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

Benjamin Davidson; Farshad Nassiri; Alireza Mansouri; Jetan H Badhiwala; Christopher D Witiw; Mohammed F Shamji; Philip W Peng; Richard I Farb; Mark Bernstein

doi:10.1016/j.wneu.2017.01.123

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.

Authors

Benjamin Davidson¹, Farshad Nassiri², Alireza Mansouri², Jetan H Badhiwala², Christopher D Witiw², Mohammed F Shamji², Philip W Peng³, Richard I Farb⁴, Mark Bernstein²

Affiliations

¹ Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].
² Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
³ Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.

PMID: 28192268
DOI: 10.1016/j.wneu.2017.01.123

Abstract

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