Spontaneous Intracranial Hypotension: A Review and Introduction of an Algorithm For Management

World Neurosurg. 2017 May:101:343-349. doi: 10.1016/j.wneu.2017.01.123. Epub 2017 Feb 9.


Background: Spontaneous intracranial hypotension (SIH) is a condition of low cerebrospinal fluid volume and pressure caused by a leak of cerebrospinal fluid through a dural defect. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines for myelography, blood patching, and possible surgical repair. Patients should be monitored closely, because they can deteriorate into a coma or even death. There are no widely accepted guidelines for the management of SIH.

Methods and conclusions: We review the existing SIH literature, illustrate management challenges via a case review, and propose an algorithm developed by neurosurgeons, radiologists, and anesthesiologists intended to simplify and streamline the management of SIH.

Keywords: Algorithm; Blood patch; CSF leak; Myelography; Orthostatic; Spontaneous intracranial hypotension; Trendelenberg.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Algorithms*
  • Blood Patch, Epidural / methods
  • Cerebrospinal Fluid Leak / diagnostic imaging
  • Cerebrospinal Fluid Leak / epidemiology
  • Cerebrospinal Fluid Leak / surgery
  • Disease Management*
  • Humans
  • Intracranial Hypotension / diagnostic imaging*
  • Intracranial Hypotension / epidemiology
  • Intracranial Hypotension / surgery*
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed / methods