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Spontaneous intracranial hypotension (SIH)

Spontaneous Intracranial Hypotension (SIH) is a neurological condition caused by a spontaneous leak of cerebrospinal fluid (CSF) from the spine.

The loss of this fluid reduces the pressure around the brain and spinal cord, which can lead to severe headaches and other neurological symptoms. SIH is often underdiagnosed but is increasingly recognized as a treatable cause of persistent headaches.

The most characteristic symptom of SIH is a headache that worsens when standing or sitting upright and improves when lying down. Other symptoms may include:

  • Neck stiffness
  • Nausea or vomiting
  • Sensitivity to light or sound
  • Dizziness or balance problems
  • Visual disturbances
  • Hearing changes or ringing in the ears
  • Fatigue or cognitive difficulties

Symptoms can vary in severity and may sometimes develop gradually.

Diagnosis typically involves a combination of clinical evaluation and advanced imaging. Magnetic resonance imaging (MRI) of the brain and spine may reveal signs of low cerebrospinal fluid pressure or help identify the location of a spinal CSF leak. In some cases, specialized imaging techniques such as CT myelography or digital subtraction myelography may be used to detect the exact source of the leak.

Treatment aims to stop the cerebrospinal fluid leak and restore normal pressure around the brain and spinal cord. Initial management may include conservative measures such as rest, hydration, and caffeine intake.

If symptoms persist, minimally invasive procedures such as an epidural blood patch may be used to seal the leak. In more complex cases where the leak source can be identified, targeted treatments or surgical repair may be considered.

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