Intracranial hypotension

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R K Khurana1

  • 1Division of Neurology, Union Memorial Hospital, Baltimore, Maryland, USA.

Seminars in Neurology
|March 1, 1996
PubMed

Insights

Intracranial hypotension (IH), characterized by low cerebrospinal fluid (CSF) pressure, often causes severe headaches. Understanding its causes and symptoms is crucial for effective diagnosis and treatment.

Area of Science:

  • Neurology
  • Neurosurgery

Background:

  • Intracranial hypotension (IH) is defined by cerebrospinal fluid (CSF) pressure ≤ 60 mm H2O without prior dural puncture.
  • It disproportionately affects women (3:1 ratio) and presents with orthostatic headache as a primary symptom.
  • Associated symptoms include visual disturbances, auditory issues, and potential visual field defects upon examination.

Purpose of the Study:

  • To elucidate the pathophysiology, diagnostic approaches, and management strategies for intracranial hypotension.
  • To highlight the importance of neuroimaging in patients with postural headaches before lumbar puncture.
  • To review the utility of radionuclide cisternography in identifying CSF fistulas.

Main Methods:

  • Review of clinical presentation, postulated mechanisms (brain sagging, venous dilation, adenosine receptor activation), and diagnostic findings.
  • Discussion of primary IH (occult dural leak) and secondary causes (lumbar puncture, trauma, etc.).
  • Evaluation of diagnostic imaging and CSF fistula detection methods.

Main Results:

  • Orthostatic headache is the hallmark symptom of IH.
  • Radionuclide cisternography is highly sensitive for detecting CSF leaks.
  • Neuroimaging is recommended prior to lumbar puncture in patients with suspected IH.

Conclusions:

  • Intracranial hypotension encompasses diverse etiologies and clinical manifestations.
  • Prompt diagnosis and appropriate management, including caffeine or epidural interventions, can alleviate symptoms.
  • Further research into the underlying mechanisms and optimal treatment is warranted.

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