Orthostatic headache absence may not rule out Spontaneous Intracranial Hypotension: JAMA

UK: A diagnosis of spontaneous intracranial hypotension (SIH) should not be excluded based on the absence of orthostatic headache, suggests a recent review in the journal JAMA Neurology. Other conditions that should not hinder SIH diagnosis include normal neuroimaging findings, or normal lumbar puncture opening pressure.

SIH is a highly disabling condition characterized by debilitating postural headaches secondary to spontaneous spinal cerebrospinal fluid (CSF) leak and/or CSF hypotension. The condition is diagnosed when headache develops spontaneously and in temporal relation to a CSF leak (evident on imaging) and/or CSF hypotension (lumbar puncture opening pressure <60 mm CSF). The best management options for patients with SIH are still uncertain. Considering this, Linda D'Antona, National Hospital for Neurology and Neurosurgery, London, United Kingdom, and colleagues aimed to provide an objective summary of the available evidence on the clinical presentation, investigations findings, and treatment outcomes for SIH.

For the purpose, the researchers performed a literature search on SIH using three databases from the time of the database inception through April 30, 2020. They included original studies published in English that had 10 or more patients with SIH in their analysis.

Predetermined main outcomes included the pooled estimate proportions of symptoms of SIH, brain and spinal imaging findings and treatment outcomes, including conservative treatment, epidural blood patches and surgical interventions.