Acta Neurologica Belgica

, Volume 116, Issue 2, pp 119–125 | Cite as

Spontaneous intracranial hypotension: diagnosis to management

  • Kaustubh LimayeEmail author
  • Rohan Samant
  • Ricky W. Lee
Review Article


Spontaneous Intracranial Hypotension typically occurs from spontaneous CSF leak. CSF volume depletion rather than decrease in CSF pressure is thought to be the main causative feature for intracranial hypotension. More and more cases of intracranial hypotension are getting diagnosed with the advances in the imaging. The advances in the imaging have also led to the better understanding of the dynamic changes that occur with intracranial hypotension. The old theories of CSF overproduction or CSF underproduction have not been substantially associated with intracranial hypotension. It has also led to the fore different atypical clinical features and presentations. Although, it has been known for a long time, the diagnosis is still challenging and dilemma persists over one diagnostic modality over other and the subsequent management. Spontaneous CSF leaks occur at the spinal level and the skull base and other locations are rare. The anatomy of spontaneous intracranial hypotension is a very complex process with significant overlap in connective tissue disorders, previous dural weakness or meningeal diverticula. To localize the location of the CSF leak—CT myelography is the modality of choice. CSF cysternography may provide additional confirmation in uncertain cases and also MRI spine imaging may be of significant help in some cases. Spontaneous intracranial hypotension continues to be a diagnostic dilemma and our effort was to consolidate available information on the clinical features, diagnostics, and management for a practicing neurologist for a “15–20 min quick update of the topic”.


Intracranial hypotension Low pressure headache CSF leak Orthostatic headache New onset headache 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Source of Funding


Ethical and Informed Consent

No identifiable patient information was used in the making of this review article.


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Copyright information

© Belgian Neurological Society 2015

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Department of RadiologyUniversity of Arkansas for Medical SciencesLittle RockUSA

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