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Spontaneous intracranial hypotension
Sanjay Cheema1,2, Dwij Mehta1,2, Ayman Qureshi3
1Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
Insights
Spontaneous intracranial hypotension (SIH) is a disabling headache cause. This summary outlines practical diagnosis and treatment strategies for SIH, including leak site identification and targeted interventions.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Spontaneous intracranial hypotension (SIH) is a significant cause of disabling headaches.
- Advances in neuroradiology have improved understanding and diagnosis of SIH.
- A UK multidisciplinary group developed consensus guidelines for SIH management.
Purpose of the Study:
- To summarize a practical approach to diagnosing and treating SIH.
- To detail clinical and radiological diagnostic methods.
- To outline interventional and targeted treatment strategies for SIH.
Main Methods:
- Review of current neuroradiological techniques for SIH diagnosis.
- Summary of symptomatic and non-targeted interventional treatments.
- Description of methods for radiological leak site identification.
- Outline of targeted treatment approaches post-localization.
Main Results:
- Progress in neuroradiology enhances SIH diagnosis and understanding.
- Multidisciplinary guidelines offer a structured approach to SIH management.
- Effective methods exist for both identifying and treating the source of CSF leak.
Conclusions:
- SIH is a treatable cause of headache with improved diagnostic capabilities.
- A practical, multidisciplinary approach is key for effective SIH management.
- Targeted treatment following accurate leak localization offers the best outcomes for SIH patients.
Abstract:
Spontaneous intracranial hypotension (SIH) is a highly disabling but treatable secondary cause of headache. Recent progress in neuroradiological techniques has catalysed understanding of its pathophysiological basis and clinical diagnosis, and facilitated the development of more effective investigation and treatment methods. A UK-based specialist interest group recently produced the first multidisciplinary consensus guideline for the diagnosis and treatment of SIH. Here, we summarise a practical approach to its clinical and radiological diagnosis, symptomatic and non-targeted interventional treatment, radiological identification of leak site and targeted treatment of the leak once it has been localised.
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