Problems of diagnosis and treatment of intracranial hypotension syndrome – an interdisciplinary problem

Vertigo and dizziness are often found among the complaints of patients when contacting doctors of various specialties.
In this article we conducted a meta-analysis of 458 literature sources in the PubMed database, of which 87 publications received the most attention. Attention is paid to the late diagnosis of a number of symptomatically similar nosologies, the
lack of specific research methods that could exclude or confirm with a high degree of confidence the presence of the patient intracranial hypotension syndrome (IHS), vestibular migraine (VM), Meniere’s disease (BM), non-inflammatory
perilymphatic fistulas of the labyrinth windows (NPFLW). Due to the complexity of the diagnosis of these pathologies, the possibility of inaccuracies in the statistical data is allowed. This may lead to an overestimation of the mentioned
prevalence of the most well-known diseases with a similar symptom complex, and to insufficient or untimely identification
of the true causes of suffering of the patient. The high frequency of occurrence of cochleovestibular complaints in IHS
is emphasized, and often their incorrect interpretation, which leads to erroneous diagnoses.
The purpose of research. The optimization of diagnostic search in cochleovestibular disorders with the determination
of indications for a new type of surgical treatment of patients with IHS with the evaluation of the results of the treatment.
Material and methods. Authors present their own experience in the diagnosis and treatment of 36 patients with IHS, including 27 women and 9 men, aged 26 to 72 years, with vestibulopathies of unknown origin, who, based on the analysis
of the course of the disease, were diagnosed with IHS. To relieve or reduce the severity of vertigo attacks in IHS and to enhance and prolong the result of symptomatic treatment the use of selective laser destruction (KTP radiation with
a wavelength of 0.53 microns) of the receptor apparatus of the horizontal semicircular labyrinth channel is proposed.
Results. The information content of a number of audiometric and otoneurological tests is shown. Emphasis is placed on the validity of “impact” audiometric tests (with head tilt, hyperventilation, and caffeine administration),
associated with changes in intracranial pressure. The authors present their own clinical observation of a 40-year- old patient with IHS, who received the author’s surgical treatment. During the two-year catamnestic observation,
no negative dynamics were observed.
Conclusions. Not only a neurologist, but also an otorhinolaryngologist should take an active part in the recognition of IHS. In vestibulopathies, it is advisable to expand the indications for performing “impact” audiometric tests, which
improves differential diagnosis with symptomatically similar diseases. Dynamic monitoring of patients with IHS who underwent combined treatment with the use of exposure a pulsed high-energy laser on the semicircular channel of
the labyrinth, confirms its effectiveness. Identification of interest of the peripheral department the cochleovestibular analyzer, even with the leading central genesis of the underlying pathology, allows us to expand the reasonable selection of patients for high-tech otorhinolaryngological surgical interventions.
Key words: vertigo, intracranial hypotension syndrome, endolymphatic hydrops of the labyrinth, selective laser destruction of the semicircular canal of the labyrinth
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study