Skip to main content

Advertisement

Log in

A Practical Approach to the Diagnosis of Spontaneous Intracranial Hypotension

  • Uncommon and/or Unusual Headaches and Syndromes (J Ailani, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Spontaneous intracranial hypotension can be difficult to diagnose as there are a number of tests available and knowing how to appropriately choose amongst them is not always easy. In this article, we will review the available diagnostic options and provide a practical approach to the workup of a patient with suspected intracranial hypotension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd ed. (ICHD-3) Cephalalgia 2013;33(9):629-808. Provides the most authoritative and comprehensive classification of all headache diagnoses.

  2. Starling A, Hernandez F, Hoxworth JM, Trentman T, Halker R, Vargas BB, et al. Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak. Neurology. 2013;81:1789–92. Provides a practical algorithm for the diagnosis of SIH.

    Article  PubMed  Google Scholar 

  3. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295(19):2286.

    Article  CAS  PubMed  Google Scholar 

  4. Amoozegar F, Guglielmin D, Hu W, Chan D, Becker WJ. Spontaneous intracranial hypotension: recommendations for management. Can J Neurol Sci. 2013;40:144–57.

    Article  PubMed  Google Scholar 

  5. Watanabe A, Horikoshi T, Uchida M, Koizumi H, Yagishita T, Kinouchi H. Diagnostic value of spinal MR imaging in spontaneous intracranial hypotension syndrome. AJNR Am J Neuroradiol. 2009;30:147–51.

    Article  CAS  PubMed  Google Scholar 

  6. Schoffer KL, Benstead TJ, Grant I. Spontaneous intracranial hypotension in the absence of magnetic resonance imaging abnormalities. Can J Neurol Sci. 2002;29:253–7.

    Article  PubMed  Google Scholar 

  7. Luetmer PH, Schwartz KM, Eckel LJ, Hunt CH, Carter RE, Diehn FE. When should I do dynamic CT myelography? Predicting fast spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2012;33:690–4.

    Article  CAS  PubMed  Google Scholar 

  8. Bonetto N, Manara R, Citton V, Cagnin A. Spinal subtraction MRI for diagnosis of epidural leakage in SIH. Neurology. 2011;77(21):1873–6.

    Article  CAS  PubMed  Google Scholar 

  9. Schievink WI, Maya MM, Louy C. Cranial MRI predicts outcome of spontaneous intracranial hypotension. Neurology. 2005;64:1282–4.

    Article  PubMed  Google Scholar 

  10. Yoo HM, Kim SJ, Choi CG, et al. Detection of CSF leak in spinal CSF leak syndrome using MR myelography: correlation with radioisotope cisternography. AJNR Am J Neuroradiol. 2008;29(4):649–54.

    Article  PubMed  Google Scholar 

  11. Wang YF, Lirng JF, Fuh JL, et al. Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension. Neurology. 2009;73:1892.

    Article  PubMed  Google Scholar 

  12. Akbar JJ, Luetmer PH, Schwartz KM, Hunt CH, Diehn FE, Eckel LJ. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2012;33:535–40.

    Article  CAS  PubMed  Google Scholar 

  13. De Andres J, Esparza MJ, Ferrer-Rebolleda J, Castillo-Ruiz A, Villaneuva-Perez VL. Radioisotope cisternography: a potentially useful tool for headache diagnosis in patients with an IDD pump. Pain Physician. 2014;17(1):E89–94.

    PubMed  Google Scholar 

  14. Sakurai K, Nishio M, Yamada K, et al. Comparison of the radioisotope cisternography findings of spontaneous intracranial hypotension and iatrogenic cerebrospinal fluid leakage focusing on chronological changes. Cephalalgia. 2012;32:1131.

    Article  PubMed  Google Scholar 

  15. Hoxworth JM, Trentman TL, Kotsenas AL, Thielen KR, Nelson KD, Dodick DW. The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol. 2012;199:649–53.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Kristen Steenerson and Rashmi Halker each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rashmi Halker.

Additional information

This article is part of the Topical Collection on Uncommon and/or Unusual Headaches and Syndromes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steenerson, K., Halker, R. A Practical Approach to the Diagnosis of Spontaneous Intracranial Hypotension. Curr Pain Headache Rep 19, 35 (2015). https://doi.org/10.1007/s11916-015-0509-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-015-0509-9

Keywords

Navigation