A Review of Spontaneous Intracranial Hypotension
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Purpose of Review
Spontaneous intracranial hypotension (SIH) is an underdiagnosed phenomenon predominantly presenting with low cerebrospinal fluid (CSF) pressure and postural headache in setting of CSF leak. The goal of this paper is to provide updates on the pathology, diagnosis, and management of SIH. The utility of multiple imaging modalities and the use of epidural blood patches and fibrin glue polymers are explored.
In regard to diagnosis, new non-invasive modalities in detection of SIH including transorbital ultrasound and serum biomarkers are found. In addition, increased efficacy of large volume and repeated placement of multiple epidural blood patches (EBP) are seen. In addition, the management of refractory SIH using fibrin glue polymers has proved efficacious in recent case series.
While the diagnosis may be challenging for clinicians, future research in SIH is leading to more rapid detection methods. Future studies may target optimal use of EBP in comparison to fibrin glue polymers, in addition to new developments in increased understanding of SIH physiology and phenotype.
KeywordsSIH, spontaneous intracranial hypotension CSF leak Epidural blood patch Postural headache Fibrin glue
Compliance with Ethical Standards
Conflict of Interest
Jessica Ailani reports personal fees from Allergan, Alder, Amgen, Avanir, Eli Lilly, Biohaven, Teva, Impel, Promius, Electrocore, AlphaSites Consulting, Miller Medical Communications, Aptus Health, and Current Pain and Headache Reports, outside the submitted work. Parth Upadhyaya declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance
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