decreased intracranial pressure; intracranial hypotension

Etiology

• ventriculostomy
• lumbar puncture
• trauma
• spontaneous (idiopathic)
• risk factors
  • young age, female, low BMI
  • use of larger gauge needles or conventional cutting

Pathology

• CSF leakage

Clinical manifestations

• postural headache worsening in upright position, improving in supine postition
• physical examination generally normal
  • cranial nerve 6 palsy possible

Diagnostic procedures

• lumbar puncture with opening pressure & CSF analysis

Radiology

• contrast-enhanced MRI of brain & spinal cord
  • diffuse parenchymal enhancement in 80%
  • diffuse smooth dural thickening with contrast-enhancement (80%)*
  • cerebellar tonsil descent*
  • clinically insignificant subdural fluid collections*
• CT myelography if MRI does not reveal site of CSF leakage

* from case

Management

• bedrest, analgesia, clinical hydration
• if conservative measures fail, 10-15 mL of homologous blood can be injected into the epidural space (epidural blood patch)
  • epidural blood patch associated with resolution of symptoms in 80-90% of patients
• alternative treatments:
  • intravenous caffeine
  • epidural saline

More general terms

• sign/symptom
• disease/disorder primarily affecting brain

Additional terms

• cerebral perfusion pressure (CPP)
• criteria for removal of intracranial pressure (ICP) monitor
• increased intracranial pressure (ICP)
• intracranial pressure (ICP)