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Orthostatic headaches caused by CSF leak but with normal CSF pressures
B Mokri1, S F Hunter, J L Atkinson
1Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Neurology
|September 25, 1998
Summary
Orthostatic headaches from cerebrospinal fluid (CSF) leaks can occur even with normal CSF pressures. Clinicians should consider CSF leaks in patients with typical symptoms and imaging, regardless of pressure readings.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Cerebrospinal fluid (CSF) leaks or shunt overdrainage typically cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPGE).
- These conditions are usually associated with unmeasurable or very low CSF pressures.
Observation:
- This study identified seven patients with orthostatic headaches and DPGE who consistently had normal CSF pressures.
- These patients were part of a larger cohort of 40 consecutive patients evaluated for these symptoms.
Findings:
- Of the seven patients, two had overdraining shunts and five had documented CSF leaks.
- Six of the seven patients experienced complete symptom resolution and normalization of MRI abnormalities after surgical treatment or epidural blood patch.
Implications:
- Normal CSF opening pressure should not rule out a CSF leak diagnosis in patients with characteristic clinical and imaging findings.
- This highlights the importance of considering CSF leaks even when pressure measurements are within the normal range.