Cerebrospinal fluid

Engineering

Leak

Surgery

Intracranial Hypotension

Psychiatry

Lumbar puncture

Spontaneous Intracranial Hypotension

Anesthesia

Cerebrospinal fluid leak

Radiology

Environmental engineering

Epidural blood patch

Blood pressure

Internal medicine

Orthostatic vital signs

Medicine

Neuroimaging

The Lancet Neurology

Spontaneous intracranial hypotension is caused by loss of CSF at the level of the spine. The most frequent symptom of this disorder is orthostatic headache, with the headache worsening in the upright position and subsiding after lying down. Neuroimaging has a crucial role in diagnosing and monitoring spontaneous intracranial hypotension, because it provides objective (albeit often subtle) data despite the variable clinical syndromes and often normal lumbar puncture opening pressure associated with this disorder. Spine imaging aims to classify and localise the site of CSF leakage as either (1) a ventral dural leak, (2) a leaking spinal nerve root diverticulum, or (3) a direct CSF-venous fistula. Searching for a CSF leak can be very difficult; the entire spine must be scrutinised for a dural breach often the size of a pin. Precisely locating the site of CSF leakage is fundamental to successful treatment, which includes a targeted epidural patch and surgical closure when conservative measures do not provide long-term relief. Increased awareness of spontaneous intracranial hypotension among clinicians highlights the need for dedicated diagnostic and therapeutic guidelines.

Spontaneous intracranial hypotension: searching for the CSF leak