A Review of Spontaneous Intracranial Hypotension

Curr Neurol Neurosci Rep. 2019 Mar 19;19(5):22. doi: 10.1007/s11910-019-0938-7.


Purpose of review: Spontaneous intracranial hypotension (SIH) is an underdiagnosed phenomenon predominantly presenting with low cerebrospinal fluid (CSF) pressure and postural headache in setting of CSF leak. The goal of this paper is to provide updates on the pathology, diagnosis, and management of SIH. The utility of multiple imaging modalities and the use of epidural blood patches and fibrin glue polymers are explored.

Recent findings: In regard to diagnosis, new non-invasive modalities in detection of SIH including transorbital ultrasound and serum biomarkers are found. In addition, increased efficacy of large volume and repeated placement of multiple epidural blood patches (EBP) are seen. In addition, the management of refractory SIH using fibrin glue polymers has proved efficacious in recent case series. While the diagnosis may be challenging for clinicians, future research in SIH is leading to more rapid detection methods. Future studies may target optimal use of EBP in comparison to fibrin glue polymers, in addition to new developments in increased understanding of SIH physiology and phenotype.

Keywords: CSF leak; Epidural blood patch; Fibrin glue; Postural headache; SIH, spontaneous intracranial hypotension.

Publication types

  • Review

MeSH terms

  • Blood Patch, Epidural
  • Cerebrospinal Fluid Leak
  • Headache / diagnosis*
  • Headache / physiopathology
  • Headache / therapy*
  • Humans
  • Intracranial Hypotension / diagnosis*
  • Intracranial Hypotension / physiopathology
  • Intracranial Hypotension / therapy*
  • Magnetic Resonance Imaging
  • Male