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Spontaneous Intracranial Hypotension.

Horst Urbach1, Christian Fung2, Philippe Dovi-Akue1

  • 1Department of Neuroradiology, Universitätsklinikum Freiburg.

Deutsches Arzteblatt International
|October 14, 2020
PubMed
Summary
This summary is machine-generated.

Spontaneous intracranial hypotension (SIH) is often underdiagnosed. Confirming spinal cerebrospinal fluid (CSF) leaks with imaging and surgical closure are key to successful treatment.

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Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Spontaneous intracranial hypotension (SIH) is an underdiagnosed condition with an estimated incidence of 5 per 100,000 person-years.
  • The exact cause of SIH is often unclear, with no demonstrable cerebrospinal fluid (CSF) leak in up to 50% of cases.

Purpose of the Study:

  • To review diagnostic and therapeutic strategies for spontaneous intracranial hypotension.
  • To highlight the importance of advanced imaging in localizing spinal CSF leaks.

Main Methods:

  • Selective literature search of PubMed (2000-2019) and authors' clinical experience.
  • Review of diagnostic modalities including lumbar puncture and myelographic CT.
  • Evaluation of treatment outcomes for epidural blood patches and surgical interventions.

Main Results:

  • SIH results from spinal CSF leaks via dural tears or nerve root diverticula; 2-5% involve CSF-venous fistulas.
  • Low opening pressure on lumbar puncture is infrequent; imaging is crucial for diagnosis and localization.
  • Myelographic CT identifies ventral dural tears in 50% of patients, often in the upper thoracic spine.
  • Epidural blood patches achieve 30-70% success; 90% of ventral dural tears require surgery.
  • Further studies like dynamic myelography are needed for leaks not visible on CT.

Conclusions:

  • Accurate diagnosis of SIH necessitates complementary imaging to identify the spinal CSF leak.
  • Surgical closure of the identified CSF leak is frequently required for successful management.
  • Further controlled studies are needed due to the limited evidence currently available.