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A Review of Spontaneous Intracranial Hypotension

  • Headache (R. Halker Singh, Section Editor)
  • Published:
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Abstract

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.

Recent Findings

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.

Summary

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.

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Author information

Authors and Affiliations

  1. Department of Neurology, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, 7PHC, Washington, DC, 20007, USA

    Parth Upadhyaya

  2. Department of Neurology, Medstar Georgetown Headache Center, Medstar Georgetown University Hospital, 3800 Reservoir Road NW 7PHC, Washington, DC, 20007, USA

    Jessica Ailani

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  1. Parth Upadhyaya
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Correspondence to Parth Upadhyaya.

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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.

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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).

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Upadhyaya, P., Ailani, J. A Review of Spontaneous Intracranial Hypotension. Curr Neurol Neurosci Rep 19, 22 (2019). https://doi.org/10.1007/s11910-019-0938-7

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