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Headache secondary to intracranial hypotension
Wouter I Schievink1, Constance R Deline
1Department of Neurosurgery, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, Sixth Floor, A-6600, Los Angeles, CA, 90048, USA, schievinkw@cshs.org.
Current Pain and Headache Reports
|September 27, 2014
Summary
Spinal cerebrospinal fluid (CSF) leaks cause intracranial hypotension, often presenting as orthostatic headaches. Early diagnosis and interventions like epidural blood patching generally lead to good outcomes, though research continues.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Intracranial hypotension is frequently caused by spinal cerebrospinal fluid (CSF) leaks.
- These leaks can be iatrogenic, traumatic, or spontaneous, with spontaneous cases increasingly recognized.
- Orthostatic headache is a common but not universal symptom.
Purpose of the Study:
- To review the current understanding of spontaneous spinal CSF leaks.
- To discuss diagnostic imaging modalities and treatment strategies.
- To highlight areas for future research.
Main Methods:
- Review of clinical presentations and cranial magnetic resonance imaging findings.
- Discussion of imaging modalities including CT, MR, and digital subtraction myelography.
- Overview of treatment interventions such as epidural blood patching and surgery.
Main Results:
- Spontaneous spinal CSF leaks are linked to underlying connective tissue disorders affecting dural strength.
- Advanced imaging techniques improve diagnostic sensitivity for identifying CSF leaks.
- Epidural blood patching is the primary intervention, with surgery reserved for refractory cases.
Conclusions:
- While prognosis is generally favorable with timely intervention, complications can arise.
- Further research is essential to elucidate the genetics and pathophysiology of dural weakness.
- Refining imaging protocols, treatment approaches, and evaluating outcomes are critical for advancing patient care.
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