TY - JOUR
T1 - Spontaneous intracranial hypotension
T2 - updates from diagnosis to treatment
AU - Farnsworth, Paul J.
AU - Madhavan, Ajay A.
AU - Verdoorn, Jared T.
AU - Shlapak, Darya P.
AU - Johnson, Derek R.
AU - Cutsforth-Gregory, Jeremy K.
AU - Brinjikji, Waleed
AU - Lehman, Vance T.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/2
Y1 - 2023/2
N2 - Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
AB - Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
KW - CSF leak
KW - Digital subtraction myelography
KW - Dynamic CT myelography
KW - Orthostatic headache
KW - Sponaneous intracranial hypotension
KW - Tranvenous Onyx embolization
UR - http://www.scopus.com/inward/record.url?scp=85141385161&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85141385161&partnerID=8YFLogxK
U2 - 10.1007/s00234-022-03079-5
DO - 10.1007/s00234-022-03079-5
M3 - Review article
C2 - 36336758
AN - SCOPUS:85141385161
SN - 0028-3940
VL - 65
SP - 233
EP - 243
JO - Neuroradiology
JF - Neuroradiology
IS - 2
ER -