Spontaneous intracranial hypotension. Clinical, neuroradiological, cisternographic, and cerebrospinal fluid findings

We report 11 patients with orthostatic headache due to spontaneous intracra nial hypotension. Nausea (3 patients) and abducens palsy (2 patients) were the main additional symptoms. Ten patients had CSF pleocytosis (6 to 43 whi te cells/mu l) and/or increased protein (581 to 1668 mg/l). CT and/or MRI d ocumented bifrontal accentuated subdural hygromas and hematomas in 5 patien ts. MRI also documented diffuse meningeal gadolinium enhancement in all 4 p atients examined, and descent of the brain in one. Cisternography was done in 9 patients and revealed a decreased or absent activity over the convexit ies and early detection of the tracer in the bladder in all, and a CSF leak at the cervicothoracal junction in 2 patients. Most patients improved with bed rest, increased fluid intake (oral or intravenous),steroids, and/or ep idural blood patch. Subdural hematomas increased in 2 patients and have to be drained. Spontaneous intracranial hypotension is due to a CSF leak follo wed by decreased CSF volume and hydrostatic CSF pressure changes. The locat ions of the tea ks are mainly cervical or at the cervicothoracal junction. MRI always documents diffuse meningeal gadolinium enhancement. Treatment of choice is an epidural blood patch. Surgical treatment may be needed in pat ients with subdural hematomas or meningeal diverticula. Prognosis is typica lly good, but subdural hematomas may occasionally lead to an increased intr acranial pressure.