![]() It is thought that the condition can occur after a relatively minor trauma when there is already a slight weakness in the dura. The causes of spontaneous spinal fluid leak are not completely understood. 1 Prior work has shown that with an increased duration of a CSF leak, head pain is less likely to be orthostatic, opening pressure (OP) is less likely to be low, and brain MRI is less likely to show. (Other, extremely rare, causes of spontaneous intracranial hypotension include diabetic coma or a leakage of CSF through the ears or nose.) Spontaneous intracranial hypotension (SIH) is a syndrome resulting from the leakage of the CSF through a spinal dural defect, meningeal nerve root sleeve diverticulum, or CSF-venous fistula (CVF). The most common cause of spontaneous intracranial hypotension is spontaneous spinal fluid leak. Implanted shunts (drains) that are surgically placed to treat an accumulation of CSF might drain too much of the fluid, causing hypotension.īut spontaneous intracranial hypotension arises for reasons unrelated to inherited disorder, major trauma, or medical intervention. Trauma to the dura, as from spinal surgery or a lumbar puncture, can also allow CSF to leak. For example, a congenital (in-born) defect in the dura may allow CSF to escape too quickly. Intracranial hypotension has several causes. It is a rare condition, estimated to occur in 1 in 50,000 people. Spontaneous intracranial hypotension affects women more frequently than men, and occurs most frequently in the fourth or fifth decade of life. The dye is visible to the CT scan, so the scan can often reveal where the CSF and dye are escaping from the dura. But unlike a plain CT, a myelo-CT uses an opaque dye that is injected into the CSF. Like a plain CT scan, this procedure uses a computer and a series of X-rays to construct images of structures inside the body. The most useful test for locating the leak is usually the computed tomography plus myelogram (myelo-CT). This can be a challenge–sometimes the defect causing the leak cannot be located at all. Once a diagnosis of spontaneous intracranial hypotension has been made, it still remains to locate the spinal fluid leak. Spontaneous leaks are often the result of idiopathic intracranial hypertension (IIH) resulting from decreased CSF reabsorption. (This can resemble a structural problem known as Chiari malformation.) For example, due to the lower pressure inside the skull, the brain may “sag” toward, or even partially sag out of, the skull base. On magnetic resonance (MR) imaging, certain signs may lead a physician to suspect intracranial hypotension. A tentative diagnosis may be reached based on the symptoms alone, especially the postural dependency of the headache.
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