Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

Intracranial Hypotension Intraocular Infection 855

■Nausea, vomiting, uni- or bilateral 6th nerve palsy occur commonly;

tinnitus, hyperacusis sometimes occur

■May be history of lumbar puncture (LP) in previous week, or of

trauma

■No neurologic deficit

tests

■None required unless symptoms occur in absence of history of LP;

gadolinium-enhanced MRI may then show dural enhancement or

associated subdural hematoma

differential diagnosis

■Absence of fever, other neurologic symptoms & signs of meningeal

irritation makes meningitis unlikely

■History of trauma suggests cranial CSF fistula (eg, otorrhea or rhin-

orrhea)

■MRI will detect subdural hematoma or pituitary tumor, which may

erode sella to cause CSF leak

■Absence of overt cause suggests CSF leak from arachnoid cyst related

to spinal root sleeve

management

■Bed rest may alleviate headache

specific therapy

■Symptoms occasionally respond to caffeine, sodium benzoate

■Persistent symptoms may respond to epidural blood patch or epidu-

ral or intrathecal saline infusion

■Surgical closure of spontaneous dural leak is required in rare

instances

■Surgery may be required for subdural hematoma or fistula related to

trauma or tumor

follow-up

■None needed once symptoms settle

complications and prognosis

■Symptoms eventually settle spontaneously

Intraocular Infection..................................

TODD P. MARGOLIS, MD, PhD

history & physical

History

■Decreased vision