This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (36)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Diagnosis  • Headache  • Alert me on articles by topic

Wouter I. Schievink, MD

Arch Neurol. 2003;60:1713-1718.

Background  Spontaneous intracranial hypotension is an important cause of "new daily persistent headaches" but is not a well-recognized entity. The misdiagnosis of spontaneous intracranial hypotension can have serious consequences.

Methods  The clinical course in 18 consecutive patients with spontaneous intracranial hypotension who were evaluated for definitive surgical treatment of the underlying spontaneous spinal cerebrospinal fluid leak from January 1, 2001, through June 30, 2002, was investigated by correspondence with the patients and physicians.

Results  Seventeen patients (94%) initially received an incorrect diagnosis, and the diagnostic delay ranged from 4 days to 13 years (median, 5 weeks; mean, 13 months). Migraine, meningitis, and psychogenic disorder were the most commonly entertained diagnoses. Diagnostic or therapeutic procedures for disorders that mimicked spontaneous intracranial hypotension included cerebral arteriography in 2 patients, craniotomies for Chiari malformation in 2 patients, craniotomy for evacuation of subdural hematomas in 1 patient, and brain biopsy in 1 patient.

Conclusions  Patients with spontaneous intracranial hypotension are commonly misdiagnosed, causing a significant delay in the initiation of effective treatments and exposing patients to the risks associated with treatment for disorders that mimic intracranial hypotension. Increasing the awareness of this spontaneous type of intracranial hypotension is required to decrease the high rate of misdiagnosis.

From the Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Emergency department evaluation of sudden, severe headache
Breen et al.
QJM 2008;101:435-443.
ABSTRACT | FULL TEXT  

The Venous Distension Sign: A Diagnostic Sign of Intracranial Hypotension at MR Imaging of the Brain
Farb et al.
Am. J. Neuroradiol. 2007;28:1489-1493.
ABSTRACT | FULL TEXT  

Spontaneous intracranial hypotension in adolescence
Bladen et al.
J. Neurol. Neurosurg. Psychiatry 2007;78:167-167.
FULL TEXT  

Subdural hematoma in spontaneous CSF hypovolemia.
Chung et al.
Neurology 2006;67:1088-1089.
ABSTRACT | FULL TEXT  

Quadriplegia and cerebellar hemorrhage in spontaneous intracranial hypotension
Schievink and Maya
Neurology 2006;66:1777-1778.
FULL TEXT  

Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension
Schievink
JAMA 2006;295:2286-2296.
ABSTRACT | FULL TEXT  

Pseudo-subarachnoid hemorrhage: A CT-finding in spontaneous intracranial hypotension
Schievink et al.
Neurology 2005;65:135-137.
ABSTRACT | FULL TEXT  

Cranial MRI predicts outcome of spontaneous intracranial hypotension
Schievink et al.
Neurology 2005;64:1282-1284.
ABSTRACT | FULL TEXT