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Spontaneous intracranial hypotension: Pathophysiology, clinical features, and diagnosis

Christina Sun-Edelstein, MD
Christine L Lay, MD, FRCPC
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editors
John F Dashe, MD, PhD
Susanna I Lee, MD, PhD


The production, absorption, and flow of cerebrospinal fluid (CSF) play key roles in the dynamics of intracranial pressure. Alterations in CSF pressure can lead to neurologic symptoms, the most common being headache.

This topic will discuss the pathophysiology, epidemiology, clinical features, and diagnosis of headache attributed to spontaneous intracranial hypotension. Treatment is discussed separately. (See "Spontaneous intracranial hypotension: Treatment and prognosis".)

Post-lumbar puncture headache is reviewed elsewhere. (See "Post-lumbar puncture headache".)


Spontaneous intracranial hypotension is being recognized with increasing frequency. Orthostatic headache, low cerebrospinal fluid (CSF) pressure, and diffuse meningeal enhancement on brain MRI are the major features of the classic syndrome. However, some cases have nonorthostatic headache, normal CSF pressure, or no evidence of diffuse meningeal enhancement [1].

Our understanding of spontaneous intracranial hypotension is still evolving, and historically a number of other terms have been used to describe it:

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Literature review current through: Nov 2017. | This topic last updated: Jul 06, 2017.
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