Update on the Diagnosis and Treatment of Spontaneous Intracranial Hypotension

  • Peter G. KranzEmail author
  • Michael D. Malinzak
  • Timothy J. Amrhein
  • Linda Gray
Migraine and Beyond (R Cowan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Migraine and Beyond


Purpose of Review

The purpose of this study is to provide an update on recent developments in the understanding, diagnosis, and treatment of spontaneous intracranial hypotension (SIH).

Recent Findings

SIH is an important cause of headaches caused by spinal cerebrospinal fluid (CSF) leaks, with an increasingly broad spectrum of clinical presentations and diagnostic findings. A simple conception of the condition as being defined by the presence of low CSF pressure is no longer sufficient or accurate. A number of etiologies for spinal CSF leaks have been identified, including the recent discovery of CSF-venous fistulas, and these various etiologies may require different diagnostic and therapeutic pathways in order to affect a cure.


Familiarity with the spectrum of presentations and causes of SIH is critical to accurate and timely diagnosis and management. Challenges exist in both diagnosis and treatment, and require understanding of the underlying pathogenesis of the condition in order to appropriately select testing and treatment. Prospective studies are needed going forward in order to inform workup and guide treatment decisions.


Spontaneous intracranial hypotension CSF leak Epidural blood patch Cerebrospinal fluid CSF-venous fistula 


Compliance with Ethical Standards

Conflict of Interest

Peter G. Kranz, Michael D. Malinzak, Timothy J. Amrhein, and Linda Gray each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Peter G. Kranz
    • 1
    Email author
  • Michael D. Malinzak
    • 1
  • Timothy J. Amrhein
    • 1
  • Linda Gray
    • 1
  1. 1.Department of RadiologyDuke University Medical CenterDurhamUSA

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