How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension?

Cephalalgia. 2016 Nov;36(13):1209-1217. doi: 10.1177/0333102415623071. Epub 2016 Jul 19.


Objectives To determine the proportion of patients with spontaneous intracranial hypotension (SIH) who had a cerebrospinal fluid (CSF) pressure >6 cm H2O and to investigate the clinical and imaging variables associated with CSF pressure ( PCSF) in this condition. Methods We retrospectively reviewed 106 patients with SIH. PCSF was measured by lumbar puncture prior to treatment. Clinical and imaging variables - including demographic data, brain imaging results, symptom duration, and abdominal circumference - were collected. Univariate and multivariate analyses were performed to determine the correlation of these variables with PCSF. Results Sixty-one percent of patients had a PCSF between 6 and 20 cm H2O; only 34% had a PCSF ≤6 cm H2O. The factors associated with increased PCSF included abdominal circumference ( p < 0.001), symptom duration ( p = 0.015), and the absence of brain magnetic resonance imaging findings of SIH ( p = 0.003). A wide variability in PCSF was observed among all patients, which was not completely accounted for by the variables included in the model. Conclusions Normal CSF pressure is common in patients with SIH; the absence of a low opening pressure should not exclude this condition. Body habitus, symptom duration, and brain imaging are correlated with PCSF measurements, but these factors alone do not entirely explain the wide variability in observed pressures in this condition and this suggests the influence of other factors.

Keywords: Spontaneous intracranial hypotension; cerebrospinal fluid leak; low cerebrospinal fluid pressure.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebrospinal Fluid Leak / epidemiology
  • Cerebrospinal Fluid Leak / pathology*
  • Cerebrospinal Fluid Leak / physiopathology*
  • Cerebrospinal Fluid Pressure*
  • Comorbidity
  • Female
  • Humans
  • Intracranial Hypotension / epidemiology
  • Intracranial Hypotension / pathology*
  • Intracranial Hypotension / physiopathology*
  • Magnetic Resonance Imaging / statistics & numerical data
  • Male
  • Manometry / statistics & numerical data*
  • Middle Aged
  • North Carolina / epidemiology
  • Prevalence
  • Reference Values
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Young Adult