Most clinicians are familiar with the features of a post-lumbar puncture headache, with its hallmark severe, global head and neck pain, which is relieved by lying flat. Less well known is a related presentation that occurs in the absence of a recent spinal procedure — spontaneous cerebrospinal fluid leak. Increased clinician awareness has the potential to significantly improve outcomes for this group of patients.
Spontaneous intracranial hypotension is secondary to a cerebrospinal fluid CSF leak at the level of the spine and the resulting loss of CSF volume to support the brain and spinal cord. Men and women of all ages are affected but the diagnosis is more common in women. Annual incidence of 5 peris likely an underestimate and overall prevalence is unknown.
The Migraine Resource Center collects the most up-to-date clinical research to educate readers on the art and science of migraine management. Spinal fluid leaks also can lead to serious complications, including seizures. Patients may have a CSF leak for years or decades before it is diagnosed.
The most common cause of intracranial hypotension is a cerebrospinal fluid CSF leak. CSF is the fluid that cushions and protects the brain and spinal cord. It is contained within a saclike covering called the meninges.
Cerebrospinal fluid CSF depletion may be caused by a leak, a shunt, inadequate production or too-rapid absorption. These symptoms are rather nonspecific as they are commonly encountered in migraine and post-traumatic headache. Cognitive decline has also been noted.
The clinical syndrome of lower motor neuron dysfunction due to degeneration of the anterior horn cells in the cervicothoracic region has been described in Hirayama disease HDamyotrophic lateral sclerosis and progressive muscular atrophy spinal variety, spondylotic myelopathy, and spinal cord infarction. A year-old male presented with progressive weakness of bilateral upper extremities for 1 year, followed by atrophy of muscles of the distal forearm and hand. He also had postural hypotension.
I get facial numbness just from being upright it has nothing to do with position of upright sitting vs standing vs leaning against something I have constant paresthesia in my mouth area and pain in my teeth. My symptoms are progressively worse the longer I'm upright. Strangely, they are also worse when when I'm lying on my left side.
Headache in cerebrospinal fluid volume depletion syndrome: a case report. Innocenzo Lupo a. Giuseppe Salemi a.
It is not unusual for the headache to become less positional over time or for the positional aspect to resolve entirely. Occasionally, the headache is never positional and rarely, a reverse pattern of worse headache when recumbent has been reported. Note that not all patients with a positional headache have a spinal CSF leak and not all headaches related to spinal CSF leaks are positional.