Abstract
Spontaneous intracranial hypotension describes the clinical syndrome brought on by
a cerebrospinal fluid (CSF) leak. Orthostatic headache is the key symptom, but others
include nausea, vomiting, and dizziness, as well as cognitive and mood disturbance.
In severe cases, the brain slumps inside the cranium and subdural collections develop
to replace lost CSF volume. Initial treatment is by bed rest, but when conservative
measures fail, attention is focused on finding and plugging the leak, although this
can be very difficult and some patients remain bedbound for months or years. Recently,
we have proposed an alternative approach in which obstruction to cranial venous outflow
would be regarded as the driving force behind a chronic elevation of CSF pressure,
which eventually causes dural rupture. Instead of focusing on the site of rupture,
therefore, investigation and treatment can be directed at locating and relieving the
obstructing venous lesion, allowing intracranial pressure to fall, and the dural defect
to heal. The case we describe illustrates this idea. Moreover, since there was a graded
clinical response to successive interventions relieving venous obstruction, and eventual
complete resolution, it also provides an opportunity to consider particular symptoms
in relation to cerebral venous insufficiency in its own right.
Keywords
Spontaneous intracranial hypotension - cerebrospinal fluid leak - idiopathic intracranial
hypertension - cranial venous outflow obstruction - jugular stenosis - jugular venoplasty
- styloidectomy - C1 transverse process resection
