Journal of Zhejiang University-SCIENCE B

, Volume 18, Issue 7, pp 577–585 | Cite as

Factors affecting cerebrospinal fluid opening pressure in patients with spontaneous intracranial hypotension

  • Ling-ling Yao
  • Xing-yue HuEmail author



Spontaneous intracranial hypotension (SIH) is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid (CSF) pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure (CSF OP) and explore the factors affecting CSF OP in SIH patients.


We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables (including demographic data, body mass index (BMI), duration of symptoms, and brain imaging findings). Univariate and multivariate analyses were performed to identify the potential factors affecting CSF OP.


In a total of 114 (55.3%) cases the CSF OP was ≤60 mmH2O (1 mmH2O=9.806 65 Pa), in 90 (43.7%) cases it was between 60 and 200 mmH2O, and in 2 (1.0%) cases it was >200 mmH2O. Univariate analysis showed that the duration of symptoms (P<0.001), BMI (P<0.001), and age (P=0.024) were positively correlated with CSF OP. However, multivariate analysis suggested that only the duration of symptoms (P<0.001) and BMI (P<0.001) were strongly correlated with CSF OP. A relatively high R 2 of 0.681 was obtained for the multivariate model.


Our study indicated that in patients without a low CSF OP, a diagnosis of SIH should not be excluded. BMI and the duration of symptoms can influence CSF OP in SIH patients, and other potential factors need further investigation.


Spontaneous intracranial hypotension Low cerebrospinal fluid opening pressure Body mass index Magnetic resonance imaging 





评估正常脑脊液开放压在自发性颅内低压(SIH) 患者中所占的比例,并初步探讨SIH 患者的脑脊 液开放压的影响因素。


通过大样本容量的病例证实了正常脑脊液开放压 在SIH 患者中占较高比例,并进一步得出体重指 数和症状持续时间与脑脊液开放压存在显著相 关性。


回顾了206 例在我院确诊的SIH 患者,收集其人 口学信息、体重指数、症状持续时间、影像检查 结果等资料。通过单变量分析和多变量分析识别 影响脑脊液开放压的潜在因素。


本研究进一步证实正常脑脊液开放压在SIH 患者 中并不少见,特别是那些肥胖和症状持续时间长 的患者。除了体重指数和症状持续时间,仍然存 在其他未识别的因素影响SIH 患者的脑脊液开 放压大小


自发性颅内低压;低脑脊液开放压;体重指数 头颅增强磁共振 

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The authors would like to thank Dr. Qiao-wei ZHANG and Dr. Yi YANG at our hospital (Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China) for image re-evaluation and critical review of the manuscript.


  1. Berdahl, J.P., Fleischman, D., Zaydlarova, J., et al., 2012. Body mass index has a linear relationship with cerebrospinal fluid pressure. Invest. Ophthalmol. Vis. Sci., 53(3): 1422–1427. Scholar
  2. Bloomfield, G.L., Dalton, J.M., Sugerman, H.J., et al., 1995. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J. Trauma, 39(6): 1168–1170. Scholar
  3. Bloomfield, G.L., Ridings, P.C., Blocher, C.R., et al., 1997. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit. Care Med., 25(3): 496–503. Scholar
  4. Chung, S.J., Kim, J.S., Lee, M.C., 2000. Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcome. Neurology, 55(9): 1321–1327. Scholar
  5. Chung, S.J., Lee, J.H., Kim, S.J., et al., 2006. Subdural hematoma in spontaneous CSF hypovolemia. Neurology, 67(6): 1088–1089. Scholar
  6. Greer, M., 1962. Benign intracranial hypertension. I. Mastoiditis and lateral sinus obstruction. Neurology, 12:472–476PubMedGoogle Scholar
  7. Kranz, P.G., Tanpitukpongse, T.P., Choudhury, K.R., et al., 2015. How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension? Cephalalgia, 36(13): 1209–1217. Scholar
  8. Kranz, P.G., Tanpitukpongse, T.P., Choudhury, K.R., et al., 2016. Imaging signs in spontaneous intracranial hypotension: prevalence and relationship to CSF pressure. Am. J. Neuroradiol., 37(7): 1374–1378. Scholar
  9. Limaye, K., Samant, R., Lee, R.W., 2016. Spontaneous intracranial hypotension: diagnosis to management. Acta Neurol. Belg., 116(2): 119–125. Scholar
  10. Luce, J.M., Huseby, J.S., Kirk, W., et al., 1982. Mechanism by which positive end-expiratory pressure increases cerebrospinal fluid pressure in dogs. J. Appl. Physiol. Respir. Environ. Exerc. Physiol., 52(1): 231–235.PubMedGoogle Scholar
  11. Luetmer, P.H., Mokri, B., 2003. Dynamic CTmyelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks. Am. J. Neuroradiol., 24(8): 1711–1714.PubMedGoogle Scholar
  12. Luetmer, P.H., Schwartz, K.M., Eckel, L.J., et al., 2012. When should I do dynamic CTmyelography? Predicting fast spinal CSF leaks in patients with spontaneous intracranial hypotension. Am. J. Neuroradiol., 33(4): 690–694. Scholar
  13. Markey, K.A., Uldall, M., Botfield, H., et al., 2016. Idiopathic intracranial hypertension, hormones, and 11ß-hydroxysteroid dehydrogenases. J. Pain Res., 9:223–232. Scholar
  14. Marmarou, A., Shulman, K., Rosende, R.M., 1978. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J. Neurosurg., 48(3): 332–344. Scholar
  15. Miyazawa, K., Shiga, Y., Hasegawa, T., et al., 2003. CSF hypovolemia vs intracranial hypotension in “spontaneous intracranial hypotension syndrome”. Neurology, 60(6): 941–947. Scholar
  16. Mokri, B., 1999. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia—evolution of a concept. Mayo Clin. Proc., 74(11): 1113–1123. Scholar
  17. Mokri, B., 2001. The Monro-Kellie hypothesis: applications in CSF volume depletion. Neurology, 56(12): 1746–1748. Scholar
  18. Mokri, B., 2004. Spontaneous low cerebrospinal pressure/ volume headaches. Curr. Neurol. Neurosci. Rep., 4(2): 117–124. Scholar
  19. Mokri, B., 2013. Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache, 53(7): 1034–1053. Scholar
  20. Mokri, B., Hunter, S.F., Atkinson, J.L., et al., 1998. Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology, 51(3): 786–790. Scholar
  21. Rando, T.A., Fishman, R.A., 1992. Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology, 42(3 Pt 1):481–487. Scholar
  22. Schievink, W.I., 2006. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA, 295(19): 2286–2296. Scholar
  23. Schievink, W.I., 2008. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia, 28(12): 1345–1356. Scholar
  24. Schievink, W.I., Maya, M.M., Louy, C., 2005. Cranial MRI predicts outcome of spontaneous intracranial hypotension. Neurology, 64(7): 1282–1284. Scholar
  25. Schievink, W.I., Dodick, D.W., Mokri, B., et al., 2011. Diagnostic criteria for headache due to spontaneous intracranial hypotension: a perspective. Headache, 51(9): 1442–1444. Scholar
  26. Schoffer, K.L., Benstead, T.J., Grant, I., 2002. Spontaneous intracranial hypotension in the absence of magnetic resonance imaging abnormalities. Can. J. Neurol. Sci., 29(3): 253–257. Scholar
  27. Shin, H.S., Lee, S.H., Ko, H.C., et al., 2016. Extended pneumocephalus after drainage of chronic subdural hematoma associated with intracranial hypotension: case report with pathophysiologic consideration. J. Korean Neurosurg. Soc., 59(1): 69–74. Scholar
  28. Spears, R.C., 2014. Low-pressure/spinal fluid leak headache. Curr. Pain Headache Rep., 18(6):425. Scholar
  29. Sugerman, H., DeMaria, E., Felton, W.R., et al., 1997. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology, 49(2): 507–511. Scholar
  30. Takahashi, K., Mima, T., Akiba, Y., 2016. Chronic subdural hematoma associated with spontaneous intracranial hypotension: therapeutic strategies and outcomes of 55 cases. Neurol. Med. Chir. (Tokyo), 56(2): 69–76. Scholar
  31. Wang, J., Zhang, D., Gong, X., et al., 2014. Rapid resolution of subdural hematoma after targeted epidural blood patch treatment in patients with spontaneous intracranial hypotension. Chin. Med. J. (Engl.), 127(11): 2063–2066.Google Scholar
  32. Whiteley, W., Al-Shahi, R., Warlow, C.P., et al., 2006. CSF opening pressure: reference interval and the effect of body mass index. Neurology, 67(9): 1690–1691. Scholar

Copyright information

© Zhejiang University and Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Neurology, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouChina

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