Introduction: Orthostatic headache is very suggestive of intracranial hypotension. It has a good prognosis as it usually responds to conservative treatment or epidural blood patches. Case report: A 36-year-old female presented with severe and prolonged orthostatic headache starting after a seizure. No stigma of intracranial hypotension was detected on brain MRI, and intracranial pressure was within normal range. No imaging evidence of a fistula was found. She was refractory to symptomatic treatment including five epidural blood patches. Progressive improvement occurred simultaneously to the introduction of vitamin A supplementation. Discussion: A series of six similar patients is discussed, in which five patients remained severely symptomatic and workdisabled at an average follow-up of four years. It is proposed that the pathophysiological mechanism producing orthostatic headache might not be dependent on intracranial hypotension and could respond to vitamin A.
机构:
Tan Tock Seng Hosp, Dept Neurosurg, Natl Neurosci Inst, Singapore, SingaporeTan Tock Seng Hosp, Dept Neurosurg, Natl Neurosci Inst, Singapore, Singapore
Primalani, Nishal K.
Quek, Terence J.
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Tan Tock Seng Hosp, Anaesthesiol Intens Care & Pain Med Dept, Singapore, SingaporeTan Tock Seng Hosp, Dept Neurosurg, Natl Neurosci Inst, Singapore, Singapore
机构:
Shaoxing Second Hosp, Dept Neurol, Shaoxing, Zhejiang, Peoples R ChinaShaoxing Second Hosp, Dept Neurol, Shaoxing, Zhejiang, Peoples R China
Zhou, Yang
Tong, Chenglin
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Shaoxing Second Hosp, Dept Emergency Internal Med, Shaoxing 312000, Zhejiang, Peoples R ChinaShaoxing Second Hosp, Dept Neurol, Shaoxing, Zhejiang, Peoples R China