Intracranial hypotension secondary to spontaneous spinal cerebrospinal fluid fistula: Three case reports

Spontaneous intracranial hypotension syndrome (SIH) is a rare condition. The main symptom is orthostatic headache, although other symptoms such as vegetative symptoms, meningism, or focal neurological deficits may appear. The most common cause is a cerebrospinal fluid leak, usually traumatic. Spontaneous cerebrospinal fluid leaks are rare and associated with the presence of meningeal cysts / diverticula or in the setting of connective tissue diseases. The diagnosis is based on imaging tests, both to detect intracranial complications and bilateral subdural hematomas and to locate the leak point at the intracranial or spinal level. The treatment of SIH is usually conservative: bed rest, caffeine and analgesics. Epidural blood patch is a good option when symptoms persist. Surgery is indicated in refractory cases or when there is an evident and accessible anatomic defect. This article describes three clinical cases with intracranial hypotension syndrome secondary to a spontaneous spinal cerebrospinal fluid leak.