J Korean Neurol Assoc.  2019 May;37(2):117-122. 10.17340/jkna.2019.2.1.

Neurological Symptoms of Intracranial Hypotension

• Kang K
• Kim BK

• KMID: 2454836
• DOI: http://doi.org/10.17340/jkna.2019.2.1

Abstract

Intracranial hypotension usually arises in the context of known or suspected leak of cerebrospinal fluid (CSF). This leakage leads to a fall in intracranial CSF pressure and CSF volume. The most common clinical manifestation of intracranial hypotension is orthostatic headache. Post-dural puncture headache and CSF fistula headache are classified along with headache attributed to spontaneous intracranial hypotension as headache attributed to low CSF pressure by the International Classification of Headache Disorders. Headache attributed to low CSF pressure is usually but not always orthostatic. The orthostatic features at its onset can become less prominent over time. Other manifestations of intracranial hypotension are nausea, spine pain, neck stiffness, photophobia, hearing abnormalities, tinnitus, dizziness, gait unsteadiness, cognitive and mental status changes, movement disorders and upper extremity radicular symptoms. There are two presumed pathophysiologic mechanisms behind the development of various manifestations of intracranial hypotension. Firstly, CSF loss leads to downward shift of the brain causing traction on the anchoring and supporting structures of the brain. Secondly, CSF loss results in compensatory meningeal venodilation. Headaches presenting acutely after an intervention or trauma that is known to cause CSF leakage are easy to diagnose. However, a high degree of suspicion is required to make the diagnosis of spontaneous intracranial hypotension and understanding various neurological symptoms of intracranial hypotension may help clinicians.

Keyword

Intracranial hypotension; Cerebrospinal fluid leak; Headache; Post-dural puncture headache; Ventriculoperitoneal shunt

MeSH Terms

Brain
Cerebrospinal Fluid
Cerebrospinal Fluid Leak
Classification
Diagnosis
Dizziness
Fistula
Gait
Headache
Headache Disorders
Hearing
Intracranial Hypotension*
Movement Disorders
Nausea
Neck Pain
Photophobia
Post-Dural Puncture Headache
Spine
Tinnitus
Traction
Upper Extremity
Ventriculoperitoneal Shunt