Is Bariatric Surgery Associated with Spontaneous Intracranial Hypotension?

Published in Neurology 2014 Oct 22

Authors: Schievink WI et al.

Possibly, based on findings of a small case-control study

Spontaneous intracranial hypotension is a highly disabling syndrome that most commonly presents with severe, disabling orthostatic headache. Although spinal meningeal cysts are often visible in these patients, and conditions such as Ehler-Danlos syndrome have been implicated, the etiopathogenesis is not well understood.

To determine whether bariatric surgery is a risk factor for spontaneous intracranial hypotension, investigators compared the frequency of bariatric surgery in 338 patients with spontaneous intracranial hypotension and 245 patients with unruptured intracranial aneurysm.

Eleven patients (3.3%) with spontaneous intracranial hypotension had undergone bariatric surgery compared with two patients (0.8%) with unruptured intracranial aneurysms (P=0.02). The time interval between bariatric surgery and onset of symptoms of spontaneous intracranial hypotension was between 3 and 241 months, with a mean of 56.5 months.

Comment
The authors conclude that bariatric surgery is a risk factor for spontaneous intracranial hypotension. As a possible explanation, they allude to a link between body mass and cerebrospinal fluid (CSF) pressure, as the group who underwent bariatric surgery experienced weight reduction between the time of surgery and the presentation of spontaneous intracranial hypotension. However, one challenge to this explanation is the long delay time between surgery and onset of symptoms in some patients, exceeding 20 years in one case. Moreover, the authors cite other study limitations, such as the poor matching of groups by age and the possibility of referral bias due to the involvement of a center with an interest in CSF hypotension. If body habitus or weight change is a driver, the link with spontaneous intracranial hypotension could be studied in other groups as a window into understanding what is a frequently perplexing and sometimes very challenging management problem.