Clinical outcome

The girl had a worsening postural headache after spinal tap that slowly passed away in the following two weeks.

Pathology

Intracranial hypotension is caused by CSF reduction:

• CSF leak
  • most are spontaneous
    • probably spontaneous meningeal tears that occur with higher incidence in connective tissue disorders (Marfan, Ehler Danlos,...)
  • idiopathic procedure like spinal tap, myelography, spinal surgery, spinal anesthesia or excessive CSF shunting
  • trauma
• medical causes probably because of smaller CSF production (rare)
  • dehydration
  • diabetic coma
  • uremia

Headache is thought to arise because of loss of CSF cushion effect with traction on intracranial structures or/and in part to venous vasodilatation.

Treatment

Usually conservative treatment with rest, hydration, caffeine intake and acetaminophen, if severe steroids.

If conservative treatment fails, epidural blood patches of leakage is usually effective. Surgical ligature is usually not needed.