Definition:
Spontaneous intracranial hypotension is probably an under diagnosed cause of headache, even though it is estimated to affect only about one in 50,000 individuals.
Diagnosis:
Diagnosis is usually suspected based on the postural dependency of the headache, although in many cases the diagnosis of intracranial hypotension is not considered for some time. A contrast-enhanced brain scan typically shows thickened and brightly enhancing meninges (pachymeningeal enhancement). Other discoveries include descent of the thalamus and cerebellar tonsils. Continuous intracranial pressure screening is definitive for documenting abnormally negative intracranial pressures.
Treatment:
If the site of the spinal CSF leak can be identified, then options include: Epidural blood patch, performed by an anesthesiologist pain management specialist, surgical repair of the defect. Over-draining CSF shunts are controlled by replacing the valve with one that drains less. Lumboperitoneal shunts can have to be removed or ligated.
Symptoms and Signs:
The classic symptom is severe headache when upright, which is relieved when lying flat. While other symptoms can include nausea, vomiting, double vision and difficulty with concentration.
Causes:
The condition is usually caused by the leakage of spinal cerebrospinal fluid (CSF). A combination of an underlying weakness of the spinal meninges and a more or less trivial traumatic scene, such as riding a roller coaster or jet skiing, is often found to cause spontaneous intracranial hypotension.
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