Spontaneous intracranial hypotension: a case series and literature review

Michele Pistacchi; Andrea Pezzato; Roberta Rudà; Manuela Gioulis; Franco Contin; Federica Fragiacomo; Sandro Zambito Marsala

doi:10.5114/fn.2023.126209

eISSN: 1509-572x
ISSN: 1641-4640

Folia Neuropathologica

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abstract:

Review paper

Spontaneous intracranial hypotension: a case series and literature review

Michele Pistacchi

¹

,

Andrea Pezzato

²

,

Roberta Rudà

¹

,

Manuela Gioulis

³

,

Franco Contin

²

,

Federica Fragiacomo

⁴

,

Sandro Zambito Marsala

³

San Giacomo Hospital, Castelfranco Veneto (TV), Italy
Santorso Hospital, Santorso (VI), Italy
San Martino Hospital, Belluno (BL), Italy
Dell’Angelo Hospital, Mestre (VE), Italy

Folia Neuropathol 2023; 61 (3): 225-234

DOI: https://doi.org/10.5114/fn.2023.126209

Online publish date: 2023/04/06

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Spontaneous intracranial hypotension (SIH) is a condition of negative intracranial pressure resulting from cerebrospinal fluid (CSF) leakage from the dural sac and is a well-known cause of orthostatic headache. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines. Low CSF pressure and diffuse meningeal enhancement on brain MRI are the major instrumental features of the classic syndrome. Neuroimaging plays a key role in diagnosing SIH, particularly in atypical clinical presentations, by recognizing the specific findings of brain sagging on MRI and detecting the level of CSF leak on spinal imaging, thus guiding therapy accordingly. Since SIH could present with such a heterogeneous clinical picture, careful history taking and increased awareness of atypical presentations are of utmost importance.

We review the existing SIH literature, illustrate management, clinical and neuroimaging findings of four consecutive patients with atypical SIH, who were recently referred to our hospital for evaluation to simplify and streamline the management of SIH.

keywords:

Spontaneous intracranial hypotension: a case series and literature review

Michele Pistacchi 1 , Andrea Pezzato 2 , Roberta Rudà 1 , Manuela Gioulis 3 , Franco Contin 2 , Federica Fragiacomo 4 , Sandro Zambito Marsala 3

orthostatic headache, spontaneous intracranial hypotension, low CSF pressure

Michele Pistacchi

¹

,

Andrea Pezzato

²

,

Roberta Rudà

¹

,

Manuela Gioulis

³

,

Franco Contin

²

,

Federica Fragiacomo

⁴

,

Sandro Zambito Marsala

³