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NEUROLOGY 1992;42:481
© 1992 American Academy of Neurology

Spontaneous intracranial hypotension

Report of two cases and review of the literature

Thomas A. Rando, MD, PhD and Robert A. Fishman, MD

Department of Neurology, University of California at San Francisco, School of Medicine, San Francisco, CA.

We report two patients with spontaneous intracranial hypotension. In addition to the cardinal features of a postural headache and a low CSF pressure, the patients also had subdural fluid collections demonstrated by head MRI. In both patients, radionuclide cisternography revealed a CSF leak along the spinal axis and rapid accumulation of radioisotope in the bladder. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Associated symptoms, including tinnitus and vertigo, and subdural fluid collections are presumably from hydrostatic changes among intracranial fluid compartments that occur at low CSF pressures. Methods of treatment are identical to those for post-dural puncture headaches. Epidural blood patches and epidural saline infusions have rapidly ameliorated the symptoms of spontaneous intracranial hypotension.

Address correspondence and reprint requests to Dr. Robert A. Fishman, Department of Neurology, M-794 Box 0114, University of California at San Francisco, School of Medicine, San Francisco, CA 94143.

Presented in part at the 42nd annual meeting of the American Academy of Neurology, Miami Beach, FL, May 1990.

Received June 7, 1991. Accepted for publication in final form August 9, 1991.




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