Hypotension of The Intracranial Circulation with CSF Leakage: A Rare Etiology of Misdiagnosed Orthostatic Headache; Using A Successful Blood Patching Technique: A Case Report and Literature Review

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for researchers?

Comments: Yes, the topic is relevant to the journal of surgery area of interest. The successful use of a cervical epidural blood patch as a treatment for spontaneous intracranial hypotension caused by CSF leakage presents an interesting case study for surgeons and medical professionals. The rarity of the condition, coupled with its misdiagnosis, makes this case contemporary and intriguing for researchers in this field. The report can provide insights into alternative treatment methods and strategies for dealing with similar cases in the future.

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

Comments: Yes, the abstract includes all the required components. It has a clear background, case presentation, discussion and conclusion.

The chosen keywords accurately represent the content of the abstract and are specific to the topic of Spontaneous Intracranial Hypotension and its treatment.

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

Comments: Yes, the structure of the paper is coherent. It follows the conventional structure of a case report with an introduction, case presentation, discussion, and conclusion. It begins with a brief introduction about Spontaneous Intracranial Hypotension (SIH), followed by the presentation of a specific patient case. It then discusses the condition and treatment options in more depth, and concludes with the outcome of the treatment for the patient in the case presentation.

This structure is in coherence with the goal of the paper, which appears to be to present a unique case of SIH and discuss its diagnosis and treatment.

Tools and Methods

Q: Are methods the author uses adequate and well used?

Comments: Yes, the methods used by the authors are adequate and well used. In this case report, the authors employed a comprehensive approach in diagnosing and managing Spontaneous Intracranial Hypotension (SIH) in their patient. They used a combination of physical examination, laboratory investigations, and imaging studies (brain MRI, MRA, MRV, spinal MRI, and MRI myelogram) to identify the issue. They also detailed the technique of the cervical-targeted epidural blood patch procedure, including the positioning of the patient, use of X-ray guidance, and the step-by-step process of the procedure. They carefully monitored the patient during and after the procedure, leading to a successful outcome. This thorough and methodical approach contributed to the accurate diagnosis and treatment of this complex case.

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

Comments: Yes, the discussion and conclusion are related to the results presented in the case study. They provide an explanation of the condition (SIH), discuss its diagnosis and treatment options, and explain how the patient's symptoms were successfully managed using an epidural blood patch. This approach is directly linked to the patient's case presented in the results section, making the discussion and conclusion coherent with the rest of the case report.

Literature

Q: Does the author utilize relevant literature?

Comments: Yes, the author appears to utilize relevant literature. References to previous studies are found throughout the case report, suggesting that the author has conducted a thorough literature review on the topic. The introduction cites previous research to provide background information on Spontaneous Intracranial Hypotension (SIH), including its prevalence, common misdiagnosis, and treatment options. The discussion also cites previous research to further explain the condition and the effectiveness of the treatment used in the case. The use of such references enhances the validity of the information presented and aids in situating the case within the broader context of existing knowledge on the topic.

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

Comments: The length of the paper appears to be adequate for the topic at hand. It's a detailed case report on a rare condition, Spontaneous Intracranial Hypotension (SIH), and its successful treatment with an epidural blood patch. The author has provided sufficient details about the patient's history, clinical presentation, diagnostic process, treatment, and follow-up, which are all essential components of a comprehensive case report. Each section is concise and focused. Therefore, it might not be advisable to shorten the paper as it may lead to the omission of important details.

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: The author has used figures appropriately to support the description of the case. The images clearly show the medical findings and aid in understanding the patient's condition. In terms of legends and notations, they seem to be described well in the text.

Writing style

Q: Is it clear and understandable?

A: Based on the text provided, the writing style appears to be clear and understandable overall. Medical and technical terminology are used appropriately and are likely to be understood by readers with a background in the field. The narrative of the case report is logically structured and easy to follow, from the initial presentation of the patient through to the diagnosis and treatment. The discussion and conclusion also effectively summarise the key points and findings. However, the text could benefit from minor proofreading for typographical and grammatical errors to ensure clarity. For example, "phase" should be "face" in the introduction, and "precede" should be "proceed" in the case presentation.

Further comments on the paper

Comments:
The paper offers a valuable contribution to the existing literature, presenting a rare case of Spontaneous Intracranial Hypotension (SIH) and a successful treatment approach.

1.     Case Presentation: The author does an excellent job detailing the presentation and the history of the patient. The detailed history gives the reader insight into the evolution of the patient's symptoms over time, which is valuable for understanding the diagnosis and treatment approach.

2.     Use of Imaging: The use of images in the case presentation is a strong point. The figures give the reader a visual understanding of the condition and the location of the CSF leak. This aids comprehension of the case and the treatment approach.

3.     Discussion and Conclusion: The author effectively synthesizes the case with current literature on SIH, showing understanding of the condition and its management. The conclusion succinctly summarises the case and its significance, which is helpful for readers.

4.     Literature Review: The author has done a commendable job incorporating relevant literature throughout the text. This helps frame the case within the broader scientific and medical context, giving it more significance and relevance.

5.     Clarity and Comprehensibility: The text is well-organized and clearly written. The author does a good job of explaining complex medical terms and conditions, making the content accessible to readers who might not be experts in the field.

6.     Significance: The paper successfully highlights the importance of considering SIH as a potential cause of severe headaches. This is a valuable reminder for clinicians and could contribute to better patient outcomes in the future.

Overall, the paper is well-organized and informative, offering a valuable resource for clinicians and researchers in this field.

Q: Would you recommend this manuscript for further publication?

A: Yes- This manuscript is recommended for further publication. The case presented is unique and the approach to diagnosis and treatment provides valuable insights for other practitioners who may encounter similar cases. The author's meticulous reporting and clear communication make it a strong contribution to medical literature.

If you have any questions and clarifications you can write to the journal.

Thanks,
Science Repository Team