Syndrome of Cerebral Spinal Fluid Hypovolemia: Clinical and Imaging Features and Outcome

Neurology. 2000 Nov 14;55(9):1321-7. doi: 10.1212/wnl.55.9.1321.


Objective: To investigate clinical, MRI, and radioisotope findings and therapeutic outcome of the syndrome of CSF hypovolemia.

Methods: Retrospective review was performed of 30 consecutive patients (10 men, 20 women; mean age 37 years) with the syndrome of CSF hypovolemia.

Results: All patients had an orthostatic headache, which was alleviated to a variable extent on recumbency. Additional clinical symptoms included nausea, dizziness, neck stiffness, blurring of vision, tinnitus, plugged ear, hearing difficulties and radicular pain of the arm. Eighty-two percent of the patients had CSF opening pressure less than 60 mm H2O, 59% had CSF pleocytosis, and 95% had increased CSF protein. Brain MRI showed diffuse pachymeningeal gadolinium enhancement on T1-weighted image in 83%, which was seen as hyperintense signals on T2-weighted imaging. Other features included subdural hematoma/hygroma in 17% and descent of the brain in 48% of the patients. Radioisotope cisternographic results identified CSF leakage sites in 52%, most often at the lumbar region. Also observed were limited ascent of the tracer to the cerebral convexity (91%), early appearance of radioisotope in the bladder (65%), and early soft tissue uptake of radioisotope (43%). Epidural blood patches were performed in 23 patients, which produced complete resolution of headaches in 70%. Two patients underwent drainage of subdural hematoma. None died or were disabled during hospitalization.

Conclusions: Patients with CSF hypovolemia frequently have distinct MRI and radioisotope cisternographic abnormalities and often respond favorably to an epidural blood patch.

MeSH terms

  • Adult
  • Cerebrospinal Fluid Pressure*
  • Female
  • Humans
  • Hypovolemia / cerebrospinal fluid*
  • Hypovolemia / pathology
  • Hypovolemia / physiopathology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Subdural Effusion / cerebrospinal fluid
  • Subdural Effusion / pathology
  • Subdural Effusion / physiopathology
  • Syndrome