidemiological data of individuals with the studied condition. The inclusion criteria used were adult patients with a diagnosis of spontaneous nasal CSF fistula. A positive history of skull surgery or head trauma was used as an exclusion criterion to define the spontaneous fistula. The present study represents the partial results of the major research, as all the patients with the disease are yet to be accessed.
Results: All these patients were diagnosed with the support of both magnetic resonance imaging (MRI) and computerized tomography and 2 of them were submitted to lumbar puncture to evaluate the presence of high opening pressure. Only one patient received a proper diagnosis of idiopathic intracranial hypertension from the attending physician. The mean age at diagnosis was 36,5 (ages of 26, 28, 57 and 35 at the first presentation) and all the patients were female. The main clinical manifestations of the disease were nasal CSF leak and headache, present in all four patients. Other signs and symptoms observed were paresthesia (1 patient), ear pain (1 patient), dizziness (1 patient), tinnitus (1 patient), and epistaxis (1 patient). Half of the patients had recurrent meningitis at some point in their disease, while 1 of them progressed with seizures. The four patients were submitted to surgical procedures, but only one of them evolved without relapse. The absence of symptoms was achieved only with the use of acetazolamide in the remaining three patients, with one of them requiring the setup of a ventriculoperitoneal shunt. The mean time to relapse after surgical procedure was 2 months.
Conclusion: In conclusion, this study presented a partial profile of patients with spontaneous nasal CSF fistula in a Brazilian teaching hospital, showing the demography of individuals with the disease, as well as the difficulty in treating and recognizing this condition, and a high relapse rate. The apparent success of the use of pharmacological agents in the treatment opens new possibilities for use and further research.

Palavras Chave

cerebrospinal fluid fistula fistule spontaneous; headache; idiopathic intracranial hypertension; acetazolamide;

Área

Neuroepidemiologia