Spontaneous intracranial hypotension: updates from diagnosis to treatment.
Paul J FarnsworthAjay A MadhavanJared T VerdoornDarya P ShlapakDerek R JohnsonJeremy K Cutsforth-GregoryWaleed BrinjikjiVance T LehmanPublished in: Neuroradiology (2022)
Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
Keyphrases
- cerebrospinal fluid
- primary care
- machine learning
- deep learning
- healthcare
- risk factors
- minimally invasive
- cancer therapy
- magnetic resonance imaging
- spinal cord
- coronary artery bypass
- contrast enhanced
- risk assessment
- magnetic resonance
- drug delivery
- resting state
- multiple sclerosis
- human health
- brain injury
- smoking cessation
- dna methylation
- neural network
- cerebral ischemia
- atrial fibrillation
- replacement therapy
- aortic dissection