low pressure headache

Question 1

define

Answer 1

Headache from CSF leak

aka: Spontaneous Intracranial Hypotension

aka craniospinal hypotension is defined as (CSF) pressure <7 cm H2O in patients

Question 2

aetiology

Answer 2

primary: usually referred to as spontaneous intracranial hypotension

• skull fracture
• epidural or a spontaneous CSF leak

secondary: iatrogenic (lumbar puncture or surgery), over shunting due to diversion devices or traumatic

• • LP – typically

Question 3

s/s

Answer 3

• Recumbent: no pain
• Exacerbating factors: sit or stand up, straining and coughing = develop headache
• postural headache,
• nausea, vomiting,
• neck pain, visual and
• hearing disturbances, and
• vertigo.

Question 4

ix

Answer 4

MRI: with contrast may show diffuse meningeal enhancement

Question 5

rx

Answer 5

• Non-targeted epidural blood patch is often used in cases of spontaneous intracranial hypotension, on the assumption that the leak is from the spine, with variable success. When successful, headaches resolve within 72 hours of intervention. Subdural effusions can resolve within a few days or weeks. Larger subdural collections often require far longer.
• In cases where such speculative treatment fails, localisation of the CSF leak is required allowing for targeted epidural blood patch or surgical intervention