Spontaneous intracranial hypotension
- Spontaneous intracranial hypotension
Spontaneous intracranial hypotension (SIH), also known as a spontaneous low CSF (Cerebrospinal fluid) pressure headache, usually presents without any preexisting trauma or known violation of the epidural or thecal space.
ymptoms
The headache is usually orthostatic and related to traction on pain-sensitive intracranial and meningeal structures. The condition is benign and self limited. It may be associated with nausea, vomiting, horizontal diplopia, unsteadiness, vertigo, altered hearing, neck pain/stiffness, interscapular pain, and occasionally visual field cuts.
Diagnosis
The diagnosis is made based on history, exclusion of competing differential diagoses, and the following studies:MRIs with gadolinium may display diffuse patchy meningeal enhacement, "sagging" of the brain, tonsilar descent, and posterior fossa crowding. This condition is associated with low CSF opening pressure on lumbar puncture (normal CSF pressure is at least 60cmH2O). [Lay CM. Low Cerebrospinal Fluid Pressure Headache.Curr Treat Options Neurol. 2002 Sep;4(5):357-363]
Treatment
Although conservative management should by attempted, an epidural blood patch should be attempted, as it is the treatment of choice.
References
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