Spontaneous intracranial hypotension - a spinal disease

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Spontaneous intracranial hypotension (SIH) is an underdiagnosed neurological condition.
• Delayed diagnosis of SIH leads to significant physical impairment and potential long-term damage.
• Increasing awareness and scientific advances are improving SIH diagnosis and management.

Purpose of the Study:

• To provide an overview of the diagnostic workup for suspected SIH.
• To highlight new developments in imaging and therapeutic strategies for SIH.
• To emphasize the importance of early detection and treatment of SIH.

Main Methods:

• Selective literature search on PubMed (1990-2023) and authors' clinical experience.
• Two-stage diagnostic workup including noninvasive MRI and focused myelography.
• Review of diagnostic pitfalls, complications, and treatment options for SIH.

Main Results:

• SIH primarily affects middle-aged women, with position-dependent orthostatic headache as a key symptom.
• MRI of the head and spine indicates SIH presence; myelography precisely locates cerebrospinal fluid (CSF) leaks.
• Intrathecal pressure measurement and gadolinium injection are no longer primary diagnostic tools.

Conclusions:

• SIH diagnosis relies on a staged approach: MRI followed by myelography to identify CSF leaks.
• Prompt diagnosis and treatment of SIH, often involving CSF leak closure, improve patient outcomes.
• Collaboration with specialized CSF centers and follow-up MRI are crucial due to the chronic and relapsing nature of SIH.