Spontaneous Intracranial Hypotension: Pathogenesis, Diagnosis, and Treatment

Peter G Kranz; Linda Gray; Michael D Malinzak; Timothy J Amrhein

doi:10.1016/j.nic.2019.07.006

Spontaneous Intracranial Hypotension: Pathogenesis, Diagnosis, and Treatment

Neuroimaging Clin N Am. 2019 Nov;29(4):581-594. doi: 10.1016/j.nic.2019.07.006. Epub 2019 Aug 26.

Authors

Peter G Kranz¹, Linda Gray², Michael D Malinzak², Timothy J Amrhein³

Affiliations

¹ Department of Radiology, Division of Neuroradiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA. Electronic address: peter.kranz@duke.edu.
² Department of Radiology, Division of Neuroradiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA.
³ Department of Radiology, Division of Neuroradiology, Duke University Medical Center, DUMC Box 3808, Durham, NC 27710, USA. Electronic address: https://twitter.com/TimAmrheinMD.

PMID: 31677732
DOI: 10.1016/j.nic.2019.07.006

Abstract

Spontaneous intracranial hypotension (SIH) is a clinical syndrome that is increasingly recognized as an important and treatable secondary cause of headaches. Insight into the condition has evolved significantly over the past decade, resulting in a greater understanding of the underlying pathophysiology, development of new diagnostic imaging tools, and a broadening array of targeted treatment options. This article reviews the clinical presentation and pathogenesis of SIH, discusses the important role of imaging in diagnosis, and describes how imaging guides treatment.

Keywords: CSF leak; CSF-venous fistula; Epidural blood patch; Myelography; Spontaneous intracranial hypotension.

Publication types

Review

MeSH terms

Bed Rest
Blood Patch, Epidural / methods
Caffeine / therapeutic use
Fluid Therapy / methods
Humans
Intracranial Hypotension / diagnostic imaging*
Intracranial Hypotension / pathology*
Intracranial Hypotension / therapy
Magnetic Resonance Imaging / methods*
Myelography / methods
Tomography, X-Ray Computed / methods*

Substances

Caffeine