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Learn More...What are the treatment options for spontaneous intracranial hypotension?
An uncertain percentage of patients with spontaneous intracranial hypotension have milder symptoms and/or symptoms that may resolve without any treatment. Simple measures including bedrest, fluids for hydration and caffeine intake may help to reduce the severity of symptoms.
Should I talk to my doctor about my intracranial hypotension symptoms?
If you experience the symptoms of idiopathic intracranial hypotension, go to the doctor and talk through your symptoms. You will likely get lab tests done and possibly imaging to confirm that there is no tumor present in your brain and the condition is, in fact, idiopathic intracranial hypotension.
What is intracranial hypotension (SIH)?
Intracranial hypotension, especially spontaneous intracranial hypotension (SIH), is a well—recognized entity associated with cerebrospinal fluid (CSF) leaks, and has being recognized better in resent years, while still woefully inadequate.
How is idiopathic intracranial hypotension (ICP) diagnosed?
You will likely get lab tests done and possibly imaging to confirm that there is no tumor present in your brain and the condition is, in fact, idiopathic intracranial hypotension. Once you have been diagnosed with idiopathic intracranial hypotension, your doctor will determine the best potential course of treatment.

What kind of doctor treats CSF leak?
Our sinus specialists, otologists/neurotologists, and neurosurgeons collaborate to diagnose and treat cranial CSF leaks. These are most often treated with surgery.
How is intracranial hypotension treated?
Treatments. Some cases of spontaneous intracranial hypotension resolve with nonoperative measures such as strict bed rest, hydration, or a procedure called an epidural blood patch. (In this procedure, the patient's own blood is injected into the dural sac.
Who can diagnose intracranial hypertension?
Your eye doctor will do several tests to check for signs of IIH, including a dilated eye exam to look at the back of your eye and a visual field test to check your peripheral vision. Your eye doctor may also want you to see a neurologist (a doctor specializing in the brain).
Is intracranial hypotension curable?
In intracranial hypotension, this descent of part of the brain is usually reversible with treatment.
Does intracranial hypotension show on MRI?
MRI is vital in the diagnosis of intracranial hypotension. A number of imaging findings have been described including dural enhancement, reversible pituitary enlargement [4, 5], subdural collections, brainstem slumping, and caudal tonsillar displacement [4, 6–8].
What happens if a CSF leak goes untreated?
CSF leaks occur when there is a breakdown in this barrier. The dura can be damaged by certain surgeries, head trauma, and tumors. Leaks sometimes occur spontaneously. Untreated CSF leaks can lead to life-threatening meningitis, brain infections, or stroke.
How do you fix intracranial hypertension?
The main treatments for idiopathic IH are:losing weight if you're overweight. ... stopping any medicine that may be causing your symptoms, including contraception methods. ... medicine to remove excess fluid from the body (diuretics)medicine to reduce the production of cerebrospinal fluid in your brain.More items...
Can intracranial hypertension be cured?
For the longer term, weight loss is necessary for treatment of IIH that is brought on by obesity. A number of investigators have shown that weight loss is a cure for patients with IIH due to obesity. In general, it takes weight loss of between 10 to 20% of your body weight to cure IIH.
What is the best treatment for IIH?
For initial treatment of patients with IIH, we suggest treatment with the carbonic anhydrase inhibitor acetazolamide (Grade 2B).
Can a CSF leak heal on its own?
How is a cerebrospinal fluid leak treated? While many CSF leaks heal on their own and require only a period of bed rest, patients with symptoms of the condition should still visit their physician due to the increased risk of meningitis that is associated with cranial CSF leaks.
Can you have intracranial hypotension without a leak?
Thus, in rare cases, intracranial hypotension may occur in the absence of CSF leakage from the dural sac. Conclusion: We propose a pathophysiological concept for the subgroup of SIH patients with typical cranial imaging findings and no evidence of CSF leakage.
What are the four stages of increased intracranial pressure?
Intracranial hypertension is classified in four forms based on the etiopathogenesis: parenchymatous intracranial hypertension with an intrinsic cerebral cause, vascular intracranial hypertension, which has its etiology in disorders of the cerebral blood circulation, meningeal intracranial hypertension and idiopathic ...
How to diagnose intracranial hypotension?
Your doctor may use the following to diagnose intracranial hypotension: 1 Physical and neurological examinations 2 Magnetic Resonance Imaging (MRI) with contrast 3 MR, digital subtraction, and CT myelography may be used to locate the site of the leak
What age is intracranial hypotension most common?
Intracranial hypotension affects men, women, and children of all ages. However, it is more common in women than in men, and the peak age of diagnosis is 40. Intracranial hypotension often results from a cerebrospinal fluid leak.
How to treat cerebrospinal fluid leak?
Your doctor may initially recommend bed rest, drinking more fluids, increasing your caffeine intake, and taking pain relievers.
What is intracranial hypotension?
Hypotension = pressure that is lower than normal. Spontaneous intracranial hypotension is a condition in which the fluid pressure inside the skull is lower than normal. The brain and spinal cord are covered by a tough, watertight membrane called the dura.
What causes spontaneous intracranial hypotension?
(Other, extremely rare, causes of spontaneous intracranial hypotension include diabetic coma or a leakage of CSF through the ears or nose.) The causes of spontaneous spinal fluid leak are not completely understood.
Why do shunts cause hypotension?
Implanted shunts (drains) that are surgically placed to treat an accumulation of CSF might drain too much of the fluid, causing hypotension. But spontaneous intracranial hypotension arises for reasons unrelated to inherited disorder, major trauma, or medical intervention. The most common cause of spontaneous intracranial hypotension is spontaneous ...
What is the fluid that surrounds the brain called?
Inside the dura is the cerebrospinal fluid (CSF), a liquid that bathes and cushions the brain and spinal cord. Normally, the CSF circulates inside the dura, gradually drains, and is constantly replenished with new fluid. But a leak in the dura can allow too much CSF to escape too quickly. This reduces the amount of CSF in circulation, ...
Overview
Spontaneous intracranial hypotension is probably an under diagnosed cause of headache, even though its estimated to affect only about one in 50,000 individuals.
Diagnosis
Computerized tomography scanning (CT) is the most reliable method for finding out exactly where the leak is.
Treatment
Treatment is usually done with surgery to patch the leak. The Cedars-Sinai Department of Neurosurgery is one of the leading medical centers where this procedure is done. The procedure is safe and generally successful.
What is idiopathic intracranial hypotension?
Idiopathic intracranial hypotension, sometimes known as pseudotumor cerebri, is a condition that causes pressure inside a person’s head even though there is no brain tumor or other discernible reason for the pressure. Though idiopathic intracranial hypotension is a rare condition, with fewer than 200,000 diagnoses in the U.S.
Can weight loss help with intracranial hypotension?
Idiopathic intracranial hypotension is most commonly found in obese women, particularly those who are old enough to have children. Weight loss may help to relieve the symptoms of idiopathic intracranial hypotension. Diagnosis and Treatment of Idiopathic Intracranial Hypotension. If you experience the symptoms of idiopathic intracranial hypotension, ...
Can intracranial hypotension cause headaches?
For example, idiopathic intracranial hypotension could cause painful headaches or problems with vision, including temporary blindness. These symptoms can cause a disruption in your life, making it difficult to drive, work or enjoy your usual activities.
Is intracranial hypotension a brain tumor?
The word “idiopathic” indicated that the cause of intracranial hypotension is not known. However, there are treatments that can help. As mentioned, idiopathic intracranial hypotension has symptoms that are similar to those you see in someone with a brain tumor. The pressure inside a person’s head increases with idiopathic intracranial hypotension.
What causes intracranial hypotension?
The underlying cause of spontaneous intracranial hypotension is a loss of cerebrospinal fluid (CSF) volume through a hole or tear in the spinal dura. The dura is the tough outermost layer of the meninges (connective tissues that surround the brain and spinal cord) that holds in the CSF. When this fluid volume is reduced, there is less fluid available to cushion the brain inside the skull. This loss of CSF causes headache and other neurological signs and symptoms and may result in a range of complications. With upright posture, the loss of CSF volume has a greater effect on the brain.
Where is the NIH clinical center?
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office: Tollfree: (800) 411-1222. TTY: (866) 411-1010.
Is intracranial hypotension worse when lying down?
The hallmark of intracranial hypotension is a positional headache. This headache is worse when upright and improves when lying down.
Is CSF venous fistula hypotension?
The etiology of the CSF-venous fistula type of leak, first recognized in 2014, is not yet understood. CSF leaks that occur spontaneously in the head (base of the skull) are not causally associated with intracranial hypotension.
Is intracranial hypotension secondary to cerebrospinal fluid leak?
Summary. Spontaneous intracranial hypotension is secondary to a cerebrospinal fluid (CSF) leak at the level of the spine and the resulting loss of CSF volume that bathes the brain and spinal cord. Males and females of all ages are affected, but the diagnosis is more common in females.
ABSTRACT
A robust treatment paradigm for spontaneous intracranial hypotension has yet to be agreed upon. We present retrospective data from the patient cohort at our UK regional neurosciences centre from 2010–2020 and describe our locally developed treatment pathway.
Introduction
Spontaneous intracranial hypotension (SIH) is an increasingly recognised cause of headache. Patients are typically adults of working age, and although postural headache is the commonest presenting complaint, non-postural headache, cranial nerve palsies, and cognitive decline are also recognised features. 1,2 Symptoms can be debilitating.
Materials and methods
Patients diagnosed with SIH who underwent imaging and/or treatment at our neurosciences centre between 2010 and 2020 were retrospectively identified, using neuroradiology and anaesthetic departmental records. The diagnosis of SIH was made based on the clinical symptoms and imaging findings.
Results
Seventy-three patients with a diagnosis of SIH were retrospectively identified. The cohort consisted of 31 men and 42 women, mean age at presentation was 42 years; age range 19–76 years.
Discussion
SIH is a relatively recently described condition that can cause debilitating symptoms. Despite its increasing recognition and better understanding of the underlying pathophysiology, SIH probably still remains under-diagnosed.
Conflicts of interest
Dr David Butteriss is a member of the Medical Advisory Committee for The CSF Leak Association (Scottish charitable incorporated organisation; charity number: SC046319).

Intracranial Hypotension Symptoms
- The most common symptom of intracranial hypotension is severe headaches.1 Positional headaches feel better with lying down. They usually get worse throughout the day as a person has been standing up, and CSF leaks with the effects of gravity. Other symptoms of intracranial hypotension include:1 1. Nauseaand vomiting 2. Neck pain and stiffness 3. Tinnitus(ringing, buz…
Causes
- Intracranial hypotension stems from having too little CSF to cushion and support the brain. This decrease typically results from a CSF leak in a tissue layer called the dura mater (dura), the outermost layer of connective tissue that encompasses the meningesof the brain. The dura helps to protect and surround the brain and spinal cord. A hole or tear in the dura is the cause of intrac…
Diagnosis
- Healthcare providers who suspect intracranial hypotension based on neurological symptoms may order one or more diagnostic tests, such as:2 1. Magnetic resonance imaging (MRI): A machine that uses magnets and radio waves to collect anatomical images. MRIs of the brain and spinal cord can help identify a CSF leak. 2. Computed tomography(CT): A diagno...
Treatment
- Fortunately, intracranial hypotension usually resolves on its own and requires no medical intervention in most cases.3 However, in cases in which this condition does not heal itself or is more severe, other procedures may be necessary.
Prognosis
- The prognosis for most people who experience intracranial hypotension is positive. In most cases, this condition resolves independently without medical intervention. However, long-term prognosis and treatment become trickier if people need additional intervention.4 The long-term prognosis depends on the severity of the dural tear or leak. If you have intracranial hypotension, …
Coping
- Coping with this condition varies and depends on its severity. Managing mild and nonoperative intracranial hypotension symptoms often involves taking some downtime to allow the leak to heal. Other simple coping measures that your healthcare provider may recommend to manage uncomfortable symptoms include:2 1. Bed rest 2. Hydration 3. Caffeine Discuss potential copin…
Summary
- Intracranial hypotension is a condition in which pressure in the brain cavity is below average due to low cerebrospinal fluid (CSF) levels. The most common symptom experienced by people with intracranial hypotension is headaches. Other symptoms may include nausea, neck pain, tinnitus, and sensitivity to light or sound. Intracranial hypertension is caused by a hole or tear in the dura. …
A Word from Verywell
- Intracranial hypotension can be painful, frightening, and even debilitating. Fortunately, it typically resolves on its own and no invasive treatment is required. If intervention is needed, there are effective treatment options available. This condition may take time to heal, so it's essential to rest and take care of yourself during the recovery process. Talk to your healthcare provider about sp…