Spontaneous Intracranial Hypotension: A Tertiary Care Experience

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Spontaneous intracranial hypotension (SIH) is a rare condition causing headaches due to cerebrospinal fluid leaks.
• Limited Indian data exists on SIH clinical profiles and treatment outcomes.
• This study addresses the gap by analyzing SIH cases in South India.

Purpose of the Study:

• To describe the clinical, radiological, and treatment characteristics of SIH patients in South India.
• To compare outcomes between epidural blood patch (EBP) and conservative management for SIH.
• To contribute to the largest Indian SIH series for better understanding and management.

Main Methods:

• Retrospective observational study of 33 SIH patients (2004-2024) meeting ICHD-3 criteria.
• Analysis of clinical features, MRI findings, and treatment modalities.
• Statistical comparison of outcomes between EBP and conservative groups (Chi-square/t tests).

Main Results:

• 91% of patients experienced orthostatic headache; 73% were female (mean age 42).
• Common MRI findings: pachymeningeal enhancement (90%), pituitary engorgement (59%), spinal fluid collections (52%).
• EBP showed higher immediate headache resolution (80% vs. 31%), with comparable 3-month outcomes (75% vs. 62%).

Conclusions:

• SIH predominantly presents with orthostatic headache and pachymeningeal enhancement in this Indian cohort.
• Epidural blood patch (EBP) offers rapid symptomatic relief and is a preferred initial therapy.
• Early recognition and standardized imaging are crucial for improving SIH patient outcomes.