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Spontaneous spinal cerebrospinal fluid leaks.

W I Schievink¹

¹Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. schievinkw@cshs.org

Cephalalgia : an International Journal of Headache

|November 29, 2008

Summary

Spontaneous intracranial hypotension, often caused by spinal cerebrospinal fluid (CSF) leaks, presents as daily headaches. Diagnosis can be delayed, but treatments like bedrest and epidural blood patching can help manage this condition.

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Area of Science:

Neurology
Neurosurgery
Radiology

Background:

Spontaneous intracranial hypotension (SIH) is an uncommon cause of daily persistent headaches.
It disproportionately affects women in their fifth or sixth decade.
The condition stems from a spontaneous spinal cerebrospinal fluid (CSF) leak.

Purpose of the Study:

To review the clinical presentation, diagnostic imaging, and treatment options for spontaneous intracranial hypotension.
To highlight the common diagnostic delays and associated symptoms.

Main Methods:

Review of clinical literature on spontaneous intracranial hypotension.
Analysis of typical and atypical headache patterns.
Discussion of diagnostic imaging modalities including MRI and myelography.
Overview of treatment strategies.

Main Results:

Headaches are typically orthostatic but can present differently.
Associated symptoms include neck pain, auditory changes, diplopia, facial numbness, cognitive issues, and coma.
Characteristic imaging findings include subdural fluid collections, pachymeningeal enhancement, pituitary hyperemia, and brain sagging, though MRI can be normal.
Myelography is key for localizing CSF leaks but not always required for diagnosis.

Conclusions:

Spontaneous intracranial hypotension is a treatable cause of daily headaches, often linked to spinal CSF leaks.
Early recognition and appropriate management, including bedrest, epidural blood patching, or surgery, are crucial.
Further research is needed to better understand patient outcomes.