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Intracranial hypotension

R K Khurana1

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

Seminars in Neurology
|March 1, 1996
PubMed
Summary
This summary is machine-generated.

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.

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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.

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  • 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.