Mild cognitive impairment in spontaneous intracranial hypotension and its rapid reversal by repair of a spinal cerebrospinal fluid leak.

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache Pub Date : 2024-12-15 DOI:10.1111/head.14882

Katharina Wolf, Florian Volz, Amir El Rahal, M Overstijns, Niklas Lützen, Charlotte Zander, Mukesch J Shah, Horst Urbach, Jürgen Beck

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引用次数: 0

Abstract

Background: Patients with spontaneous intracranial hypotension (SIH) report difficulties in concentration and memory. To objectify these deficits, we implemented standard cognitive tests into our routine SIH workup.

Method: Retrospective, single-center report of cognitive standard tests among patients with SIH consecutively admitted from May to July 2023. Cognitive testing involved the Montreal Cognitive Assessment (MoCA©, alternate versions, 0-30 points, 30 points for best performance, ≤26 indicating mild cognitive impairment at age >64 years), and the Trail Making Test, part B (TMT B, z-scores adjusted to age and education) to test for executive function. Both were administered at admission, and within 36-72 h after surgical repair of the spinal cerebrospinal fluid (CSF) leak.

Results: A total of 18 patients with an active spinal CSF leak were tested at admission (seven with ventral, three with lateral leak, and eight with CSF-venous fistula). There was no profound brain sagging as described in brain sagging dementia. The mean (standard deviation [SD]) age was 53.6 (11) years. Bern scores ranged between 0 and 9, median 6.5. The mean (SD) MoCA score at admission was 26.5 (2) points, with five patients (28%) scoring <26 points indicative of mild cognitive impairment. Performance in the TMT B was impaired in nine patients (50%, z-score ≥2). Upon targeted treatment of the CSF leak, the mean (SD) MoCA score immediately improved to 28.5 (1), p = 0.001 (n = 14), as did performance on the TMT B (mean [SD] 2.1 [2] vs. 1.1 [1], p = 0.015, n = 13).

Discussion: Spontaneous intracranial hypotension with an active spinal CSF leak is associated with cognitive impairment and surgical closure of the leak led to rapid improvement. We conclude that there may be a causal relationship between cognitive dysfunction and spinal CSF loss. We suggest considering spinal CSF leaks as a treatable cause in patients with mild cognitive impairment and with pre-dementia. This may ultimately necessitate thorough screening of brain and spine magnetic resonance images in patients with mild cognitive impairment.

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背景：自发性颅内压过低（SIH）患者在集中注意力和记忆方面存在困难。为了客观分析这些缺陷，我们在常规 SIH 检查中实施了标准认知测试：方法：对 2023 年 5 月至 7 月连续入院的 SIH 患者进行认知标准测试的回顾性单中心报告。认知测试包括蒙特利尔认知评估（MoCA©，交替版本，0-30 分，30 分为最佳表现，≤26 分表示年龄大于 64 岁时有轻度认知功能障碍）和追踪测试 B 部分（TMT B，根据年龄和教育程度调整 Z 值），以测试执行功能。这两项测试均在入院时和脊髓脑脊液（CSF）漏手术修复后 36-72 小时内进行：共有 18 名活动性脊髓脑脊液漏患者在入院时接受了测试（7 名腹腔漏、3 名侧漏、8 名脑脊液-静脉瘘患者）。没有出现脑下垂性痴呆症所描述的深度脑下垂。平均（标准差 [SD]）年龄为 53.6（11）岁。Bern 评分介于 0 和 9 之间，中位数为 6.5。入院时MoCA评分的平均值（标准差[SD]）为26.5（2）分，其中5名患者（28%）为讨论得分：自发性颅内低血压伴有活动性脊髓CSF漏与认知功能障碍有关，手术闭合漏点可迅速改善病情。我们的结论是，认知功能障碍与脊髓 CSF 泄漏之间可能存在因果关系。我们建议将脊髓脑脊液漏视为轻度认知障碍和痴呆前期患者的一个可治疗原因。这最终可能需要对轻度认知障碍患者的大脑和脊柱磁共振图像进行彻底筛查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Headache 医学-临床神经学

CiteScore

9.40

自引率

10.00%

发文量

172

审稿时长

3-8 weeks

期刊介绍： Headache publishes original articles on all aspects of head and face pain including communications on clinical and basic research, diagnosis and management, epidemiology, genetics, and pathophysiology of primary and secondary headaches, cranial neuralgias, and pains referred to the head and face. Monthly issues feature case reports, short communications, review articles, letters to the editor, and news items regarding AHS plus medicolegal and socioeconomic aspects of head pain. This is the official journal of the American Headache Society.