Spontaneous low cerebrospinal pressure: a mini review

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Spontaneous intracranial hypotension (SIH) is a clinical syndrome characterized by low cerebrospinal fluid (CSF) pressure.
• It presents with postural headaches in individuals without dural puncture or trauma.
• SIH is hypothesized to stem from an occult CSF leak, reducing CSF volume and pressure.

Purpose of the Study:

• To describe the diagnostic features and treatment strategies for spontaneous intracranial hypotension.
• To highlight the role of advanced imaging in diagnosing SIH.
• To outline the progression of treatment from conservative measures to invasive procedures.

Main Methods:

• Review of historical descriptions and modern diagnostic criteria for SIH.
• Utilization of magnetic resonance imaging (MRI) for identifying characteristic radiographic abnormalities.
• Evaluation of treatment outcomes for conservative therapies and epidural blood patching.

Main Results:

• SIH diagnosis is supported by MRI findings such as diffuse pachymeningeal enhancement, subdural fluid collections, and downward brain displacement.
• Conservative, non-invasive therapies are the initial treatment approach for SIH headaches.
• Epidural blood patch is the preferred treatment for patients unresponsive to non-invasive methods.

Conclusions:

• Spontaneous intracranial hypotension is a distinct syndrome with specific diagnostic markers on MRI.
• A stepwise treatment approach, starting with conservative management and progressing to epidural blood patching, is effective.
• Early diagnosis and appropriate treatment are crucial for managing SIH and alleviating patient symptoms.