Spontaneous Intracranial Hypotension Without CSF Leakage-Concept of a Pathological Cranial to Spinal Fluid Shift.

Goldberg, Johannes; Häni, Levin; Jesse, Christopher Marvin; Zubak, Irena; Piechowiak, Eike I.; Gralla, Jan; Dobrocky, Tomas; Beck, Jürgen; Raabe, Andreas (2021). Spontaneous Intracranial Hypotension Without CSF Leakage-Concept of a Pathological Cranial to Spinal Fluid Shift. Frontiers in neurology, 12, p. 760081. Frontiers Media S.A. 10.3389/fneur.2021.760081

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Objective: Spontaneous intracranial hypotension (SIH) is typically caused by CSF leakage from a spinal dural tear, a meningeal diverticulum, or a CSF venous fistula. However, some patients present with classic orthostatic symptoms and typical intracranial imaging findings without evidence of CSF leakage despite repeated diagnostic work-up. This article aims to elaborate a hypothesis that would explain a pathologically increased orthostatic shift of CSF from the cranial to the spinal compartment in the absence of a CSF leak. Medical Hypothesis: The symptoms of SIH are caused by a decrease in intracranial CSF volume, intracranial hypotension, and downward displacement of intracranial structures. A combination of pathologically increased spinal compliance, decreased intracranial CSF volume, low CSF outflow resistance, and decreased venous pressure might result in a pathological orthostatic cranial-to-spinal CSF shift. Thus, in rare cases, intracranial hypotension may occur in the absence of CSF leakage from the dural sac. Conclusion: We propose a pathophysiological concept for the subgroup of SIH patients with typical cranial imaging findings and no evidence of CSF leakage. In these patients, reducing the compliance or the volume of the spinal compartment seems to be the appropriate therapeutic strategy.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Goldberg, Johannes, Häni, Levin, Jesse, Christopher Marvin, Zubak, Irena, Piechowiak, Eike Immo, Gralla, Jan, Dobrocky, Tomas, Raabe, Andreas


600 Technology > 610 Medicine & health




Frontiers Media S.A.




Martin Zbinden

Date Deposited:

04 Jan 2022 12:06

Last Modified:

05 Dec 2022 15:56

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

CSF leak or fistula CSF physiology and anatomy compliance orthostatic headaches spontaneous intracranial hypotension





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