Treatments include bed rest, epidural blood patching, percutaneous placement of fibrin sealant, and surgical CSF leak repair, but outcomes have been poorly studied and no management strategies have been studied in properly controlled randomized trials.Ĭonclusions Spontaneous intracranial hypotension is not rare but it remains underdiagnosed. Myelography is the study of choice to identify the spinal CSF leak. Typical magnetic resonance imaging findings include subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain (mnemonic: SEEPS). An orthostatic headache is the prototypical manifestation but other headache patterns occur as well, and associated symptoms are common. Mechanical factors combine with an underlying connective tissue disorder to cause the CSF leaks. Women are affected more commonly than men. The incidence has been estimated at 5 per 100 000 per year, with a peak around age 40 years. Reference lists of these articles and ongoing investigations in this area were used as well.Įvidence Synthesis Spontaneous intracranial hypotension is caused by single or multiple spinal CSF leaks. Objective To summarize existing evidence regarding the epidemiology, pathophysiology, diagnosis, and management of spontaneous spinal CSF leaks and intracranial hypotension.Įvidence Acquisition MEDLINE (1966-2005) and OLDMEDLINE (1950-1965) were searched using the terms intracranial hypotension, CSF leak, low pressure headache, and CSF hypovolemia. It is an important cause of new headaches in young and middle-aged individuals, but initial misdiagnosis is common.
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