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Spontaneous intracranial hypotension: Treatment and prognosis

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. Most often, the headaches associated with low CSF pressure are orthostatic and occur after lumbar puncture, but similar headaches occur with spontaneous low CSF pressure due to spinal CSF leaks, and with CSF shunt overdrainage [1,2].

Spontaneous intracranial hypotension is being recognized with increasing frequency. Orthostatic headache, low CSF pressure, and diffuse meningeal enhancement on brain magnetic resonance imaging (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 [2]. As our understanding of this syndrome is still evolving, the terms "low CSF pressure headache," "spontaneous intracranial hypotension," "spontaneous CSF leak," "CSF hypovolemia," and "CSF volume depletion" tend to be used interchangeably.

This topic will review the treatment and prognosis of spontaneous intracranial hypotension. Other aspects of this disorder are discussed separately. (See "Spontaneous intracranial hypotension: Pathophysiology, clinical features, and diagnosis".)

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


The diagnosis of spontaneous intracranial hypotension is reviewed here briefly and discussed in detail separately. (See "Spontaneous intracranial hypotension: Pathophysiology, clinical features, and diagnosis", section on 'Evaluation and diagnosis'.).

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Literature review current through: Nov 2017. | This topic last updated: Feb 16, 2017.
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