Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension

摘要: ContextSpontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid (CSF) leaks and known for causing orthostatic headaches. It an important cause of new headaches in young middle-aged individuals, but initial misdiagnosis common.ObjectiveTo summarize existing evidence regarding the epidemiology, pathophysiology, diagnosis, management CSF hypotension.Evidence AcquisitionMEDLINE (1966-2005) OLDMEDLINE (1950-1965) were searched using terms hypotension, leak, low pressure headache, hypovolemia. Reference lists these articles ongoing investigations this area used as well.Evidence SynthesisSpontaneous single or multiple leaks. The incidence has been estimated at 5 per 100 000 year, with a peak around age 40 years. Women are affected more commonly than men. Mechanical factors combine underlying connective tissue disorder to An headache prototypical manifestation other patterns occur well, associated symptoms common. Typical magnetic resonance imaging findings include subdural collections, enhancement pachymeninges, engorgement venous structures, pituitary hyperemia, sagging brain (mnemonic: SEEPS). Myelography study choice identify leak. Treatments bed rest, epidural blood patching, percutaneous placement fibrin sealant, surgical leak repair, outcomes have poorly studied no strategies properly controlled randomized trials.ConclusionsSpontaneous not rare it remains underdiagnosed. spectrum clinical radiographic manifestations varied, diagnosis largely based on suspicion, cranial imaging, myelography. Numerous treatment options available, much be learned about disorder.