Spontaneous Intracranial Hypotension (SIH)
Spontaneous intracranial hypotension (SIH) is a cause of headache and a variety of other neurologic manifestations. A causative CSF leak at the level of the spine can be detected in most patients, and several types of leaks have been identified. Epidural blood patching is successful in reducing or eliminating symptoms in most patients and can be used without localization of the leak. For cases that do not respond to blood patching, specialized spinal imaging is indicated to local- ize the site of the CSF leak, and several surgical and nonsurgical treatment options have become available, depending on the type of leaks.
Zítek H, Stratilová M, Radovnický T, Sejkorová A, Klzo LH, Sameš M. Spontaneous intracranial hypotension. Ces a Slov Neurol a Neurochir. 2022;85(1):18–23.
Headache: Often described as a severe, throbbing pain that may worsen when standing or sitting up and improve when lying down (orthostatic headache).
Nausea and Vomiting: Due to increased intracranial pressure or related to headaches.
Neck Pain or Stiffness: Discomfort in the neck region.
Tinnitus: Ringing or buzzing sounds in the ears.
Other symptoms:
Visual Disturbances: Blurred vision or changes in vision.
Hearing Changes: Hearing loss or sensations of fullness in the ears.
Cognitive Changes: Difficulty concentrating or confusion.
Clear Fluid Draining: Leakage of clear, watery fluid from the nose or ears, particularly if there has been recent head trauma.
Symptoms
Trauma: Head injuries, including fractures of the skull or spine, can create openings for CSF to escape.
Surgery: Surgical procedures involving the brain or spine may inadvertently cause a CSF leak.
Spontaneous Leak: Often occurs without any apparent cause, especially in individuals with conditions such as spontaneous intracranial hypotension or connective tissue disorders.
Infections: Certain infections, such as meningitis, can damage the membranes surrounding the brain and spinal cord, leading to leaks.
Invasive Procedures: Lumbar punctures (spinal taps) or epidural injections can sometimes lead to a CSF leak.